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