We wanted to bring to your attention recent developments you may have read or heard about related to cancer care.

Legislative and Administrative Activities
Oncology continues to be a highly visible issue on Capitol Hill.   There is an active group of members in both the House and Senate that are supporting the oncology community’s top priorities.  Rep. Ralph Hall (R-TX) and Rep. Nathan Deal (R-GA), who were instrumental in passing a Resolution last year that supported the cancer community, continue to be strong advocates for oncology issues, along with Rep. Nancy Johnson (R-CT), Rep. Jim Ramstad (R-MN), Sen. Arlen Specter (R-PA), Sen. Sam Brownback (R-KS), Sen. Chuck Hagel (R-NE) and many others. 

ASCO is meeting with key committee members and staff to advance legislative and administrative proposals that:

• Promote quality cancer care.  Any proposal related to quality care must recognize and build on the tremendous progress already achieved by ASCO and others in the cancer community in promoting quality cancer care.  Such proposals must also be consistent with the current political realities.  For instance, the American Medical Association signed an agreement with Congressional Leadership late last year -- in order to avert a physician payment cut for 2006 -- that would launch a pay-for-performance system for 2007.  The agreement ensures that specialty societies, not HHS, will develop the quality measures and stipulates that physicians who report the measures should receive an extra payment to offset administrative costs.  While there may be timing and other issues with this model, it is consistent with exciting advances in quality care, such as:
  • The development of validated quality measures for major cancers as a result of ASCO’s multi-year study, the National Initiative on Cancer Care Quality (NICCQ),
  • The Cancer Care Quality Alliance formed last year by the National Coalition for Cancer Survivorship and ASCO.  This Alliance brings together stakeholders – physicians, nurses, and patients -- in the cancer community to promote quality cancer care,
  • The Quality Oncology Practice Initiative (QOPI), a community practice-developed and based quality-reporting system that is recognized by the American Board of Internal Medicine.
    
• Advance initiatives that focus on appropriate payment for cancer care services.  ASCO will support legislation that fairly reimburses physicians for the work that goes into providing and managing patients on complex chemotherapy regimens, including the important work of treatment planning and management of toxicities.
  
• Support legislative changes to ensure that Medicare pays practices fairly for chemotherapy drugs and at the rates practices are able to obtain the drugs.  ASCO is working to advance proposals that would ensure fair and adequate payments for chemotherapy drugs at the time the service is provided.  ASCO’s proposal would allow for adjustments when drugs are not available to practices. 

There are already a number of cancer-related legislative initiatives that have been introduced, with more to come.  ASCO will work with all members of Congress to refine legislative initiatives to ensure positive reform.  For instance, some of these proposals include a provision to retroactively reconcile payments for chemotherapy drugs to address the lag between the time ASP data are collected and the time Medicare ASP-based drug payments are updated.  ASCO is concerned about proposals that would 1) remove resources from the system, or 2) allow payment reductions after the service has been provided.  The impact for such a provision may not be the same for every practice.  If you’d like to know how it would affect your practice, please contact ASCO for an easy-to-use spreadsheet.

Finally, while there are many different approaches to advancing cancer care issues, we all agree that the outcome must be to ensure that people living with cancer have access to the highest quality of care.

“Heath Affairs” Study on Reimbursement
Earlier this week the journal "Health Affairs" published a study asserting that Medicare reimbursement – under the previous AWP system – influenced the choice of chemotherapy regimen that oncologists provide to patients.  

The study authors used data from cancer registries and linked this information to Medicare claims for all Medicare-eligible patients over age 65 with metastatic lung, breast, colorectal, or other GI cancers between 1995 and 1998.  The study focused on differences in the calculation of AWP for the same drug by various carriers and concluded that higher reimbursement led to greater use of a drug.

The study was covered in the New York Times earlier this week, but has not yet received additional media attention. The Times article incorrectly stated that the study examined the current reimbursement system. ASCO has requested a correction, and is also communicating its concerns about the study’s assumptions and conclusions to Times editors and the reporter who wrote the article, noting that: 

• It examines the AWP reimbursement system, which is no longer in use, making the study irrelevant,
• The claimed effect of reimbursement influence choice of drug appeared clearly in only two of the four cancers studied, with one having the opposite result, and one indeterminate,  The scope of the study was limited.

To view the study abstract please go to the Health Affairs website.

OIG report
The Department of Health and Human Services (HHS) Office of Inspector General (OIG), recently released a report challenging how the Centers for Medicare & Medicaid Services (CMS) calculates average sales price (ASP) for multiple source Part B drugs.  The report suggests that overpayment has exceeded underpayment for cancer drugs under the new system. 

In responding to the report, CMS did not agree with the OIG’s findings.  This issue involves not only the mechanics of calculating a weighted ASP but also the statutory language, which the OIG did not evaluate. Those of us who provide cancer care services everyday may dispute the OIG’s finding, but it is likely to draw attention from both Congress and CMS.  ASCO is reviewing this report and will be communicating concerns about it to Congress and CMS.

ASCO members should contact ASCO’s Cancer Policy and Clinical Affairs Department, at 703-299-1050, or by email at publicpolicy@asco.org with any questions or concerns. We will continue to provide legislative and regulatory updates as more develops.