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!