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Community Cancer Care Preservation Act of 2005 Introduced in House of Representatives

Posted on: Friday, 21 October 2005, 15:01 CDT

WASHINGTON, Oct. 21 /PRNewswire/ -- The Community Oncology Alliance (COA) is pleased to announce that Congressman Jim Ramstad (R-Minnesota) has introduced the Community Cancer Care Preservation Act of 2005 -- HR 4098. The bill seeks to improve the impact of the Medicare Modernization Act (MMA) upon the delivery of cancer care in Community Oncology Clinics. "We are grateful for the leadership of Congressman Ramstad on this issue," said Leonard Kalman, MD President of COA. "Congressman Ramstad, along with many other members of Congress, understands our concerns about patient access and quality care. This bill makes great headway in resolving these concerns."

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

Community Oncology Clinics provide cancer care for over 84 percent of the nation's cancer patients. A 2005 study by PriceWaterhouseCoopers indicated that the impact of MMA upon cancer clinics was a 10 year reduction of $15.7 billion -- nearly four times the amount intended by Congress when it passed MMA. The Community Cancer Care Preservation Act focuses on appropriate corrections to align the impact of MMA with Congressional intent.

The bill addresses a series of specific issues that impact quality and access to care. These include:

-- Fix critical aspects of ASP. The Community Cancer Care Preservation Act of 2005 (HR 4098) will provide a true-up or reimbursement correction for drugs that are increased (or decreased) in price by the manufacturer. This will correct the current problem whereby community cancer clinics are subsidizing Medicare for six months on average for price increases. Additionally, the bill will eliminate prompt payment discounts from the calculation of ASP. Currently, the inclusion of prompt payment discounts, which average about 2%, artificially depress drug reimbursement rates from ASP + 6% to ASP + 4%. -- Pay for pharmacy facilities. The bill will reimburse community cancer clinics for pharmacy facilities at 2% of ASP, which is what CMS intends to pay outpatient hospital clinics that administer drugs. The payment system for these clinics is changing from AWP-based to ASP + 6% in 2006, with an additional 2% of ASP to cover pharmacy facilities. This provision puts community cancer clinics and outpatient hospital facilities on the same basis for drug reimbursement and pharmacy facilities. -- Extend the demonstration project. The chemotherapy demonstration project would be extended at its current funding level through 2006. This is a critical component of retaining $300 million in funding to cancer care. 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.

Meanwhile, COA intends to provide CMS and the Congress with data supporting the need for additional reimbursement codes covering essential services such as treatment planning.

Additionally, The Community Cancer Care Preservation Act of 2005 directs the Secretary of Health and Human Services (HHS) to work with community oncology in defining measures of quality cancer care. COA has an ongoing committee on quality cancer care, which is chaired by Dr. Linda Bosserman, a practicing community oncologist. Presently, there is significant momentum behind the pay-for-performance approach for quality medical care. This provision will make sure that community oncology is involved in arriving at viable solutions.

In addition, the bill directs the Director of the National Cancer Institute (NCI) to work with community oncology in developing a strategic plan that is designed to increase the number of patients who enroll in clinical trials, by improving patient education regarding clinical trials, facilitating the clinical trial process, and ensuring the viability of conducting clinical trials in the community oncology setting.

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.

COA is concerned that cancer 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. The Community Cancer Care Preservation Act is a well thought out appropriate solution to the current situation.

For additional information, contact Steve Coplon, COA Co-Executive Director, 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 901-683-0055 x 1312

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20050817/NYW098LOGOAP Archive: http://photoarchive.ap.org/PRN Photo Desk, photodesk@prnewswire.com

The Community Oncology Alliance

CONTACT: Deborah D. Coble, Press Officer of Community Oncology Alliance,+1-901-683-0055 x 1312

Web site: http:www.communityoncology.org

Source: PRNewswire

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