by Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC
National Cancer Institute’s (NCI’s) recent announcement that two community-based research networks, the Community Clinical Oncology Program (CCOP) and the NCI Community Cancer Centers Program (NCCCP), would be combined under the NCI Community Oncology Research Program (NCORP), raised concern and confusion about future clinical trial funding for community-based programs. In a blog post last week, ACCC expressed concern about a reduction in clinical trials and a possible gap in funding.
The NCI announcement about the change states that the new NCORP will have fewer investigators and “will be comprised of some of the sites formerly funded through the CCOPs, MB-CCOPs, and NCCCP, as well as new grantee institutions….”
NCI Director Harold Varmus has now released an open letter to the oncology community clarifying how this consolidation will impact clinical trial funding. The newly formed NCORP network will center on treatment and prevention-based clinical trials, as well as population-based studies and other research.
Dr. Varmus responded to concerns about maintenance of funding between the current round of annual CCOP awards (June 2014) and the start of the newly created NCORP (estimated to be August 2014), stating:
“With Fiscal Year 2014 budgets now in place, our grantees can be assured that NCI will fund all CCOPs at their current levels during this period. While this was always our intention, this has not been clearly communicated. Furthermore, currently funded investigators should continue the active, uninterrupted accrual of patients to new or ongoing clinical trials during this interval. As in the past, full funding for all research activities required to carry out approved studies will be provided.”
In addition, the letter states that programs not selected to receive funding under the new NCORP will receive assistance to ensure the smooth closeout of operations.
ACCC continues to monitor developments and will keep members updated as additional information is released.
By Sydney Abbott, JD, Manager, Public Policy & Provider Economics, ACCC
For nearly 30 years, researchers, physicians, and cancer patients have relied on clinical trials provided by the National Cancer Institute’s (NCI’s) Community Clinical Oncology Program (CCOP). Now, due to the Congressional budget-reduction mindset, NCI is woefully underfunded, leading to the Institute’s decision to end funding for federally-funded clinical trials through CCOP as of June 1, 2014. The NCI CCOPs bring clinical trials to patients in their local communities across the country and support for these could end until new NCI research grants are awarded in September 2014, at the earliest.
Additionally, NCI’s new National Clinical Trials Network (NCTN) is facing a 40 percent budget reduction, which has led to a reorganization of cancer clinical trials, including fewer investigators and a total reduction in number and size of trials funded.
The primary programs in the NCTN, CCOP, the Minority-based Community Clinical Oncology Program (MB-CCOP), and the NCI Community Cancer Centers Program (NCCCP) will be consolidated into the NCI Community Oncology Research Program (NCORP). As announced by NCI on April 4, “NCORP will be comprised of some of the sites formerly funded through the CCOPs, MB-CCOPs, and NCCCP…” [emphasis added]. Please see the NCI statement here.
ACCC is concerned that a reduction in clinical trials will lead to decreased innovation of cancer therapies, as well as decreased access to the best care for cancer patients. ACCC urges NCI to reinstate funding for the CCOP and to continue support for community-based clinical trials and research.
Editor’s Note: Since this blog was posted, NCI has issued a letter clarifying funding for community clinical trials during the transition to the new NCORP. Read our update blog here.
By Amanda Patton, Manager, Communications, ACCC
By the time ACCC’s Annual National meeting wrapped up this week, attendees had heard plenty of numbers. Here is just a small sampling:
7.1 million Estimated number of enrollees under the ACA’s health insurance marketplaces
70% Percent of plans on insurance exchange that are considered “narrow networks”
30 Number of states that have now passed oral parity legislation
13.7 million Current number of cancer survivors in the U.S.
1.5 million Number of new cancer cases diagnosed annually
18% Percent of U.S. population that will be Medicare eligible by 2020
17 Number of times Congress has passed a “doc fix” to the SGR
All these figures and more added up to some overarching themes from this year’s meeting sessions:
Strength in numbers is needed to make the voice of community cancer care heard on Capitol Hill. “At the end of the day, I think we need more clinical voices in the policy setting,” said keynote speaker Kavita Patel, MD, of the Brookings Institution. “You don’t want Medicare or Congress thinking about cancer care without [your voices being heard].”
Patient-centered care requires open communication. In Tuesday’s panel on “What Are the Costs and Where Is the Value in Cancer Care?” panelists agreed that discussion about value in cancer care is complex but must be patient-centered. “For patients, value has a number of different meanings,” said panelist Nancy Davenport-Ennis of the Patient Advocate Foundation. “Patients want to have open dialogue with physicians about what the options are and how they are going to pay for this [treatment].”
The need for good communication with patients was also part of an earlier panel discussion on Multidisciplinary Care in Oncology. Smaller hospitals and cancer programs trying to create multidisciplinary programs should first look to the relationship that needs to exist between patients and the team, said panelist Tom Kean, MPH, of C-Change. It’s important to ask: “What does the patient value?”
The future oncology care delivery structure & workforce will look different. Given the perfect storm brewing of escalating costs, a growing demand for oncology services, and a projected future shortage of oncologists, the way we deliver cancer care will have to change. Several presenters circled around the medical home (possibly in combination with some type of pay-for-performance) as potentially a good fit for oncology—in part because many cancer centers are already providing the services encompassed by this model. And several sessions touched on how the cancer care workforce will have to change to meet the projected demand. This new “care force” will not only include more non-physician providers, but also is likely to have non-clinical care providers and make increased use of community resources.
One shift that is already underway in some cancer programs is careful assessment of skill sets. Multidisciplinary Care in Oncology panelist Marie Garcia, RN, OCN, said, for example, her practice took a close look at the skill set needed to provide survivorship services. For their survivorship program was a nurse practitioner needed? Could the position be filled by a nurse? Or a patient navigator? “In a value-based world, you need everyone on the team performing at the top of their licenses,” said co-panelist Mark Soberman, MD, MBA, FACS.
We must be the change. Across sessions the recurrent message was that cancer providers need to be proactive. It’s fine to start small, but start now, assess ways to demonstrate value, explore new payment models, and work more collaboratively with payers, providers, and community resources.
With polarization on Capitol Hill impeding the legislative process, ACCC 40th Annual National Meeting keynote speaker Kavita Patel, MD, of the Brookings Institution told attendees: “If you are looking for change, I would point you to your own selves in the mirror, not to Washington, D.C.”
With the Senate having passed the SGR reform patch the night before, Patel noted that despite the fact that SGR reform was one of the few things with bi-cameral support in Congress, ultimately, we once again have a one-year “doc fix.” This is the 17th time Congress has enacted an SGR patch since the formula went into effect in 2002.
Still, Patel believes there is potential for Congress to act on long-term reform next year.
The current “SGR fix” legislation reflects Congress’s focus on “value” and value-based alternative payment models, she noted.
“At some point, it will be important for your community to think about what that would look like at your programs.” She believes medical oncology may be well suited to what Congress is thinking about with alternative payment models.
While cancer care has evolved so greatly over the past several decades, our reimbursement policies to pay for that care have not evolved.
Among the alternative payment models, Patel believes the medical home model may be suited to oncology, while bundling is a poor fit.
“If people think there’s going to be bundling in oncology, they are wrong,” she said.
So is fee for service gone forever? “No,” says Patel. “The answer is there is always going to be room for fee for service in certain settings.”
But, some form of risk-sharing is definitely in the cards. “In 10 to 15 years, the majority of people in this room will have some sort of risk-based contract…that will become the norm in the next several decades.”
However, she warned that if you turn to Congress for a solution, they are likely to turn it around and ask you to show them viable solutions—and this is a good thing.
At the end of the day, I think we need more clinical voices in the policy setting arena, “ she said. “You don’t want Medicare or Congress thinking about cancer care without [our] voices.”
by Amanda Patton, Manager, Communications, ACCC
More than 50 ACCC members from 27 states were walking the halls of Congress on March 31 for ACCC’s Capitol Hill Day. With the Senate poised to vote on the SGR patch legislation, the timing was perfect for talking with elected officials about the need for a permanent fix to the sustainable growth rate.
Participants were scheduled for more than 100 visits with House and Senate offices throughout the day.
From first-time meeting attendees to veteran hill day participants, the consensus was that the time spent meeting with elected officials was well worth the effort.
The day was “extremely educational,” said new ACCC member Cindy Krasnecky, director of the cancer center at Harrington Memorial Hospital in Southbridge, Massachusetts. “I was impressed by the level of knowledge and experience of the [Hill] staffers.”
ACCC members focused on four main concerns in their conversations with Hill staff:
- Finding a permanent solution to the flawed SGR formula
- Passing oral parity legislation
- Removing anti-cancer drugs from the Medicare sequester
- Eliminating the prompt pay discount.
“It felt empowering to have your voice actually heard by someone setting policy,” said Angela Tambini of the Lahey Clinic in Massachusetts.
Anecdotally, we heard frustration in many congressional offices over the status of SGR reform and disappointment with an inability to effect more sweeping change.
At the end of the day on Monday, the Senate passed a bill to extend Medicare physician pay rates through March 15, 2015. The legislation will also delay ICD-10 implementation until 2015.
According to BNA Bloomberg this marks the 17th time Congress has acted to prevent scheduled reimbursement cuts due to the SGR since the formula went into effect in 2002.
By Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC
ACCC’s Capitol Hill Day on March 31 is just around the corner. ACCCBuzz is featuring a primer series on the key issues ACCC members will be talking about on Capitol Hill. In this final of four installments, we’ll look at the need to pass legislation to fix the prompt pay discount.
The issue: Many drug manufacturers offer a 2% incentive for distributors who pay promptly. However, this 2% discount is not generally passed on to providers. Medicare includes this discount in its calculation of average sales price (ASP), a key component in the Medicare reimbursement formula. Although Congress intends for Medicare Part B to reimburse providers at ASP +6%, the prompt pay discount artificially reduces payments to ASP+ 4%. When you take into account the additional reduction on all drugs and services billed to Medicare due to the sequester, providers are actually seeing reimbursement closer to ASP +2.3%. That’s a long way from the congressionally intended ASP+6%.
Legislation introduced by Congressman Ed Whitfield (HR 800) would change how ASP is calculated by eliminating the prompt pay discount from the Medicare Part B reimbursement formula. Those of you coming to Washington, D.C., on March 31st for ACCC’s Hill Day will have a chance to explain why this legislation matters in person.
ACCC members who cannot make the trip to D.C. next week can still express support for the elimination of the prompt pay discount and ask Congress to pass HR 800. Visit ACCC’s Legislation Action Center to find out how.
by Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC
ACCC’s Capitol Hill Day on March 31 is less than one week away. ACCCBuzz is featuring a primer series on the key issues ACCC members will be talking about on Capitol Hill. In this third of four installments, we’ll look at the need to pass federal oral parity legislation.
By now you know the issue: oral parity legislation is needed to ensure that patients can afford their oral anti-cancer medications. And you have probably already heard that 29 states have passed oral parity laws requiring insurance companies to cover oral chemotherapies at the same rate they already cover IV-infused medications. Considering that more than half of the states have passed oral parity laws, and that number continues to grow, why is oral parity an advocacy issue for ACCC’s federal Hill Day?
Even though state laws are currently being passed, federal legislation is still required for two important reasons:
- Language of the laws varies across the states and only federal legislation will ensure the same protections for all patients; and
- State laws only impact state-regulated plans. Federal legislation is needed to cover self-insured plans (ERISA).
Currently, there are bills in both chambers of Congress, just waiting for ACCC advocates to push them forward. HR 1801 in the House has 71 cosponsors, while the newer S 1879 in the Senate only has one cosponsor. ACCC members, please speak up for this important legislation.
Those of you coming to Washington, D.C., on March 31st for ACCC’s Hill Day will have a chance to explain why this legislation matters in person.
ACCC members who cannot make the trip to D.C. next week can still express support for federal oral parity legislation and ask Congress to pass HR 1801 and S 1879. Visit ACCC’s Legislation Action Center to find out how.
by Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC
Just 12 days remain until ACCC’s Capitol Hill Day on March 31. ACCCBuzz is featuring a primer series on the key issues ACCC members will be talking about when they visit their elected officials. In this second of four installments, we’ll look at the sequester and legislation to exempt cancer drugs from the cuts.
As you already know, the sequester was put into effect as a result of failed debt negotiations in Congress in 2011. Initially, the sequester was designed to impact all domestic spending equally for 10 years. However, through the budget deal at the end of 2013, pre-sequester funding was restored to some federal agencies, while being extended for other programs. Medicare was one of those unfortunate programs. Instead of ending in 2021, the 2% across-the-board sequester on Medicare has been extended through 2023.
Considering this extension, ACCC has shifted focus from eliminating the sequester altogether to exempting cancer drugs specifically. There is currently a bill in the House that would leave the sequester intact for all items billed to Medicare except for cancer drugs. Because of the high fixed costs of cancer drugs, the sequester disproportionately impacts oncology. However, HR 1416, with 110 bipartisan cosponsors, would help level the playing field between oncology and other specialties.
By Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC
As we count down the days until ACCC’s Capitol Hill Day on March 31, ACCCBuzz will feature a primer series on the key issues ACCC members will be talking about. In this first of four installments, we’ll look at SGR repeal and replacement.
Due to the flawed sustainable growth rate (SGR) formula that determines Medicare reimbursement, each year physicians face reimbursement uncertainty. Each year, Congress has been forced to step in with a “doc fix” to prevent enormous pay cuts for providers.
We’ve been following the progress on SGR reform in ACCCBuzz.
As you know, there’s been much discussion on how best to fix the SGR. Should there be a time-limited pay freeze vs. annual updates? Which quality metrics should be used? Should the new policy develop over five years or ten? At last Congress is showing some consensus around the policy discussion, while still grappling with the question of how to pay for a fix. Companion legislation in the House (HR 4015) and Senate (S 2000) is now moving forward and includes the following reforms:
Predictable Payment Updates—Under these bills, a positive 0.5% for fee-for-service update would be implemented for 2014–2018. The 2018 Medicare reimbursement rate would then remain in place through 2023. Starting in 2024, provider reimbursement could increase by 1% for those participating in alternative payment models, while remaining at 0.5% for those not participating.
Reimbursement Tied to Quality—The proposed legislation would consolidate the three Medicare incentive/penalty programs –Physician Quality Reporting System (PQRS), the Value-Based Modifier (VBM), and Meaningful Use of electronic health records (EHR MU)—into one streamlined program, the Merit-Based Incentive Payment System (MIPS). The MIPS will evaluate providers based on quality, resource utilization, EHR meaningful use, and clinical improvement activities. Although specific measures would be established through CMS rulemaking, positive or negative payment adjustments would be made to providers using a composite score compared to a performance threshold. Negative adjustments will be capped at 4% in 2018, 5% in 2019, 7% in 2020, and 9% in 2021.
Providers who receive a significant portion of their revenues through alternative payment models (APMs) involving risk of financial loss and with a quality measurement component would receive a 5% bonus each year 2018–2023. Importantly, the legislation encourages CMS to test APMs relevant to specialty professionals, like oncology.
Additionally, at least one new payment code will be created for care management services provided to patients with chronic conditions.
Each year CMS would propose a plan for establishing the quality measures to be used in the MIPS and APM programs. Annual funding of $15 million would be allocated for the development of such measures, and stakeholders would be able to submit comments to CMS’s proposed plans.
Physician-Specific Data Would be Made Public—Starting in 2015, CMS would publish utilization and payment data for providers on the Physician Compare website, including information on the most commonly provided services and the submitted charges for those services. Providers would have the opportunity to review and correct inaccurate data.
Potentially Misvalued Codes—As ACCC has noted previously, identification of potentially misvalued codes remains in the SGR repeal legislation. The current goal is 0.5% of fee schedule expenditures to be slated for identification of misvalued services each year in 2015–2018.
Although the current legislation reflects much consolidation on SGR reform, much work remains in identifying $126 billion in offsets to pay for this fix. The current “doc fix” runs out at the end of March. On Capitol Hill Day ACCC members will be walking the halls of Congress, urging members from the House and Senate to work together to pass this reform and permanently replace the SGR with responsible policy that emphasizes value over volume.
Join us for ACCC’s Capitol Hill Day and help educate your representatives about the importance of SGR reform.
Stay tuned to the rest of this blog series for a deep dive into the issues ACCC members will be talking about on Capitol Hill: Exempt cancer drugs from the 2% Medicare sequester, create equity in out-of-pocket expenses for oral and IV-infused therapies, and eliminate of the prompt pay discount. See you on the Hill!
By Sydney Abbott, JD, Manager, Provider Economics and Public Policy, ACCC
In a recent blog, we raised concerns about the slippery slope of CMS’s proposed sweeping changes to the Medicare Part D Program, including a proposal to eliminate at least two of the six protected classes of drugs. ACCC submitted comments, coalesced with 371 organizations to send a letter urging withdrawal of the proposal, and supported the Senate Finance Committee’s request to avoid changes to this already successful program.
ACCC is proud to announce that, thanks to the voices of our members and the work of related organizations, CMS Administrator Marilyn Tavenner has announced that the agency will not be moving forward with four of the proposed changes to the Part D Program, including the proposal related to the “protected classes” definition of three drug classes.
On behalf of Medicare beneficiaries, we thank Administrator Tavenner for this sound decision.