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For Immediate Release: March 11, 2005
CMS Administrator Reaches Out to Oncology Providers at ACCC’s Annual National Meeting
ROCKVILLE, Md.—Mark McClellan, MD, PhD, administrator of the Centers for Medicare and Medicaid Services (CMS), addressed almost 500 attendees at the Association of Community Cancer Centers’ 31st Annual National Meeting in Alexandria, Va., March 9. During his keynote address, Dr McClellan touched on several key policy issues including payments to physicians, drug coverage, and delivery of cancer care to MEDICARE patients.
"While we’re moving full force toward implementation of the new prescription drug benefit, we are also working diligently to make sure beneficiaries have effective access to the oncology drugs that are covered now under Medicare Part B,” said McClellan. "…the underlying problem was that Medicare had been overpaying for oncology drugs and underpaying for the administration services—the critical clinical support services that go along with the drug. We are trying to get those payments right now, based on the average sales price or ASP for the drug, and we are also making sure we are paying appropriately for the drug administration.”
McClellan thanked attendees for their input through ACCC “in terms of helping to get these drug payments up.” He noted that CMS has added new codes and issued clarifications so providers know they “can bill for complications that occur during chemo administration. All these changes have been estimated as having a substantial positive impact on the appropriateness of payments.”
Oncology practices are being closely monitored by CMS. While CMS is not seeing a drop off in billing for oncology drugs, McClellan did acknowledge that some individual practices are “facing a challenge” in getting a better price for their drugs. CMS is interested in hearing from practices that are experiencing problems, and attendees are encouraged to provide input on the proposed rule on the competitive acquisition program (CAP) that is scheduled to go into effect in January 2006.
Addressing the agency’s recent national coverage decision (NCD) on off-label uses of drugs for colorectal cancer, McClellan said CMS is trying to collect more definitive evidence. McClellan said the agency would be issuing another draft guidance on this issue by the end of March. “We are looking forward to comments from all stakeholders, particularly all of you, to make sure we are moving forward as effectively as possible” on this critical policy area, said McClellan.
A recurrent theme in McClellan’s remarks was Medicare’s “new approach” to helping support high-quality, innovative, efficient healthcare. That new approach includes taking steps to move away from benefits and coverage that focus on treating diseases and their complications after they occur to a more proactive and preventative model for care. In this effort, McClellan cited CMS’s increased coverage for certain screening procedures and programs to ensure that Medicare patients are accessing these screening benefits.
But offering coverage for screening and preventative services is "only half the battle," according to McClellan. “Now our challenge is to make sure the patients are using them. According to our latest surveys many Medicare beneficiaries do not receive recommended screening because they didn’t know it was needed. This has a very important consequence. …More than half of our beneficiaries have not made use of the screening test that can detect colorectal cancer at an early curable stage.”
Medicare is also identifying more ways to move toward quality and outcomes-based or performance care. As an example, McClellan cited a pilot program created under MMA that targets beneficiaries who have chronic disease (heart failure, chronic lung diseases, and “complex” diabetes), which account for much of Medicare costs. Under the program, Medicare will contract with entities that will help support doctors and patients with chronic illnesses to help prevent complications from these diseases. To be paid, these entities will have to show improved clinical outcomes for patients, improved patient and provider satisfaction, and lower costs.
"Once this pilot program is shown effective, it may be expanded nationwide and expanded to include cancer care," said McClellan.
McClellan thanked ACCC meeting attendees for spending so much time working with CMS on coverage, payment, benefit, and prevention issues. The goal is to make sure “we are doing everything possible to support high-quality, effective, evidence-based, prevention-oriented 21st century healthcare.”