As 2007 starts, we have been receiving reports from community cancer clinics across the country that the 2006 Medicare cuts have had a negative impact. In fact, we actually have reports of clinic closings. This is especially disconcerting because we estimate effective Medicare cuts of an additional $400 million in 2007. These cuts include the expiration of the 2006 demonstration project funding and cuts to drug administration codes buried in the 5-year RVU update to work values and practice expenses.
The Community Oncology Alliance (COA) has commissioned an independent analysis of these Medicare cuts to cancer care and a report will be forthcoming.
These cuts are in addition to the ongoing problems associated with Average Sales Price (ASP) (including the 6-month reporting lag and artificial lowering of ASP by including prompt payment discounts), which are causing many drugs to be reimbursed less than cost.
COA is actively working on reversing these Medicare cuts. The COA team has been meeting with Members of Congress and the leadership. COA has an 8-Point Agenda for 2007 that it is now pursuing with the Congress. This agenda is as follows:
- Eliminate the inclusion of prompt payment discounts from the calculation of Average Sales Price (ASP). This artificially lowers ASP by an estimated 2%.
- Eliminate the 6-month lag in updating Medicare reimbursement rates, which currently results in community oncology subsidizing the Medicare for price increases.
- Deal with the bad debt reality, which results in further subsidization of the Medicare program.
- Increase payments for the first hour of drug administration, which have declined by 25% since 2004.
- Restore payments for the subsequent hour of drug administration.
- Create a code for pharmacy facilities management.
- Create codes for medical oncology treatment planning, an essential component of quality cancer care.
- Restore payments for imaging services, which will be cut substantially in 2007.
The sole focus of COA and this agenda is on community oncology.
Next week, Dr. Fred Schnell, COA President, will lead the COA team in discussions with the congressional leadership. We will report back on those meetings.
Lobbying in DC is only as effective as the grassroots of community oncology. We can’t emphasize enough how important it is right now for all in community oncology to reach out to their Members of Congress. New Members of Congress need to be educated about our issues and returning Members need to be reminded of the Medicare cuts that are dismantling the community cancer care delivery system.
This is a new Congress. There is a different environment because it is a new Congress. It is more important than ever that community oncology stand up for community oncology!
Please reach out to your Members of Congress today. Invite them into your practice and share your data and stories. These cuts can be reversed but only if Congress understands the problems and the negative impact they are having on the cancer care delivery system in this country.
The Community Oncology Alliance: http://www.communityoncology.org
For further information or comments, please contact Matt LePage <mlepage@communityoncology.org> or Dianne Kube <dianne.kube@att.net>
MedPAC Report on Medicare Reimbursement Cuts
MedPAC, which is the advisory entity to the Congress, has released a report on the Impact of Changes in Medicare Payment for Part B Drugs. The Medicare Modernization Act (MMA) mandated MedPAC to conduct two studies on the impact of MMA reimbursement changes. The first study dealing specifically with oncology was reported on last year. This current report deals with all other specialties; however, it provides an update on oncology. A copy of the MedPAC report is attached.
We strongly recommend that you read this report, especially as it relates to oncology. MedPAC is an impartial advisory entity and their reports carry weight. It is important that you understand the report and share your practice situation with your Members of Congress.
In general terms, as it relates to oncology, the MedPAC report is now history. That is the problem with virtually all of these government reports — they use old data and look backwards, not forwards. The report’s findings do not consider that Medicare cuts in the reimbursement of cancer care continues. In 2007, we expect these cuts to be at least an additional $400 million. This is already having a greater adverse impact on access to care according to close to 200 community cancer clinics reporting to the Community Oncology Alliance (COA).
In particular, note several points in the MedPAC report:
MedPAC acknowledges problems with Average Sales Price (ASP) due to the 6-month reporting lag and the inclusion of prompt payment discounts in the calculation of ASP.
- MedPAC mentions that “Congress could also mandate a dispensing fee”
- MedPAC reports on practices having to spend more resources in procuring drugs.
COA has an 8-Point Agenda for 2007 that ties to many of the points raised in the MedPAC report. However, once again, the report deals with history and old data. It does not look forward, especially as Medicare reimbursement rates continue to be ratcheted down by the Centers for Medicare & Medicaid Services (CMS).
Again, we encourage you to reach out to your Members of Congress to express your opinion on the MedPAC report. Do not let the MedPAC report represent the situation facing your practice. Speak up for your practice.
The Community Oncology Alliance: http://www.communityoncology.org
For further information or comments, please contact Matt LePage <mlepage@communityoncology.org> or Dianne Kube <dianne.kube@att.net>
House Passes Stem Cell Research Enhancement Act
January 12, 2007
On January 11, the House of Representatives approved H.R. 3, the “Stem Cell Research Enhancement Act”, by a vote of 253 to 174. The total fell 37 votes short of what would be needed to override an expected veto from President Bush should the legislation pass in the Senate. The Senate is slated to take up the same bill, S. 5, in February.
The Stem Cell Research Enhancement Act calls for the expansion of embryonic stem cell research eligible for federal funding by allowing research utilizing human embryonic stem cells that are derived from human embryos and have been donated from in vitro fertilization clinics. The legislation also sets out protections; it does not authorize human cloning or somatic cell nuclear transfer.
Thank you to those ASCO members who contacted their Representatives urging their support of H.R. 3. We will let you know when the legislation is scheduled to go before the Senate, so you can contact your Senators at that time. Please contact ASCO’s Cancer Policy & Clinical Affairs Department with any questions at 703-299-1050 or publicpolicy@asco.org.
