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Community Oncology Alliance (www.communityoncology.org)






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Community Oncology Alliance (www.communityoncology.org) Community Oncology Alliance (www.communityoncology.org) Presentation Transcript

  • Ohio Oncology Meeting Healthcare Reform and the Impact on the Practice of Oncology Ted Okon Executive Director November 9, 2009 Sandusky, Ohio
  • Summary
    • We will get health care reform legislation
      • It is not a pretty process but the president and his party faces Armageddon if it does not pass
    • Health care reform has the potential to fundamentally and severely change cancer care — like never before
    • There are immediate impacts as well as impacts “around the corner”
    • This is now all about the 2010 elections — Politics, politics, politics
    • It is essential that OHIO practices be as unified and involved as possible!!!
  • Status of Reform Legislation
    • House approved health care reform bill (220-215)
      • Passed by 3 votes — 39 Democrats voted against; 1 GOP for
      • Kucinich & Boccieri only OH Dems voting “no”
    • The two Senate committees have passed bills
      • Senate leadership is working on merging two bills
      • Merged Senate bill may not come up for a vote till right before/after Thanksgiving
    • Next Steps — Till Christmas (or beyond):
      • Senate votes on its bill
      • Conference Committee to merge Senate and House bills
      • Vote on one final bill
      • Send to the president for signing
  • Beliefs Shaping the Debate
    • The US healthcare system is more driven by profit than patient best interests
    • Physicians and hospitals over-diagnose/treat based on churning revenue
    • Care is uncoordinated
    • Regional differences in cost/outcomes unacceptable
    • Government’s role is to supervise/manage the health care system
      • Must read — The Cost Conundrum (The New Yorker) by Gawande
  • House Health Care Reform Legislation — H.R. 3962
    • 1,990 pages of law; 400,000 words
      • Cost over $1 trillion
    • Increases coverage from 83% to 96%
      • Provides subsidies in 2013 to extend coverage
      • Mandates individuals to purchase coverage
      • Bans insurers from denying coverage
      • However, estimated penalties of $167 billion over 10 years to individuals and businesses not purchasing insurance
    • Establishes insurance “exchanges” for individuals and small businesses
      • Creates a government-run public plan
      • Crackdown on insurer “unjustified premium increases”
      • Eliminates insurers antitrust exemption
  • House Health Care Reform Legislation (continued)
    • Expands Medicaid up to 150% of the FPL.
    • Pushes Part B towards bundling of services, care coordination, and greater empowerment of CMS to make payment changes
    • How it is paid for:
      • $460 billion in new income taxes on individuals
      • $400 billion in Medicare & Medicaid cuts
      • $13 billion in limiting contributions to FSAs
      • Industry fees and other taxes
  • Lessons from H.R. 3962
    • “ Do or Die” for Democrats to pass health care reform
    • Big issues of contention:
      • Public plan
      • Abortion
      • Illegal immigrant health care coverage
    • Pelosi last minute deal on abortion sealed the vote
      • Pro-abortion did not block the vote but livid
    • Democrat “no votes” came from moderate-conservative districts — 2010 most vulnerable list
      • This was in reaction to Tuesday night and a preview of 2010
    • Sets up “Who will blink?” scenario in the Senate and House — moderates or liberals?
  • Senate Bill — Best Guess
    • Not yet finalized but indications of how it will differ from House bill
    • Almost everyone must obtain coverage through employer, on their own, or through the government
    • Employers not required to provide insurance but business with 50+ employees must pay a fee if government subsidizes
    • Tax credits for certain individuals and small businesses
    • No denial of coverage
    • Creates state/regional co-ops and public plan (???)
    • Initiatives to fundamentally transform the Part B payment system
      • Initiatives to bundle care and force coordination
      • Providers with top 10% highest costs docked a 5% penalty
      • Greater Medicare control in independent (?) entity
    • Paid for by taxes and fees
      • Individuals who do not purchase insurance
      • Premium insurance plans
      • Insurance companies, drug companies, and device manufacturers
  • Public Plan — The Great Debate
    • Government needs to offer a “public” insurance plan
      • Concept is to provide a low cost option that will keep private insurers honest
        • Will act as a magnet forcing private insurers to decrease costs in order to compete
        • Accordingly, will force insurers to lower provider payments
    • Liberals want a “strong” public plan based on Medicare rates +5%
      • This will eventually lead to government control or simply a one-payer system
    • Moderates want a public plan where HHS negotiates rates with providers… or no plan at all
    • Topic of great debate in the House and Senate
  • The “Doc Fix” — Political Hot Potato
    • Senate attempted to pull the “doc fix” out of health care reform
      • Voted on S. 1776 to zero out the 21.5% cut and repeal the SGR (but no replacement)
      • 53-47 vote could not overcome a filibuster
    • House has taken the same approach — H.R. 3961
      • Update for 2010 would be % increase in the MEI
      • In 2011, creates separate growth rates and conversion factors for E&M/Preventive Services and all other services
      • Would only include MD services in the growth rates
      • Cost of $210 billion over 10 years
  • Impacts on Oncology
    • Current Impacts
      • 2010 Medicare Physician Fee Schedule
        • Cuts to drug administration, consult codes, and imaging
      • Audits and changing payment rules
    • “ Around the Corner” Impacts
      • Greater risk sharing on oncology providers
      • Payments based on the oncologist reducing costs
      • Making the primary care physician the medical home
      • Making oncology providers a spoke in accountable care organizations (ACOs)
      • Government coming between the oncologist and the patient
      • Stripping services such as imaging out of the practice
  • 2010 Medicare Physician Fee Schedule
    • Averted severe cuts in 2010 but cuts phased in over 4 years
      • Drug administration payments cut 5% in 2010; 19% by 2013
      • Elimination of consultation codes — 1% cut in 2010
      • E&M payments increased by 5% in 2010
    • Payment reductions to diagnostic imaging
      • 38% phased in over 4 years
    • Averted major payment reductions to therapeutic radiation
    • Overall 21.5% cut in all physician services payments unless Congress acts
      • Even then, fixing this may likely reduce drug administration payments
  • Do Not Minimize These
    • RAC audits
    • MIC audits
    • Changes to “incident to” rule restricting use of non-physician services
    • Comparative Effectiveness Research
    • Additional imaging cuts/restrictions — the next AWP?
  • Drivers of Oncology Impacts
    • Fundamental lack of understanding of what is involved in providing cancer care
    • A belief that specialists drive up the cost of care so put PCPs in the driver seat — medical home, gatekeeper, etc.
    • Integrated medical practices are driven by profits versus patient quality of care and convenience
      • Take special note, if you have in-house imaging and radiation
    • Rapidly escalating costs of cancer care are excessive
    • Focus on costs rather than quality, outcomes by policy makers
    • Policy makers with little/no experience in medicine
  • What Oncology Needs to Do
    • Educate policy markers on the complexity and trends in cancer care
      • Provide objective data
      • Provide success stories
    • Provide solutions in leading, rather than be led by policy makers
    • Fight reimbursement cuts in order to keep the cancer care delivery system viable
    • Generate more positive press
    • Become more politically engaged and active!!!
  • COA Position
    • US has the best documented cancer care in the world *
    • We are in the first stage of crisis due to reimbursement cuts
    • We are entering the second stage of crisis as we lose oncologists to demand
      • By 2020, short an oncologist for every 1 in 4 cancer patients
    • Healthcare reform has to correct the problems, not exacerbate them
      • As President Obama says, “Fix what is broken and build on what works”
      • Source: US Cancer Care Is Number One, National Center for Policy Analysis, Brief Analysis No. 596, October 11, 2007.
  • What COA is Doing
    • Providing data and educating policy makers
      • Components of Care and Oral Oncolytics Studies
    • Providing legislative solutions
      • H.R. 3675 and H.R. 1392/S. 1221
    • Fighting Medicare cuts with data and political support
    • Creating greater information sharing and unity among practices
    • Generating more positive and illuminating press/PR
    • Making community oncology stronger politically
  • Collecting Data
    • Components of Care Study
      • Created a committee comprised of all functional disciplines within community oncology
      • Identified the clinical and operational components of delivering cancer care
      • Fielded a survey to quantify the components of care
      • Preliminary results:
        • Medicare only covers 55% of cancer care costs
    • Oral Oncolytics Study
      • Identified barriers to use of oral cancer agents
      • Shaping policy in concert with care delivery
  • Educating
    • Over 300 meetings with congressional members and staff
    • Hill Education Series on Cancer Care
      • First initiative was Off Label Cancer Drug Use & Compendia in conjunction with ACCC and US Oncology
      • Next is Components of Care & Medicare Fee Schedule
        • Inviting all House legislative and health staff
        • November 18 th
    • Ongoing outreach to CMS/HHS, MedPAC, and others
  • Oncology Legislative Solutions
    • H.R. 3675 — National Quality Cancer Care Demonstration Project Act of 2009
      • National demonstration program on treatment planning and follow-up care planning
      • Developed by a task force of practicing medical oncologists
      • Open to all oncology nationwide
      • Provides $300 million in annual funding
      • Summary provision is in Senate Finance bill
    • H.R. 1392/S. 1221 (Prompt pay solution bill)
      • Important for any payment system based on ASP
      • Adds 2% back to drug reimbursement based on ASP
      • Defense against additional drug reimbursement cuts
      • Provision was in House Energy & Commerce bill
  • Fighting Medicare Cuts
    • Congressional staff arranged HHS/CMS meeting for oncology practice administrators
      • 15 administrators presented data and stories, highlighting impact on patients and their care
    • Outreach to the White House on the impact of planned Medicare cuts
    • Letters from Representatives and Senators to HHS Secretary to forestall implementation of Medicare payment cuts
      • 113 Representatives signed onto one letter to HHS Secretary
  • House Letter to HHS Secretary
  • Information Sharing and Unifying Oncology
    • COA website at www.communityoncology.org
      • News, education, resources, and action items
    • COA Administrators’ Network
      • Run by and for oncology practice administrators
      • Goals of networking practices and enhancing information sharing
      • A unified oncology is a stronger oncology!
      • Need a state representative from MO!!!
  • Oncology Public Relations
    • Articles in major papers — NYT, WSJ, WP
      • WSJ War on Specialists
    • OpEds by oncologists in papers around the country
    • TV stories/appearances — FOX, local outlets
    • OncologySTAT policy updates
    • Social networking
      • COA YouTube Channel
      • COA on Facebook
      • OncologyCOA, TedOkonCOA, PatrickCobbCOA
  • Increased Political Action Source: Center for Responsive Politics
  • What Ohio Can Do NOW
    • Pull Ohio together in one massive outreach to the congressional delegation — House and Senate
      • Call attention to the Medicare cuts
      • Outreach to House members/staff on 11/18 Hill briefing
      • Follow-up after briefing
    • Specific unified outreach to Senator Brown on cuts and prompt pay issue
    • Come to DC as a group for Hill visits
    • Reach out to your media — OpEds, letters, interviews
    • Oncologists and clinical providers… Help us to develop proactive solutions for oncology
    • Administrators… get involved with your fellow administrators through CAN
    • Help build the political clout of oncology through COA PAC
  • Support COA
    • Become involved with COA — individually and practice
      • Contribute to COA!!!
        • Funds go towards advocacy, studies, and public relations
      • Contribute to COA PAC!!!
        • Oncology needs to strengthen politically
      • Join a COA working committee
      • Join the Administrators’ Network team
    • Help bring community oncology together
  • Thank you!
    • Ted Okon
    • [email_address]
    • 203-715-0300 (cell)
    • www.communityoncology.org