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Lori Gardner, Senior Director
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301.984.9496 ext. 226
For Immediate Release: March 1, 2010
Association of Community Cancer Centers Active in 2009-2010 Cancer Care Policy Activities/Agenda
ROCKVILLE, Md.—Over the last year, during a tumultuous healthcare reform debate, the Association of Community Cancer Centers continued its advocacy efforts on Capitol Hill and with the Centers for Medicare & Medicaid Services (CMS). ACCC continues to work with stakeholder groups and decision makers on a wide range of issues, including fair reimbursement for cancer care providers and an overhaul to the SGR.
Hospital Outpatient Department Issues
CMS released the final 2010 Hospital Outpatient Prospective Payment System (HOPPS) Rule on October 30, 2009. ACCC had commented on a number of issues prior to the rule’s release, including: drug reimbursement, the packaging of certain imaging services, the packaging threshold, physician supervision, quality measures, and the date of service rule, among others.
ACCC can count a number of finalized provisions as victories based on ACCC’s meetings with and suggestions to the Centers for Medicare & Medicaid Services (CMS) before the proposed rule was released at the beginning of July. After three years of concerted efforts from ACCC and other stakeholders, CMS finally recognized that its formula for determining the average sales price (ASP) + number is flawed and needs readjustment. CMS recognized that charge compression affects the calculation, and that pharmacy services are not adequately reimbursed. Without these concessions, CMS would be reimbursing drugs at ASP -3 percent in 2010.
ACCC has requested in its comments that CMS go further in their concessions and return drug reimbursement to ASP+6 percent. ACCC and other stakeholders provided new data to CMS in private meetings that demonstrated the need to better account for pharmacy services and also to push for proper coding of packaged drugs. CMS did encourage hospitals to properly code packaged drugs, but it did not make further concessions in the area of overall drug reimbursement. The final rule states that drugs will be reimbursed at ASP+4 percent in 2010, which is what drugs were reimbursed at in 2009.
In February 2010, ACCC testified at the Ambulatory Payment Classification Group (APC) Panel meeting at CMS headquarters and requested that the panel recommend to CMS to shift more money from packaged drugs to separately paid drugs. If CMS were to do this, it would increase the ASP+ number, thus providing more money for pharmacy-related services. The APC Panel agreed with ACCC and made that recommendation to CMS.
The second victory came on the topic of physician supervision. As was highlighted at ACCC meetings, and on member conference calls, burdensome regulations were instituted in the 2009 final rule regarding the regulations for having physicians on site and immediately available in the outpatient setting. ACCC worked closely with the Oncology Nursing Society (ONS) to remove and change these regulations for the 2010 rule. ACCC and ONS suggested allowing non-physician practitioners to supervise procedures if they are allowed to do so under their state’s Scope of Practice Laws. CMS adopted this idea for the 2010 Rule.
ACCC held a call for the membership to discuss the Physician Supervision Regulation on February 24, 2010, and had 350 members participate.
ACCC is still waiting to hear back on its nominated members to the CMS MedCAC and also to the Agency for Healthcare Research and Quality (AHRQ) Advisory Board.
CMS released the final 2010 Physician Fee Schedule rule on October 30, 2009. There were significant changes to some of the areas that ACCC highlighted in its comments, including: the massive cuts to medical and radiation oncology, the SGR formula, and the elimination of consult codes, among others.
In 2010, it is finalized that medical oncology will see a roughly 6 percent reduction in Medicare payments. However, due to pressure from organizations such as ACCC and from members of Congress, the cuts will be implemented over a four-year period, with a 1 percent reduction for 2010.
Radiation oncology had been slated for a 19 percent reduction, but instead will see only a roughly 5 percent cut. This, too, will be implemented over four years, leaving a 1 percent reduction for 2010 as well. These cuts are not including the 21.2 percent that is scheduled to be cut from the SGR formula.
As of this writing, Congress has not yet stepped in to stop these cuts, but it remains highly likely that they will do so again early in 2010. A two-month freeze ended on February 28, and it appears that Congress will enact another 30-day freeze, in order to give them more time to provide a fix through the end of the year.
CMS finalized a proposal in the rule to eliminate drugs from the SGR formula. This will likely reduce the SGR adjustment from the negative 5-6 percent each year, to a more manageable –1 to +1 percent increase per year. The SGR was originally designed to keep physician spending in line with the gross domestic product (GDP), but physicians have no control over the price of drugs, which is one major reason for the massive cuts each year. ACCC supports this finalized rule.
The year 2009 will likely be remembered as a year for grand healthcare reform ideas that took until 2010 to complete. As of the writing of this report, the House and Senate have both passed their own versions of healthcare reform. However, the efforts stalled in January, and now President Obama has weighed in with his version of a compromise. The compromise version leans heavily on the Senate version with a few tweaks to aid small businesses and State governments. The President also held a bi-partisan summit on healthcare in the hopes of renewing the efforts to pass sweeping legislation. As of this writing, no final bill has emerged or been voted on.
Throughout all of the versions released thus far, there are a number of aspects that will be of importance to ACCC members. Until we know for certain what the bill will look like, it is difficult to inform the members about the final effect the legislation will have. ACCC has been busy identifying the differences in the bills for the members, so they can decide for themselves what to support. We have encouraged grassroots activity on these issues and will provide a complete summary of the final bill. Some of these issues include: inclusion of the Prompt Pay Discount amendment, language related to access to clinical trials and insurance reform, and the elimination of life-time caps and pre-existing conditions practices.
ACCC is currently drafting comments to CMS on its proposal to define meaningful use of electronic health records (EHR) in order to qualify for the EHR bonus payments. ACCC is concerned with a number of the provisions, in both the timing and of the scope proposed. ACCC will post a copy of the comments on its website once they are completed.
ACCC continues to work with other advocacy groups in the oncology community on issues ranging from pharmacy overhead payments to the introduction of chemotherapy teaching codes. At a Capitol Hill briefing, CCC worked with the Community Oncology Alliance, the American Society of Clinical Oncology, Oncology Nursing Society, the Association of Oncology Social Work, the National Patient Advocate Foundation, and US Oncology to educate members of Congress and their staff as to the importance of chemotherapy planning and teaching, especially with the increasing number of oral therapies available. This briefing was the second educational briefing with this group, and we hope to continue to hold one every six months.