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!
Thursday, February 26, 2009
Monday, February 23, 2009
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.
• 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.
Monday, February 9, 2009
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.”
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.”
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