Community Oncology Alliance (


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Community Oncology Alliance (

  1. 1. Community Oncology Alliance ( Ohio Oncology Meeting Healthcare Reform and the Impact on the Practice of Oncology Ted Okon Executive Director November 9, 2009 Sandusky, Ohio
  2. 2. Community Oncology Alliance ( 2 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!!!
  3. 3. Community Oncology Alliance ( 3 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
  4. 4. Community Oncology Alliance ( 4 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
  5. 5. Community Oncology Alliance ( 5 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
  6. 6. Community Oncology Alliance ( 6 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
  7. 7. Community Oncology Alliance ( 7 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?
  8. 8. Community Oncology Alliance ( 8 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
  9. 9. Community Oncology Alliance ( 9 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
  10. 10. Community Oncology Alliance ( 10 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
  11. 11. Community Oncology Alliance ( 11 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
  12. 12. Community Oncology Alliance ( 12 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
  13. 13. Community Oncology Alliance ( 13 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?
  14. 14. Community Oncology Alliance ( 14 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
  15. 15. Community Oncology Alliance ( 15 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!!!
  16. 16. Community Oncology Alliance ( 16 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.
  17. 17. Community Oncology Alliance ( 17 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
  18. 18. Community Oncology Alliance ( 18 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
  19. 19. Community Oncology Alliance ( 19 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 18th  Ongoing outreach to CMS/HHS, MedPAC, and others
  20. 20. Community Oncology Alliance ( 20 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
  21. 21. Community Oncology Alliance ( 21 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
  22. 22. Community Oncology Alliance ( 22 House Letter to HHS Secretary
  23. 23. Community Oncology Alliance ( 23 Information Sharing and Unifying Oncology  COA website at  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!!!
  24. 24. Community Oncology Alliance ( 24 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
  25. 25. Community Oncology Alliance ( 25 Increased Political Action Source: Center for Responsive Politics
  26. 26. Community Oncology Alliance ( 26 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
  27. 27. Community Oncology Alliance ( 27 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
  28. 28. Community Oncology Alliance ( 28 Thank you! Ted Okon 203-715-0300 (cell)