Year in Preview: Oncology Care 2012
by Matt Farber, Director of Provider Economics and Public Policy, ACCC
Now that a tumultuous 2011 is history, let’s look ahead to 2012 and all that the new year may bring to the oncology community. Overall, 2012 shapes up to be exciting–from the sustainable growth rate (SGR) fix (again) to the Supreme Court ruling on the constitutionality of the Affordable Care Act’s individual mandate to the implementation of Accountable Care Organization Rules (ACOs) and state exchanges to the Presidential election.
Here’s my Year in Preview, a glimpse into the future–with apologies to Washington Post writer Dave Barry (“Year in Review 2011”).
• A cold wind blows into Washington, D.C., when Congress returns from its winter recess. Just a few things remain on its legislative plate from 2011. First up, we hope, will be the SGR fix. My prediction: much discussion throughout the month, but ultimately, no action until February.
• The first accountable care organizations (ACOs) will start up as part of the CMS Pioneer Demo program. Thirty-two programs from across the country were selected to participate. Programs that would like to sign up for the regular ACO model can do so now with start dates in April and July.
• Cancer program leaders will gather for ACCC’s 7th Annual Hospital Summit. I predict that participants who gather in Orlando will leave with strategies to lead their cancer programs to fiscal fitness and ways to deal with a number of new and revised Commission on Cancer standards, including public reporting, new requirements for quality studies, and new responsibilities for the cancer liaison physician.
• Congress is faced with a February 29th deadline to fix the SGR before a 27 percent cut takes effect. My hope is that the extra (leap) day this month will allow legislators to put a deal together. Both parties would like to repeal the SGR, or provide a long-term fix; but cost is the issue. I expect to see another short-term fix. Two years may even be a bit optimistic, with a fix through 2012 more likely.
• I see a new acronym: HOP, the Hospital Outpatient Payment (HOP) Panel, which rises as the Ambulatory Payment Classification (APC) Panel sets. CMS has renamed and expanded the advisory panel to deal with supervision issues in the outpatient department. Since there are never any questions about supervision levels in oncology care, I am sure this will not be an issue ACCC will track.
• The federal government argues before the Supreme Court that the individual mandate of the Affordable Care Act is indeed constitutional. The Supreme Court will likely take a few months to release its ruling, but March is sure to make for an exciting time in the healthcare reform arena.
• The community oncology meeting season roars in like a lion. The most important meeting: ACCC’s 38th Annual National Meeting, March 12-14 in Baltimore, Maryland, which explores solutions to the oncology drug shortage crisis, new trends in cancer reimbursement and care , the Commission on Cancer standards, and the range of choices hospitals face in employing physician practices.
• Now that the Supreme Court has argued the merits of the Affordable Care Act, Congress renews its own debate on the Act. Despite heated confrontations and with no likely actionable outcomes, the Affordable Care Act moves forward. (ACCC has an overview of the ACA rules and their effect on oncology.)
• Programs that have been approved by CMS as ACOs start reporting benchmarks and attempting to achieve shared savings.
• States across the country continue to develop their exchanges. Much of the key aspects of state exchanges have been left up to the states to decide, such as how they may participate, what must be covered, and what to do with plans across states.
• Tensions in Washington, D.C., calm as Congress takes its recess in observance of the Easter and Passover holidays.
• The crystal ball is cloudy, but it’s possible the Supreme Court makes its decision on the Affordable Care Act in late May, but the decision also may not come until June. Many believe that, beyond the policy implications of the ruling, the decision will also have a major impact on the Presidential election in November.
• Legislative action heats up in many states as state legislatures finish their sessions in April and May. Issues affecting cancer care are debated in state capitols across the country, ranging from coverage of mammography to oral parity to the use to off-label therapy to the regulation of pain medication. (By the way, getting involved on the local level can be very important on these issues, as state officials often rely on the stories from their constituents to make decisions.)
• May will also mark the first ACCC Regional Economic and Management meeting for 2012. Check back on the website for location and agenda details.
• Excitement builds about new therapies in the oncology community thanks to the American Society of Clinical Oncology Annual Meeting the first weekend in June. As new therapies come on to the market, many questions may remain beyond the clinical utility of a therapy:
1. Will the drug be covered?
2. What is the patient responsibility?
3. Is the drug an oral or an injectable?
4. Will it only be available on a limited distribution network?
5. Will it be included on my hospital formulary if we are a participating ACO?
ACCC continues work to provide answers to these questions, helping to ensure that our members can have access to innovative therapies.
• The second and third ACCC Regional Oncology Economic and Management Meetings of 2012 get underway.
• Although the 4th of July brings fun and festivities on the home front, no such joy awaits for healthcare reimbursement policy. Each year, on the day before July 4th (or thereabout) CMS releases its proposed rules for the following years for the Hospital Outpatient Prospective Payment System (HOPPS) and the Physician Fee Schedule (PFS). With Congress on a week break for the holiday, ACCC is busy reading the hundreds of pages of proposed rules for the following year and writing a summary of the rules for members both on the website and in conference calls.
• Hopefully Congress will have passed a long-term fix of the SGR earlier this year, but if not, we may be dealing with 3-6 month fixes that come up every so often as well.
• ACOs approved by CMS can start reporting.
• Washington, D.C., is very hot and humid. Smartly, Congress takes a month long recess. However, ACCC is working diligently to draft and submit comments to CMS on the proposed HOPPS and PFS rules.
• Most likely the second meeting of the HOP Panel takes place. Here, ACCC will probably testify on issues in the proposed HOPPS rule that we are concerned with. (Recently, the testimony revolved around the issue of declining reimbursement for drugs and pharmacy overhead services. Despite the increased costs associated with drug shortages and with REMS, or Risk Evaluation and Mitigation Strategies, overhead reimbursement has continually declined, despite efforts of ACCC and other organizations.)
• We’re in to the closing stretch of the current Congressional session and the Presidential election of 2012. Congress has a number of bills it must pass in September, as the government’s fiscal year ends September 30th, which means that appropriations, or spending bills, must be approved by the end of the month. If this doesn’t happen, Congress is forced to pass continuing resolutions to keep the government operating for months at a time. Given the uncertainty around the spending bills, FDA PDUFA (Prescription Drug User Fee Act) reauthorization, the SGR fix, the status of the Affordable Care Act, and the possible repeal of the trigger, expect more continuing resolutions from Congress.
• October will play host to ACCC’s 29th National Oncology Conference in San Antonio, Texas, from October 3-6th. We will continue to recognize ACCC innovators with our second annual Innovator Award presentations. In 2011, 14 innovators received recognition.
• Watch out. October brings advertisements on TV and radio associated with a political candidate. The election is just a month away and if 2008 and 2010 are any indications, a lot of money is going to be spent on trying to convince voters who to vote for.
• Don’t be spooked if just before Halloween, CMS releases the final 2013 HOPPS and PFS rules. (CMS likes to release major rules right before holidays!)
• Finally, the Election arrives on the 2nd Tuesday after the first Monday (or November 6th, if you don’t want to look at a calendar). Okay, now that this event is over, let’s get back to the work at hand.
• ACCC will host a conference call for its members on the final 2013 rules in mid-November.
• The 4th ACCC Regional Oncology Economic and Management Meeting of the year. Locations are yet to be determined, but let us know if you have any suggestions. (My vote is for Hawaii!)
• Congress will be in recess at the end of the month for the Thanksgiving holiday. (I feel like I have said Congress will be in recess pretty often. Here is the official House of Representatives calendar for the year.)
• Congress is slated to be in session only for the first two weeks of December. This year as in the past legislators may have to delay their holiday break to deal with “must-pass” legislation such as the SGR (hopefully not), expiring tax breaks, and spending bills. But wait. Congress will be in what is called a “lame duck” session, which means that those Representatives and Senators who have been voted out of office will no longer have a future in Congress to look forward to. This change in status may lead to unpredictable votes, as members reassess their positions on important bills.
• December will also likely see the final two Regional Oncology Economic and Management Meetings of the year for ACCC. We hope to see you at one this year.
A deadline looms. Because the Super Committee failed in its efforts to find $1.2 trillion in cuts in 2011, an automatic trigger will go into effect in January 2013, unless Congress steps in to stop it. Many Congressmen have already stated a desire to do just that, even though the President has stated he would veto any effort to halt the trigger. Without Congressional action, Medicare will face a 2 percent across the board reduction in payments.
The year ends as it began with a cold wind.