As you should understand, the Centers for Medicare & Medicaid Services (CMS) is planning additional cuts to Medicare reimbursement for cancer care. In addition to a scheduled cut of 21.5% to all physician-related services, CMS is planning to cut payments to oncology by a net 6%. In brief, these cuts are based on a survey conducted by the American Medical Association (AMA), which the Community Oncology Alliance (COA) told the AMA was flawed for community oncology.

On the COA website at www.communityoncology.org under the Immediate Action Needed section is a tool that will allow you to estimate the impact of changes proposed by CMS in the 2010 Medicare Physician Fee Schedule. We encourage you to use the tool to estimate the impact of the cuts on your practice. The leadership team of the COA Administrators’ Network used the tool and collectively found the following:

• Oncology-specific cuts related to infusion room services are estimated to be 20.6% in 2010.
• The total impact of the cuts is 6.4%, factoring in an increase in E&M payments and the elimination of the consultation codes.

Please note that these estimates assume that Congress will act in health care reform legislation to avert the 21.5% cut. If this does not happen, the total estimated impact of the Medicare cuts would be 26.5% for oncology practices. Run the estimates for your practice. If you have any questions about using the tool, please contact Ricky Newton .

Understanding the impact of these proposed cuts is important because COA is challenging them and will be providing instructions on how every community oncology practice should weigh in with CMS and their Members of Congress. We also encourage every practice to return the Components of Care Survey, which can also be accessed on the COA website. Armed with actual community oncology data is critical in supporting our ask. The time is now to send in your data if you want to reverse the cuts slated for oncology.

In addition to these reductions, there are planned cuts to diagnostic imaging and therapeutic radiation. We will provide more information on those.

The Community Oncology Alliance Responds to President Obama’s Press Conference Comments Regarding Cancer Patients

WASHINGTON, D.C. (July 23, 2009) – The Community Oncology Alliance (COA), a national non-profit organization of oncologists that advocates for cancer patients and community providers of cancer care, has responded in a public statement to President Obama’s press conference, saying:

“We strongly support President Obama’s guiding principle that health care reform must “build on what works and fix what is broken.” Unfortunately, that is the exact opposite of what is happening with our country’s cancer care delivery system. The problem is that the Medicare payment system for cancer care is simply broken. The system has chipped away for years and our cancer care delivery system is now in crisis. Though it urgently needs to be fixed, we pray that reform is not forced through to meet a schedule, but thought through to meet the needs of covering costs to save the lives of cancer patients.

“In last night’s press conference, President Obama mentioned the plight of cancer patients. As the doctors who treat 84% of cancer patients in their own communities, we feel compelled to respond with the hope that even greater focus will be put on cancer as 1 in 2 men and 1 in 3 women can expect to get cancer in their lifetimes.

“As of right now, 45% of all cancer patients are covered by Medicare and yet Medicare does not reimburse oncologists for the full cost of many drugs to treat patients, and does not reimburse at all for essential services including cancer treatment planning and care coordination. In a recent national survey we commissioned of over 1,000 Americans, we learned that less than half (45%) of Americans believe their health insurance plans would cover the full cost of cancer treatment, including diagnosis, doctor visits, tests and medication, and only 25% of Americans believe that a person covered under Medicare would be covered, while 64% believe Medicare would not cover the cost of treatment.

“Today most community oncologists around the country are paying out of pocket to treat their Medicare patients. Additionally, over the past few years, Medicare has consistently cut payments for cancer patients and this is slowly dismantling the country’s treatment system. Even now CMS is pursuing a course of action, based on insufficient and inaccurate data, which will further severely cut payments for cancer care. Physicians cannot continue to shoulder these losses.

“Additional cuts now planned by CMS are simply unrealistic: they will accelerate the erosion of the nation’s cancer care delivery system. In reforming our country’s healthcare system, if a “public” insurance option is created based on Medicare — or even 5-10% above Medicare rates — and results in private insurers lowering their payments accordingly, practices simply would have to close their doors. This is borne out by modeling work recently completed by several large practices.

“We call on President Obama, who used examples of cancer patients in his comments, to consider the incredible hurdles facing both today’s cancer patients and doctors in treating cancer.

“Dr. Robert Fein, a medical oncologist practicing in Somerset, New Jersey, stated it best an editorial he penned recently for the New Jersey Star-Ledger.

“As we reform health care, we must address the plight of cancer patients… Just as I would treat a sick patient, we must fix a broken system, starting with Medicare.”

“We have heard the President’s request to the medical community to help shoulder a portion of the price for health care reform. Community oncology practices have already contributed more than their share by enduring Medicare payment cuts in excess of 25% over the past 5-6 years.

“Despite these challenges, we are committed to being a part of the solution. Over this past year, COA convened a task force of practicing oncologists to analyze Best Practices for improving the quality of cancer care while controlling costs, which can also be implemented without major infrastructure changes.

“The result of that effort is embodied in legislation that was recently introduced in the Congress by Representatives Artur Davis, Steve Israel, and Mary Jo Kilroy — the Medicare Quality Cancer Care Demonstration Project Act of 2009 (H.R. 2872). This bill would create a national cancer care demonstration project, open to all oncology clinics, which would refine quality metrics dealing with recognized, evidence-based treatment guidelines and patient-centric, coordinated care. The demonstration project would include the active involvement of community cancer clinics already using electronic medical records, bringing information to augment data collected by the Medicare system. This is a real-life application of health information technology, and the type of public-private collaborative effort that will be necessary to reform the health care system.

“The United States has the best overall cancer care in the world as documented by five-year survival rates — a true measure of performance. The success is due in large part to earlier detection, more precisely targeted therapies, and unparalleled access to quality, compassionate cancer care. During the past 25 years, cancer care in this country has evolved away from long stays at hospitals for chemotherapy treatments, to the outpatient, community setting. Along with advances in medicine, it is this system that is hailed as one of the best, and the smartest, in the world.

“With all of our success, cancer is still the second leading cause of death in this country, claiming on average the life of one American every minute.

“COA pledges that cancer clinics across the country will work together to increase the quality of cancer care while controlling costs; however, we need President Obama’s leadership to help overcome the immediate crisis that is now destroying what has worked so well for our patients. Our ability to treat the current and future generations of Americans battling cancer hangs in the balance.”

More information can be found on the COA web site at www.communityoncology.org.

COA Letter to President Obama on Cancer Crisis

Copy of a letter sent by COA President Patrick Cobb, MD to President Obama

President Barack Obama
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

Dear Mr. President:

We strongly support your guiding principle that health care reform must “build on what works and fix what is broken.” Unfortunately, that is the exact opposite of what is happening with our country’s cancer care delivery system. Recently announced cuts to Medicare reimbursement for cancer care by the Centers for Medicare & Medicaid Services (CMS) will accelerate the cancer care crisis already created by a broken Medicare payment system. On behalf of the Community Oncology Alliance (COA), a non-profit organization representing the interests of community oncology practices, I am writing to ask you to work with us to urgently address this crisis as part of health care reform.

Although health care reform is critically needed, the United States has the best overall cancer care in the world as documented by five-year survival rates — a true measure of performance. The success is due in large part to earlier cancer detection, more precisely targeted therapies, and unparalleled access to quality, compassionate cancer care. During the past twenty-five years, cancer care has evolved to the outpatient, community setting, where now over 80% of Americans battling cancer are treated. Even with this success, we should strive to better enhance the quality of cancer care, while looking for ways of controlling increasing costs.

The problem is that the Medicare payment system for cancer care is simply broken. Dr. Robert Fein, a medical oncologist practicing in Somerset, New Jersey, stated it best in these excerpts from an editorial he penned recently for the (New Jersey) Star Ledger.

“The cancer care delivery system is broken. It has reached the point where medical practices cannot stay in business and patients often cannot afford necessary treatments.

Over the past 2 to 3 years, Medicare has consistently lowered reimbursement for chemotherapy drugs and administration to oncologists. Additionally, Medicare does not reimburse for essential services such as treatment planning and care coordination.

As further cuts occur, physicians cannot continue to shoulder losses... As we reform health care, we must address the plight of cancer patients… Just as I would treat a sick patient, we must fix a broken system, starting with Medicare.”

Under the watch of the previous Administration, CMS failed to deliver on the congressional intent of the Medicare Modernization Act of 2003 relating to cancer care funding. As a result, Medicare not only significantly underpays for the critical services involving the administration of life-saving cancer drugs, but does not reimburse for essential services such as treatment planning and care coordination. Now, CMS is pursuing a course of action, based on insufficient and inaccurate data, which will further severely cut payments for cancer care.

We hear your request to the medical community to help pay a portion of the price for health care reform. Community oncology practices have already contributed more than their share by shouldering Medicare payment cuts in excess of 25% over the past 5-6 years. Additional cuts, as now planned by CMS, are simply unrealistic — they will truly accelerate the dismantling of the nation’s cancer care delivery system. If a “public” insurance option is created based on Medicare — or even 5-10% above Medicare rates — and results in private insurers lowering their payments accordingly, practices simply would have to close their doors. This is borne out by modeling work recently completed by several large practices.

Despite these challenges, we are committed to being a part of the solution. Over eight months ago, COA convened a task force of practicing oncologists to analyze ways of improving the quality of cancer care while controlling costs. The result of that effort is embodied in legislation that was recently introduced in the Congress by Representatives Artur Davis, Steve Israel, and Mary Jo Kilroy — the Medicare Quality Cancer Care Demonstration Project Act of 2009 (H.R. 2872). This bill would create a national cancer care demonstration project, open to all oncology clinics, dealing with active treatment and end-of-life care — the latter something you highlighted during your recent White House forum on health care reform. This national project would refine quality metrics dealing with recognized, evidence-based treatment guidelines and patient-centric, coordinated care. Centered on quality and cost efficient medical care, this demonstration project can be implemented without major infrastructure changes. It is intended to result in a new payment mechanism that incentivizes quality cancer care delivery that controls cost. Additionally, COA will actively involve community cancer clinics already using electronic medical records to bring information that would augment data collected by the Medicare system. As such, this is not only a real-life application of health information technology, but also the type of public-private collaborative effort that will be necessary to truly reform the health care system.

Last week, over 100 oncologists, nurses, administrators, patients, caregivers, and survivors came to Capitol Hill to discuss the crisis in cancer care. Following this legislative day, the cancer community across the country will now be making a massive outreach to their members of Congress to further discuss the crisis, recent CMS planned cuts, and specific solutions such as embodied in the demonstration project summarized above.

With all of our success, cancer is still the second leading cause of death in this country, claiming on average the life of one American every minute. Additionally, the incidence of cancer is increasing, but we are losing oncologists relative to demand. By 2020 we will be short an oncologist for every one in three cancer patients.

We need to act immediately to fix the broken Medicare reimbursement system for cancer care — and not make it worse by implementing a new round of planned payment cuts. Furthermore, basing a “public” insurance option on a broken Medicare system for cancer care, without first fixing it, will be catastrophic. COA pledges that cancer clinics across the country will work together to increase the quality of cancer care while controlling costs; however, we need your leadership to help overcome the immediate crisis that is now dismantling what has worked so well for our patients. Our ability to treat the current and future generations of Americans battling cancer hangs in the balance.

Sincerely,

Patrick Cobb, MD
President

CMS Announces Severe Cuts to Medicare Funding for Cancer Care

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule for the 2010 Medicare Physician Fee Schedule. Among other provisions are cuts to imaging services, elimination of the consultation payment codes, attempts to reinstate the Competitive Acquisition Program (CAP) for Part B drugs, and the 21.5% cut in payments to all physicians scheduled for 1/1/10 unless Congress acts to overturn this.

However, most significant, but not surprising, is an additional 6% cut in Medicare payments to community oncology practices effective 1/1/10. This is because CMS has used the data provided to the agency by the American Medical Association (AMA) in its Physician Practice Information Survey. Based on the data provided by the AMA to CMS, it shows that practice expense for community oncology has actually decreased by 8.3%. 



Community oncologists, mid-level providers, nurses, practice administrators, accountants, and policy experts reviewed the AMA survey last year and concluded that it was fundamentally flawed for community oncology. In a formal letter from COA to the AMA last year, Dr. Harry M. Barnes objected to the survey and summarized the reasons why it would not accurately capture oncology practice expense. The problem is not that CMS is basing these cuts on only 50 usable AMA surveys provided by medical oncologists. The real problem is that the AMA survey is fundamentally flawed and incapable of capturing the complexity of cancer care delivery. This is why COA so strongly objected to the AMA survey and launched the Components of Care Survey, which was designed by community oncology to accurately capture the clinical and operational components of delivering cancer care.



If community oncology practices do not act now they will experience a 6% cut in Medicare payments. Additionally, depending on how Congress addresses the scheduled 21.5% cut in physician payments, community oncology practices could be looking at additional payment cuts. Given that many in Congress want to create a public plan based on Medicare rates in order to force private insurers to lower rates, this is a true crisis point for community oncology.



COA will be meeting with CMS and the congressional leadership to protest these significant cuts. However, as we have repeatedly said, community oncology will continue to experience cuts until it has its own data to explain and document exactly what is required in delivering cancer care. COA is fighting harder than ever for community oncology. And those practices coming to DC on July 8th to Stand Up for Cancer Care will be sharing this new information with Members of Congress.



What should you be doing to deal with this crisis?



First, complete the Components of Care Survey IMMEDIATELY. Details can be found on the COA website at http://www.communityoncology.org. If community oncology does not have data to refute flawed AMA data, these cuts and others will continue.



Second, reach out to your Representatives to ask them to co-sponsor H.R. 2872, which is the National Quality Cancer Care Demonstration Project. This is the only national demonstration project that is focused on quality cancer care and open to all community oncology practices nationwide. It provides $300 million in additional funding for appropriate payment for services provided. 



Third, reach out to your Representatives and Senators to ask them to co-sponsor H.R. 1392 and S. 1221, identical bills that correct the prompt pay problem that artificially reduces any drug reimbursement based on Average Sales Price (ASP).

There is information on all these bills to share with your Members of Congress on the COA website (http://www.communityoncology.org).



COA will be providing additional information and details on all of this and more. It is critical that community oncology be fully engaged during these very challenging times when the cancer care delivery system is threatened by major healthcare reform and relentless cost cutting.

COA President Dr. Patrick Cobb Responds to President Obama's Address to the AMA

Community Oncology Alliance (COA) president Dr. Patrick Cobb responds to President Obama’s speech to the American Medical Association today on health care reform.

We agree with and applaud President Obama for stating the simple truth “that health care reform should be guided by a simple principle: fix what's broken and build on what works.”

Where we diverge respectfully with President Obama is to approach the healthcare solution as a simple fix, in part because of the misperception that “Five of the costliest illnesses and conditions - cancer, cardiovascular disease, diabetes, lung disease, and strokes - can be prevented.”

Cancer and the treatment of it must be separated out and understood implicitly by its inherent threat to life as well as the catastrophic impact of cost. We hope that the President and Congress will work together with community oncologists to address and fix what is broken. Therefore COA is advocating for the passage of multiple bills that will address the broken system as well as deliver Best Practices recommendations to improve the current model. And, in fact, oncologists already use evidence-based treatment guidelines in their daily practice.

Patients are stricken with cancer for many reasons, and not all cancer is preventable. And the longer we live, the more of us suffer from it. Concurrently, the older the patient, the more frequently the treatment is through Medicare.

Already, Medicare has cut reimbursement for cancer treatment to such a low level that it negatively impacts the quality of care provided to seniors. Models just completed by several large community cancer clinics show that if Medicare rates become the standard, clinics would have to close their doors.

Oncologists continue to struggle to stay in business under the current cancer reimbursement system, which is failing. Medicare does not sufficiently pay for the costs of chemotherapy and related drugs. As a result, oncologists are increasingly financing these patients or being forced to turn them away and even close their practices. This is at the core of the crisis in cancer care, and our government must understand that as the broken system is analyzed and fixed, cancer care must be a primary consideration.

As it is now, Medicare accounts for approximately 45% of all cancer care payments. We have to fix the broken Medicare system before even considering expanding it. We face dire consequences if we break what is working and do not address what is already broken.

Statement by Dr. Patrick Cobb, president of the Community Oncology Alliance, regarding declining rates of cancer death

“The Community Oncology Alliance is encouraged by the recently released statistics from the American Cancer Society showing a decline in the number of cancer deaths in the U.S. It is important to recognize that the decreasing cancer death rates are a result of several factors, including the quality and accessibility of cancer care provided by community oncology practices throughout the country.

Yet, we cannot ignore that in this year alone there will be almost 1.5 million new cancer cases and 560,000 cancer deaths.

The U.S. cancer care delivery system is now in the first stage of a crisis because Medicare has substantially cut payment for cancer drugs and essential services. Increasingly Americans with inadequate or no insurance, including seniors unable to pay the Medicare 20% coinsurance, are foregoing cancer treatment. We are entering a second stage crisis as we lose oncologists relative to the increasing incidence of cancer.

The Community Oncology Alliance has been actively working on solutions, starting with the Quality Cancer Care Demonstration project (QCCD), a substantive program developed by community oncologists over the past year to enhance the delivery of quality cancer care. The project will focus on patients covered by Medicare (approximately 45% of all cancer patients) and involves collecting data and implementing a patient-centric program to enhance cancer care while controlling costs. The QCCD project is a means of moving forward immediately with real healthcare reform, and provides the foundation for a solution to the crises in cancer care.

The Community Oncology Alliance is actively working with the Congress in integrating the Quality Cancer Care Demonstration project into healthcare reform legislation.”

Need for the Components of Care Survey

The Senate Finance Committee has proposed policy options that would severely cut Medicare payments for cancer care services. As CMS looks to recalculate payments for all medical services from Medicare, it too will be relying on a published report of a different kind; the AMA Practice Expense Survey Data obtained from a random sampling of physicians, both academic and community based. And, although the AMA survey may be appropriate to capture practice expense for primary care, it was not designed for the variety and complexity of services delivered by community oncology practices. Without our own data on the clinical and operational components of delivering cancer care, community oncology simply has no way of defending itself against cuts proposed by Congress and/or the Centers for Medicare & Medicaid Services (CMS).

Many of you will recall the damages incurred in 2002/2003, when CMS was provided with simplistic and outdated data on community oncology practice expense. CMS has continued to rely on that outdated and grossly inaccurate data as the rationale for not creating additional payment codes for the essential services in oncology, as was the congressional intent in the the Medicare Modernization Act of 2003 (MMA). A statement from another professional organization representing physicians who treat people with cancer helps to drive home the importance of completing COA’s Components of Care Survey and it reads: “If oncologists submit too little data to be considered valid, we may jeopardize our field relative to others who did provide sufficient data. The risk of not participating is that oncology payments will be static or reduced, while others move ahead at our expense.” 
 


The question you need to answer is, “Do you want outdated and non-specific data to be used to further cut Medicare payments for the services you provide?” If the answer is “No,” you need to return the Components of Care Survey ASAP. If you do not have a copy of the survey, go to the Community Oncology Alliance (COA) website above to access the survey and instructions. There is also contact information if you have any questions on how to fill out the survey.



The Components of Care Survey was designed by a team of representatives from community oncology practices and beta tested before it was fielded. It takes some time to fill out because it captures the complexity of what you do to deliver cancer care. If it were easy to fill out, like past surveys, it would not capture the clinical and operational complexity of cancer care.



In addition to helping your practice by contributing your data to community oncology, you will be provided with new information that will help you in your negotiations with private payers. Only practices returning the Components of Care Survey will receive specific data to help in negotiations with private payers and access to a network of administrators sharing information on how to optimally use the data in negotiations.

The Community Oncology Alliance Applauds Governor Sebelius' Appointment as U.S. Secretary of Health and Human Services

The Community Oncology Alliance (COA) is pleased with the Senate’s confirmation of Gov. Kathleen Sebelius as U.S. Secretary of Health and Human Services (HHS).

“COA congratulates Secretary Sebelius on her appointment by President Obama,” said Dr. Patrick Cobb, president of COA. “As the Administration embarks on an overhaul of the nation’s health care system, COA looks forward to working with the new Secretary to address the cancer care crisis and to secure the delivery of quality treatment for millions of cancer patients.”

As governor of Kansas, Sebelius showed a strong commitment to ensuring her constituents had access to quality and affordable health care. During her administration, she proposed that every uninsured child have health insurance from birth until age five. In addition, the Kansas Department of Health and Environment (KDHE) developed the 2009 Kansas Pandemic Influenza Preparedness and Response Plan. The plan coordinates local, state and federal agencies, healthcare professionals and the private sector to work together to maintain essential public services, preserve community health and protect the health and safety of Kansans.

“While the U.S. has the best cancer care in the world, lack of proper Medicare reimbursement for cancer drugs and services is causing a crisis for community oncologists. And every day, more people retire or face unemployment as we struggle with the impact of the economy. We look forward to Secretary Sebelius’ support as we take on these challenging issues and work to ensure that cancer patients continue to have access to quality treatment in the community clinic setting,” said Dr. Cobb.

View from Capitol Hill on Healthcare Reform and Implications for Community Oncology, Part II

A top priority of the Congress and the Obama Administration is fundamentally reforming the healthcare delivery process. Some in the healthcare community look back at the failed attempts of President Clinton and others before him to change healthcare and believe that this time will not be any different. However, this time is different. First, rather than dictate to Congress specifically what to do, President Obama sent the Congress a budget with a $634 billion down payment on healthcare reform. Secondly, the most severe economic crisis since the Great Depression is providing the rationale for why healthcare in America is deficient in quality and bankrupting the country.

Yes, it is different this time around. And although anything can happen in the roller coaster ride of politics, the odds favor that healthcare reform will happen. The changes may indeed be substantial, especially for community oncology.

One of the most important impacts could result from the push to expand the role of the government in the reimbursement of healthcare in funding universal care. There are ideas being considered that would, in effect, expand the Medicare population, at least on a transitional basis. The Democrats, who control both the Congress and Administration, favor a healthcare payment system more under the control of the government. This would result in more government leverage in paying for drugs and services, which would effectively translate into more Medicare-type reimbursement. The Republicans are not standing in the way of universal coverage, but favor a system more in control of private payers. 



In terms of looking for specific possible impacts on your practice, you need to weigh the implications of reimbursement shifting towards Medicare-type payment.

One of the other important impacts could result from the consequences of providing primary care physicians with increased payments. As you know, we face a primary care crisis in this country, which many have seen coming for years. However, now that it is here and full blown, Congress is looking at ways of dealing with it through the reimbursement system. Because all physicians will experience a 21% cut in Medicare payments on 1/1/10 (and a cumulative cut of at least 40% by 2014) unless Congress acts to avert the cut, the odds favor a real attempt to fix the payment system, not merely patch it for another year. That is supported by the fact that last week both the House and the Senate passed budget resolutions that contained approximately $300 billion to fix the Medicare physician fee schedule. 



We will not cover all of the possible fixes here, but will simply note that shifting funds to primary care will likely negatively impact high-cost specialties like oncology. Witness the fact that in averting a 10.6% payment cut this year, and substituting it with a 1.1% increase in evaluation and management (E&M) services, the impact to community oncology was a cut in drug administration reimbursement of 1-3%.



In terms of looking for specific possible impacts on your practice, you need to consider the implications of further cuts to Medicare’s payment for services.



In addition to these potential areas of reform, there are others that could potentially impact community oncology. For example, there is some talk about trying to revive the Competitive Acquisition Program (CAP) as a way of getting drug purchasing and billing out of the hands of community oncology practices.

The Community Oncology Alliance (COA) is taking a very proactive and engaged position in reaching out to the Congress as it works on healthcare reform. We will provide more on what COA is doing and how every community oncology practice needs to be engaged with their Members of Congress in having a voice in the healthcare reform debate. Look for the third and last installment of the COA view from Capitol Hill next week.



The leadership of the Congress is targeting July for House and Senate floor debate on healthcare reform legislation. The objective is to pass a bill by the summer August recess. This is shaping up to be the major congressional battle of the year, with insurers, pharmaceutical companies, patient advocacy groups, and providers all in the fray.



Patrick Cobb, MD

President

Community Oncology Alliance



Ted Okon

Executive Director

Community Oncology Alliance

Update on H.R. 1392 — Prompt Pay Correction Bill

Here is a brief update on legislation that would fix the prompt pay problem that artificially reduces any drug reimbursement based on Average Sales Price (ASP). 



There are now 16 cosponsors of H.R. 1392, the prompt pay correction bill in the House. (A list of the 16 House members is at the bottom of this email.) Eight of the cosponsors have sent a Dear Colleague letter to all of their House colleagues asking that they sign on to the legislation. A copy of the Dear Colleague letter is posted under Immediate Action Needed. 



Now that this Dear Colleague has been sent out, the Community Oncology Alliance (COA) will be sending out a letter to the House of Representatives requesting that Members support the prompt pay fix by cosponsoring H.R. 1392. It is anticipated that we will have a Senate version of H.R. 1392 introduced before the upcoming congressional break.

It is essential, however, that Members hear from you, the cancer community constituents from their very own districts. Members will be leaving DC on Thursday for a 2-week break. This is the perfect time to make sure you get at least 20-30 well-placed calls to their district offices. Moreover, it is ideal if you can check with the district office to find out where your Representative will be appearing in the district over the next week and the week after. Personal contact is very effective. 



Under the Immediate Action Needed section are materials and information for making contact with your Representatives. You can access their district office contact information in the Legislative Action Center on the COA website.
Please reach out to your Representatives on H.R. 1392. By asking for a fix to the prompt pay solution, your reach out will cast a stronger light on the problems facing community oncology practices and their patients.

Thank you!

Cosponsors of H.R. 1392 as of 3/31/2009



Rep Blackburn, Marsha [TN-7] - 3/19/2009

Rep Bono Mack, Mary [CA-45] - 3/19/2009

Rep Cohen, Steve [TN-9] - 3/19/2009

Rep DeGette, Diana [CO-1] - 3/9/2009

Rep Diaz-Balart, Lincoln [FL-21] - 3/26/2009

Rep Gingrey, Phil [GA-11] - 3/24/2009

Rep Gordon, Bart [TN-6] - 3/9/2009

Rep Hall, Ralph M. [TX-4] - 3/9/2009

Rep Meek, Kendrick B. [FL-17] - 3/11/2009

Rep Rogers, Mike J. [MI-8] - 3/9/2009

Rep Ross, Mike [AR-4] - 3/9/2009

Rep Sutton, Betty [OH-13] - 3/9/2009

Rep Terry, Lee [NE-2] - 3/9/2009

Rep Towns, Edolphus [NY-10] - 3/9/2009

Rep Wamp, Zach [TN-3] - 3/19/2009

Rep Whitfield, Ed [KY-1] - 3/9/2009






H.R. 1392 Introduced to Correct ASP Problem

House Bill to Improve Accuracy of Medicare Reimbursement Introduced: Members of Congress Seek to Stem Growing Healthcare Coverage Shortfalls, Community Oncology Alliance Advocates for Swift Passage of Bill

WASHINGTON, March 10 /PRNewswire-USNewswire/ -- Representatives Gene Green (D-TX), Ed Whitfield (R-KY), Mike Ross (D-AR), Ed Towns (D-NY), Diana DeGette (D-CO), Mike Rogers (R-MI), Betty Sutton (D-OH), Bart Gordon (D-TN), Lee Terry (R-NE) and Ralph Hall (R-TX) today introduced H.R. 1392.

This bill will amend title XVIII of the Social Security Act to ensure more appropriate payment amounts for drugs and biologicals under Part B of the Medicare Program by excluding customary prompt pay discounts extended to wholesalers from the manufacturer's Average Sales Price (ASP). These discounts artificially reduce Medicare Part B drug reimbursement rates for community oncology clinics, jeopardizing the viability of these providers. The bill is a step forward in addressing problems with Medicare reimbursement for cancer drugs.

"This bipartisan bill is imperative for millions of Americans across the nation to have access to treatment at community oncology clinics and to the life-saving medications they need," said U.S. Rep. Gene Green (D-TX).

Excluding distributor prompt pay discounts from the ASP methodology is consistent with existing policy and will create greater uniformity among federal healthcare programs, as these terms already are excluded from the Medicaid Average Manufacturer Price (AMP) methodology.

The U.S. has the best cancer care delivery system in the world, in which 84 percent of Americans receive quality, compassionate care in community cancer clinics. However, the cancer care delivery system is now in first-stage crisis because Medicare has substantially cut payment for cancer drugs and essential services.

Community cancer clinics have had to close satellite facilities and cut staff. Smaller clinics are struggling to operate and more will close. Patients with insufficient or no insurance, especially seniors covered by Medicare, are increasingly being sent elsewhere for treatment and some patients are actually foregoing treatment. The crisis will deepen as demand for cancer care is now starting to exceed the supply of oncologists during the next 11 years, when we will be short an oncologist for every 1 in 3 cancer patients.

"This is a national problem that is affecting the delivery of cancer care treatment to our most vulnerable patients," said U.S. Representative Ed Whitfield (R-KY). "It is critical that we address this issue because these cuts to the Medicare reimbursements are having an adverse impact to physicians, related practitioners and their patients in all our communities."

"This bipartisan bill will help people with cancer receive treatment in their communities. It's important that we act now to help people who need these life-saving medications," said U.S. Representative Diana DeGette (D-CO), Vice Chair of the Committee on Energy and Commerce, which has jurisdiction over health care policy.

The problem not only centers on payments for cancer drugs, but also on essential services provided to cancer patients, such as treatment planning, which are not reimbursed by Medicare.

"On behalf of community oncology clinics, I thank Congressmen Green and Whitfield and their colleagues for their leadership. The introduction of this bill is a welcome and needed first step in supporting community cancer clinics," said Patrick Cobb, M.D., president of the Community Oncology Alliance (COA) and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana. "However, more has to be done because clinics provide cancer care to their patients that is not reimbursed by Medicare."

Healthcare Reform is Here!

Healthcare reform has already started. How fast it will move and how substantial the changes will be are questions that cannot be answered at this time. In part, the speed and magnitude will depend on the state of the economy. However, and it is worth repeating again, healthcare reform is underway.

The passage of the economic stimulus bill started the healthcare reform movement in earnest with 16% of a “stimulus” bill dedicated to healthcare. Perhaps most significantly was the $1.1 billion set aside to initiate comparative effectiveness research. The Senate version of the stimulus bill clarified the intent of this by referring to this as clinical comparative effectiveness research but the clinical reference was stripped out of the final bill signed into law. So, that is a pretty good indicator that cost effectiveness will be a part of the comparative equation. Additionally, the $17 billion allocated for incentive payments for physicians and hospitals to adopt health information technology is equally significant. The resolve to introduce health IT is such that medical providers not participating by 2015 will have to pay by being penalized by Medicare.

The next step is now the President’s budget, which was submitted late last week. There are several articles posted on the Community Oncology Alliance (COA) website detailing the healthcare portion of the budget. In summary, the budget proposes writing a $634 billion check as a down payment towards meaningful healthcare reform that will “bring down costs and expand coverage.” The $634 billion will be deposited in a healthcare reserve fund that will be financed half by new tax revenue and half by cuts to insurers, providers, and pharmaceutical companies. Of note are the following cuts:

• Eliminating the Medicare Advantage subsidy to insurers — $177 billion

• Changing payments to hospitals relating to readmissions, care coordination, and quality delivery — $38 billion

• Changing payments to home health agencies — $37 billion

• Expediting the approval of “biosimilars” (biotechnology drugs deemed to be biologically similar) — $9 billion

What the press generally did not report was the creation of “radiology benefit managers,” presumably to curb imaging utilization as was recommended to the Centers for Medicare & Medicaid Services (CMS) by the Government Accountability Office (GAO) in a June 2008 report to the Congress. Additionally, the budget includes a line item that proposes to motivate physicians to form “voluntary groups” to coordinate care.

The budget assumes that Congress will fix the broken physician fee schedule, which is scheduled to cut physician payments by 21% in 2010. However, the devil is in the details of exactly how Congress will address this problem.

Community oncology practices are now realizing increased payments for Evaluation and Management (E&M) services, which directly correlate to decreased drug administration service payments. That is why community oncology has to fight its own battles! 



On Thursday of this week there will be a summit at the White House dedicated to healthcare reform. It will be interesting to hear what comes out of this gathering of the President, his Administration, Members of Congress, and others. 



Yesterday, President Obama nominated Kansas Governor Kathleen Sebelius to serve as Secretary of Health and Human Services (HHS). President Obama also announced that he was nominating Nancy-Ann DeParle, Commissioner of the Department of Human Services in Tennessee, as the Director of the White House Office for Health Reform. These announcements are likely to speed up the pace of healthcare reform.

Healthcare Reform and Community Oncology

As posted previously, healthcare reform has already started with the passage of the economic stimulus bill. Approximately 16% of the bill was related to healthcare spending and, specifically, the funding for comparative effectiveness research was the real wake-up call that healthcare reform has started. The magnitude and timing of reform will be dictated by the swiftness of the economic recovery.

Earlier this week, the President addressed a gathering at the White House, which included congressional leaders, attending a fiscal responsibility summit. Today, the President will present a 10-year budget overview that will outline how the Administration proposes substantially reducing the growing federal deficit. The budget contains the creation of a $634 billion healthcare reserve fund, which is a roadmap to universal healthcare coverage. This will be paid in large part by capping itemized deductions for the wealthy and eliminating the subsidies to insurers selling Medicare managed care plans. A more in-depth budget roadmap, with a focus on healthcare, energy, and education, will be released in early April.

With the Medicare program facing insolvency sometime during the next ten years, the resolve is increasing to tackle healthcare reform in a major way. Fueling this is that more organizations from different sectors are weighing in on the need for major healthcare reform.

Where Will Healthcare Reform Head?

It is difficult at this time to predict exactly where healthcare reform will head but, to simplify a very complex topic, there are two major thrusts. 



The first involves providing universal coverage. Especially with job losses resulting in more individuals joining the ranks of those with no healthcare coverage, there is pressure mounting to make sure that all Americans have access to healthcare. Senator Max Baucus, a Democrat from Montana and chair of the Senate Finance Committee, has proposed creating a nationwide insurance pool, the Health Insurance Exchange. While the Exchange is being created, Senator Baucus would make healthcare coverage immediately available to Americans 55-64 years old through a Medicare buy-in. This is just one idea being floated in Washington, DC that involves the federal government becoming instrumental in the negotiation and/or payment for healthcare. 



The second involves changing the way that the federal government pays for healthcare. Among other concepts, you are going to hear more about bundling healthcare payments as in, for example, paying for episodes of care. Yes, this is a twist on the old capitation model. You will also hear more about value-based purchasing, which is about paying for quality as opposed to the current payment system that pays for quantity (of services provided). 

Given that Medicare payments for physician services are scheduled to be cut by 21% on 1/1/10, it would appear that the perfect storm is forming to change the current payment formula in the context of broader healthcare reform.



Impact on Community Oncology?



The push to reform healthcare, especially relating to the way that the federal government pays for healthcare, will certainly impact community oncology. The potential impact could be severe as some of the reform measures being discussed involve fundamentally changing the way how the federal government pays for cancer care. The timing and magnitude of proposed changes will become clearer as the President unveils his budget plans. 

 COA has been actively involved in the policy discussions/debate and in crafting a specific, proactive legislative agenda. More details will be provided shortly, however here is a preview of what COA has been working on:

• Isolating the prompt pay solution as single-issue legislation, which is expected to be introduced very shortly in the House, and then in the Senate. COA has been involved in putting together a coalition of provider groups and distributors to support this legislation.

• Crafting oncology demonstration projects that can be introduced in legislation that puts community oncology proactively in front of healthcare reform and that provides lost funding.

• Fielding a major study on the clinical and operational components of delivering community cancer care, which will support legislation relating to unreimbursed aspects of care such as treatment planning, care coordination, and pharmacy facilities.

• Advancing solutions in the context of healthcare coverage that help Medicare beneficiaries with inadequate secondary insurance who are unable to pay their 20% copay.

This agenda is not just focused on Medicare but also private payers. Details will be forthcoming.

We will leave you with the thought that being engaged with your Members of Congress and policymakers is more important than ever. COA will be providing information and resources on how to engage your Members of Congress, and specific outreach on legislation as it becomes available.

As seen by the funding for health IT and comparative effectiveness in the economic stimulus bill, and now in the President's budget, healthcare reform is already underway. The next step in changing how Medicare reimburses for cancer care may well be underway. Community oncology needs to be engaged!

Stimulus Bill and Healthcare Reform

As reported extensively in the press, earlier this week President Obama signed into law the stimulus bill (H.R. 1, the American Recovery and Reinvestment Act of 2009). It is important to understand that the bill, which has been the subject of debate regarding what it will do and when to stimulate the economy, actually unveils President Obama’s commitment to make healthcare reform a national priority. That is because the bill has specific provisions that legislate the following healthcare initiatives:


• Provides $17 billion in additional Medicare/Medicaid payments to physicians and hospitals that adopt information health technology.

• Launches Comparative Effectiveness Research, which is intended to compare the relative effectiveness of treatments for particular medical conditions, by creating a 15-member council to report annually on comparative effectiveness and by providing $1.1 billion in preliminary funding.

• Creates a $1 billion prevention and wellness fund.

• Significantly expands the HIPAA Privacy Rule and Security Standards.

In total, the $789 billion stimulus bill contains a significant $130 billion in new healthcare spending. In addition to the items above, there is $87 billion in increased state funding for federal medical assistance payments, $24.7 billion in COBRA subsidies, and $10 billion in funding for the National Institutes of Health (NIH).

Some suggest that the President’s resolve to reform healthcare will be slowed until he fills the Health and Human Services (HHS) Secretary position and appoints a Director to the newly created White House Office of Health Reform. However, dedicating 16% of the economic stimulus legislation to healthcare issues sends a pretty strong message that healthcare reform is a top priority of the new Administration and Congress.

What are the Health IT provisions?

Basically, the $17 billion in funding would provide between $41,000 and $64,000 in payments to physicians, and about $2 million in payments to hospitals, for meaningful use of electronic health records. There is no upfront funding for capital costs of acquiring hardware/software, payments will not start until 2011, and there will be penalties starting in 2015 for providers not adopting and using electronic health records. Of course, the devil is in the details of just what constitutes meaningful use of the technology. Specifics will be forthcoming when the Center for Medicare & Medicaid Services (CMS) initiates their formal rule-making process, which will allow interested parties an opportunity to comment and provide input.

The Community Oncology Alliance (COA) will be providing more information as it becomes available from CMS, which is not expected until later in the year.

Where is Comparative Effectiveness Research heading?

The $1.1 billion appropriated in the stimulus bill to undertake comparative effectiveness research (CER) provides $400 million in funding to HHS, $400 million to NIH, and $300 million to the Agency for Healthcare Research and Quality (AHRQ). Once again, the specifics need to be ironed out. Several reports are required in 2009 outlining operating procedures and research priorities, which will consider the input of stakeholders; however, it is unclear at this time exactly how this process will work.

There is already heated debate between the political parties, and even among stakeholders, about where CER is heading. Obviously, having unbiased clinical information to help physicians make more informed decisions would be a positive. However, there are those who believe that this is clearly aimed at cost effectiveness and the government dictating medical treatment. There is a very slippery slope heading from well-intentioned input on clinical comparative effectiveness to the UK NICE model that dictates coverage of treatment based simply on cost effectiveness.

COA will be providing much more information on CER as it becomes available. We will be very involved in the shaping of policy on CER and ensuring that any output from this is used to enhance the quality of cancer care, rather than to dictate the lowest cost treatment.

In the next email we will discuss the implications for community oncology and the aggressive COA legislative agenda. We will leave you with the thought that being engaged with your Members of Congress and policymakers is more important than ever. As seen by the funding for health IT and comparative effectiveness in the stimulus bill, general healthcare reform is already underway. The next step is specifically changing how Medicare reimburses for cancer care. The proactive, strong, and unified voice of community oncology is more important than ever in regaining appropriate reimbursement (Medicare and private pay) for cancer care and in holding off any further damaging cuts.





CRISIS IN CANCER CARE: ONCOLOGISTS CALL ON CONGRESS AND THE ADMINISTRATION TO ACT NOW

COA Seeks to Lead Solution to Shortfalls in Medicare Reimbursement
Threatening Community-Based Care

WASHINGTON, DC February 9, 2009 – The board of directors of the Community Oncology Alliance (COA) issued a resolution today urging the leadership of Congress and the Obama Administration to restore critical aspects of Medicare reimbursement in order to stanch the impending crisis in cancer care. The opportunity to educate our lawmakers during this time of discussion and appropriation of funds through the stimulus package is an opportunity COA sees to both save the lives of cancer patients while averting larger future costs as the healthcare crisis worsens.

“The cancer care community has been negatively impacted by the changes mandated through the Medicare Modernization Act of 2003, and COA would like to lead the turnaround in this drought of resources,” explained Patrick Cobb, M.D., president of the Community Oncology Alliance (COA) and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana. “We call on Congress and the Administration to act now to assure the continuing viability quality of the community cancer delivery system, which is vital to the 84% of Americans with cancer who receive treatment in own communities. I am committed to involvement with COA as a practicing oncologist who knows firsthand the challenges of both patients and physicians, as well as a citizen who believes immediate action will be the prevention to rapidly spiraling costs as patients are left untreated.”

COA is a non-profit organization dedicated solely to community oncology, founded to educate healthcare professionals, lawmakers and the public about community oncology.

The Crisis in Cancer Care
Since the passage of the Medicare Modernization Act of 2003, reimbursement for cancer care by Medicare, which covers approximately 45% of Americans with cancer, has been cut dramatically. With diminishing service payments, an increasing number of smaller clinics have closed. Loss of these community treatment options leads to treatment of more patients in the general hospital setting. The issue has become more urgent as both the ranks of the unemployed are swelling due to our economic crisis while the gradual increase in the elder baby boomer population – the sector whose primary cause of death is cancer – is expanding rapidly.

COA Resolution
The COA resolution calls for the restoration of critical aspects of Medicare Part B reimbursement in order to stem this growing crisis in cancer care, specifically by:

• Ensuring Medicare beneficiaries, as well as other cancer patients covered by private insurance, receive the highest quality cancer care based on recognized, evidence-based standards of care that are designed to control costs.
• Ensuring affordable cancer care to Medicare beneficiaries in their own communities—without the onus of catastrophic financial loss – as well as access to new therapies available via clinical trials.
• Providing to cancer patients, including Medicare beneficiaries, access to the highest quality palliative care and end-of-life planning that treats human life with dignity and respect.

The entire resolution is attached and can be read at www.communityoncology.org. COA has already taken several steps towards these goals by developing the most comprehensive studies ever undertaken to identify and quantify the components of delivering modern-day cancer care, the Components of Care Study and the Oncology Drug Access Study.

“By addressing the evolving crisis in cancer care, the Congress and Administration will be supported by COA in our re-commitment to the War on Cancer declared over 35 years ago,” added Dr. Cobb. “I personally seek the opportunity to work alongside Sen. Max Baucus from my state in seeing a strengthening in national cancer care delivery.”

Message from new COA President, Patrick Cobb, MD

Dear Community Oncology Colleagues: 



I want to acknowledge the Board of Directors of the Community Oncology Alliance (COA) for their support in electing me to the position of President of COA. Fortunately, we have a very involved Board that takes the responsibilities of governing COA very seriously, and collectively is a group of individuals seriously committed to preserving and fostering the community oncology delivery system. 



I especially want to extend my sincere gratitude to Dr. Mac Barnes for his leadership this past year. As President of COA, Mac sacrificed an extraordinary amount of time traveling to Washington, DC and participating in a range of Board, Executive Committee, and various committee calls/meetings. Mac is always there for community oncology and now joins the list of past COA Presidents — Kurt Tauer, Lennie Kalman, and Fred Schnell — who are still giving their time and hearts to community oncology. This will be one tough act to follow! 



Why take on being President of COA? 



I believe that COA as the advocacy organization for community oncology is more important than ever before. Just a week ago I was with our lobbying team on Capitol Hill meeting with members of Congress and staff. Although we have many supporters in Congress, there are still those members and staffers who do not understand the crisis unfolding in community oncology. With the prospect for major healthcare reform very likely this year or next, community oncology has to be proactive and aggressive in shaping this reform before it swamps us. I can assure you that COA will lead the way with its sole focus — protecting and enhancing the community oncology delivery system. 



A week does not go by when we hear of yet another community oncology practice either closing or considering it. Although this appears to be especially impacting our colleagues in smaller practices, I know of larger practices laying off staff and closing satellite facilities. We have experienced this firsthand in my practice as we had to close one of our offices serving a rural area. Unfortunately, those most impacted by the pressures on our practices are those least able to bear the burden — our patients. Now, with the economic crisis, there are reports of more patients foregoing treatment. This is simply unacceptable. 



What is COA doing? 



COA is pushing harder than ever to secure relief from the Medicare reimbursement cuts and to advance proactive solutions. For the first time, key organizations on the provider and distributor sides have come together in forging a coalition to secure legislation that would eliminate prompt pay discounts from the calculation of Average Sales Price (ASP). This is important because it impacts Medicare reimbursement and those payers reimbursing for drugs based on ASP. COA has been in the forefront of forming this coalition and in pressing the Congress for prompt pay legislation. 



Second, COA has launched a landmark study to identify and quantify the clinical and operational components of delivering cancer care. All other attempts at capturing the practice expense in oncology have failed because they are not specific to oncology and are not designed to measure the complexity of the services we provide. We are already using preliminary knowledge gained in this Components of Care study to shape legislation for a demonstration project on quality and for securing payment for unreimbursed services such as treatment planning. Additionally, we have launched another major study dealing with the barriers that exist in using oral cancer drugs. 



It’s important to understand the government’s push towards payment for quality in medicine. In addition to incentive payments for PQRI reporting and use of E-Prescribing, the Congress has included language in the proposed $825 billion stimulus bill that would pay physicians for employing health information technology. A summary of this can be found on the COA website at http://www.communityoncology.org under Breaking News. COA is pushing for additional payments for quality cancer care delivery based on evidence-based guidelines. We want to proactively shape policy that provides realistic reimbursement for community oncology.



Third, COA has hired a public relations firm and an individual to head up our patient advocacy efforts. The story of community oncology is completely hidden from the public. Certainly, the crisis we face receives little attention from the press, but we are going to change that. Additionally, COA is going to provide a resource for patients to better understand why their cancer care is being impacted and to find help from the pressures they face. 



Fourth, COA is committed to unifying community oncology and providing practices with resources to help them navigate these difficult times. Among other initiatives, COA will soon launch a special website for community oncology practice administrators as part of networking practices for greater information sharing. United we stand, divided we fall. 



Finally, I want to encourage you to support COA, both with your time and funding. Trust me, as a practicing community oncologist I understand the pressures on time and money. However, no one is going to fight for us like those of us in actual community oncology practice. There have never been more individuals and practices actively involved with COA. Your funding is allowing us to increase our lobbying, public relations, patient advocacy, and data gathering efforts, which are all critical in our fight for our patients. 



During this year it will be essential that you reach out to your Members of Congress. This is a new Congress and an entirely new Administration. As a community, we have to make them aware of the cancer care crisis and the urgent need to address it before it is too late. COA will be providing you with more information and materials for you to use in getting everyone in your practice involved in these outreach efforts. 



If you have any questions, comments, or want to get more involved, you can contact me by accessing my contact information on this website.

Sincerely,

Patrick Cobb, MD 

President




Patrick Cobb, MD Elected President of COA

On behalf of the Community Oncology Alliance (COA), I have the pleasure of announcing that Patrick Cobb, MD has been elected to serve as the President of COA. Dr. Cobb is a practicing medical oncologist from Billings, Montana and has served in several capacities with COA, most recently as Vice President. As a member of the COA Executive Committee this past year, Dr. Cobb has provided oversight of COA’s legislative and lobbying initiatives. Even though his practice is based in the Midwest, Dr. Cobb has made many trips to Washington, DC last year (and already this year!) to meet with the congressional leadership. Additionally, Dr. Cobb serves on a healthcare reform advisory group to Senator Baucus, Chairman of the Senate Finance Committee.

In addition to Dr. Cobb, the following individuals were elected by the COA Board to serve as officers:

• Dave Eagle, MD, Vice President (North Carolina)
• Robert Hermann, MD, Secretary (Georgia)
• Ricky Newton, CPA, Treasurer (Virginia)
• Mark Thompson, MD, Officer at Large (Ohio)
• Lance Miller, MD, Officer at Large (Oklahoma)
• Scott Tetreault, MD, Officer at Large (Florida)

This is a very experienced team that the COA Board is relying on to work with me in directing the operations of COA. 

I extend my personal thanks to Dr. Harry “Mac” Barnes for his leadership this past year in serving as the President of COA. Dr. Barnes was instrumental in guiding COA through a transition period that has produced an even stronger advocacy voice for community oncology. New initiatives that COA will be announcing shortly relating to patient advocacy, public relations, and practice networking were conceived under Dr. Barnes watch. He too has walked the halls of Capitol Hill with us in advocating for community oncology.



Fortunately, as Immediate Past President, Dr. Barnes will serve with the other officers on the COA Executive Committee. The COA Board empowers the Executive Committee to oversee the implementation of COA initiatives. 



The Board of Directors of COA will be meeting in Scottsdale, Arizona on the eve of the 4th Annual Community Oncology Conference (February 5-7, 2009). The Board will be discussing COA’s unfolding legislative strategy and the challenge of healthcare reform. Additionally, the Board will be discussing COA efforts to call greater attention to the unfolding crisis impacting community oncology.

On behalf of the COA Board, I invite you to join us at a reception where you can meet Dr. Cobb, the officers, Board, and the COA team. The reception will be held at the FireSky Hotel, the site of the Community Oncology Conference, on February 4, 2009 at 6:00 PM (check the hotel for reception location). The Conference is a great time for community oncology to come together to discuss the issues impacting community oncology. Details on the Conference can be obtained by going to the COA website at http://www.communityoncology.org and clicking on the Conference header.

Your support of COA and community oncology is appreciated!

Ted Okon

Executive Director
Community Oncology Alliance