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Medicare Chemotherapy Demonstration Project Improves Quality of Care and Patient Access to Care

Posted on: Wednesday, 19 October 2005, 12:01 CDT

WASHINGTON, Oct. 19 /PRNewswire/ -- A comprehensive study presented by a consortium of leading cancer experts at the first Supportive Oncology Conference in Chicago on October 6-8 revealed that The Medicare Chemotherapy Demonstration Project is improving quality of care for cancer patients nationwide. In addition, appropriate access to care has been sustained by the project. The Community Oncology Alliance (COA) is calling for a one year extension of the demo project to ensure enhanced quality of care and access to care. Currently, the project will expire on December 31, 2005.

(Logo: http://www.newscom.com/cgi-bin/prnh/20050817/NYW098LOGO )

COA President, Leonard Kalman, MD of Florida in a recent letter to Senate Finance Committee Chairman, Charles Grassley, stated, "The reality of the CMS demonstration project and the situation facing community cancer clinics, where over 80% of Americans with cancer are treated, are summarized as follows:

1. The demonstration project has enhanced the quality of cancer care for patients. As documented in a recent study of 443 medical staff from 127 community cancer clinics, 40-50% of respondents believed that the demonstration project improved frequency of severity assessment of cancer pain, nausea/vomiting, and fatigue, thoroughness of symptom assessment, and, very importantly, actual treatment of these symptoms. 2. A fundamental intent of the demonstration project was to retain $300 million in Medicare funding for cancer care in 2005. This additional funding provided by CMS under the demonstration project was critical to averting a patient access-to-treatment crisis in 2005. Without the demonstration project, patients would have been unable to receive care or had to have their care shifted to more costly hospital settings. 3. Community cancer clinics face at least $500 million in Medicare reimbursement cuts in 2006. This is because of the expiration of the demonstration project, a reduction in cancer services payments, a reduction in physician fee payments, and the continued subsidy by community cancer clinics of Medicare beneficiaries unable to pay their co-insurance. Clinics simply cannot operate and provide cancer care under these historic Medicare payment cuts. We face another patient access-to-treatment crisis in 2006. 4. The underlying problem is that Medicare reform has only gone half way. It has over-corrected Medicare reimbursement for cancer drugs but has neglected to reimburse appropriately for essential medical services such as treatment planning. The Congressional Budget Office (CBO) originally estimated that the Medicare Modernization Act of 2003 (MMA) would save Medicare (or, alternatively, reduce payments to community cancer clinics) $4.2 billion from 2004-2013. According to a revised estimate by PricewaterhouseCoopers, the real impact based on actual current Medicare payment changes, not projected changes used at the time by CBO, is $15.7 billion over the same time period. This exceeds the congressional intent behind the MMA by more than 3 times. 5. In late 2004, CMS averted a crisis in cancer care for 2005 by implementing the demonstration project and other payment changes. This retained at least $400 million in Medicare reimbursement for cancer care that was scheduled to be cut in 2005. Even with the retention of these funds in the Medicare system, community cancer clinics around the country have reported sending more patients to the hospital during 2005, especially in cases where ongoing treatment is not viable because of reimbursement below actual clinic costs. This is disruptive for patients and results in higher costs for both Medicare and beneficiaries. Furthermore, many hospitals around the country have informed community cancer clinics that they are not able to provide treatment to additional patients. The shift over the past 20 years from the institution-based, inpatient setting to community- based, ambulatory sites for treating the majority of the nation's cancer patients was prompted in large part because of cost savings to the government and Medicare beneficiaries. It is ironic that we now face a situation where care is being shifted back to the hospital, especially when that setting lacks the necessary infrastructure and is more costly."

COA is underscoring that community cancer clinics are facing a substantial cut in Medicare funding for cancer care of at least $500 million in 2006. Given cuts already made to the Medicare payment system, community cancer clinics cannot absorb further payment reductions without adverse impact on patient access to care. COA has been working with members of Congress and CMS to avert any problems in 2006 by providing specific solutions, especially ones that enhance the quality and affordability of cancer care for Medicare beneficiaries and all Americans.

For additional information contact Steve Coplon, Co-Executive Director, Community Oncology Alliance, 901-683-0055 ext. 1119.

The Community Oncology Alliance (COA) is committed to fostering and protecting high quality, affordable and accessible cancer care for all Americans battling cancer. COA's vision is to strongly promote initiatives that further enhance the quality and affordability of cancer care, which along with accessibility have been hallmarks of cancer treatment delivered in the community setting where over 80% of Americans with cancer are treated. For additional information, visit: http://www.communityoncology.org/.

Contact Information: Deborah D. Coble Community Oncology Alliance Press Officer 901-683-0055x1312 901-831-1010 cellular

Photo: http://www.newscom.com/cgi-bin/prnh/20050817/NYW098LOGO

Community Oncology Alliance

CONTACT: Deborah D. Coble, Press Officer, Community Oncology Alliance,+1-901-683-0055x1312, 901-831-1010 cellular

Web site: http:www.communityoncology.org

Source: PRNewswire

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