Capitol Hill Update: HR 2869–Medicare Patient Access to Treatment Act

Posted in ACCC News, Advocacy, Healthcare Reform by ACCCBuzz on August 5, 2013

By Sydney Abbott, JD, Manager, Provider Economics and Public Policy, ACCC

U.S. Capitol The Medicare Patient Access to Cancer Treatment Act of 2013, HR 2869, was recently introduced by Representative Mike Rogers (R-MI).  The bill would equalize Medicare payments between the hospital outpatient department (HOPD) and the physician office setting for chemotherapy administration.  Because the legislation calls for budget neutrality, the bill proposes to increase physician office setting reimbursement while decreasing the hospital outpatient department payments. The legislation leaves the mechanics of reimbursement equalization to the Secretary of Health and Human Services.

HR 2869 is largely based on the findings of studies showing care is increasingly provided in the HOPD as a result of hospitals purchasing physician practices.  The legislation cites the savings of the 340B Program and Medicare bad debt reimbursement to hospitals as reasons why payment should be the same between the settings.  However, the bill does not address the other costs hospitals incur that are not present in the physician office setting, such as higher overhead or the fact that hospitals often treat patients who require more complex services than are available in the physician office setting.  ACCC is working with Representatives Mike Rogers (sponsor) and Doris Matsui (D-CA) (original co-sponsor) to educate them on the full implications of this legislation.

HR 2869 is co-sponsored by Representatives Doris Matsui (D-CA) and Trey Radel (R-FL).  It has been assigned to the House Energy & Commerce and Ways & Means Committees for further review.  ACCC will continue to follow this legislation closely and will update members on any developments.

6 Responses

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  1. MrsT said, on August 7, 2013 at 3:30 pm

    This bill doesn’t take into account all the additional regulatory requirements in a hospital setting that add to resource utilization. Just the Joint Comission requirements alone add increased time and resources (full nursing H&P, nursing care plans, TB screening, fall risk screening, domestic violence screening, bar coding, and on and on just to get though the door)

    • Sydney Abbott said, on August 8, 2013 at 9:39 am

      Thank you for your comment. This is the kind of information ACCC is using to further educate the bill’s sponsors and other members of Congress.

  2. Robert D. Orzechowski said, on August 7, 2013 at 6:36 pm

    The bill indeed has several flaws. It also ignores hospitals’ extensive use of volunteer labor, significant access to capital and wealthy donors to add to infrastructure while competing with private practices, paying significantly more for physician and nursing labor, and paying executives more than private practice physicians earn. Just examine Guidestar website.
    That said, I’m unconvinced that this particular Bill will solve anything. Curent reimbursement models for both types of entities are flawed.
    Most importantly, we must guard against allowing the issue to take our eye off the mission of caring for patients.
    Bob O.

    • Sydney Abbott said, on August 8, 2013 at 9:45 am

      Thank you for your comment. You hit the nail on the head – we only want legislation that will encourage improved care for patients. If you feel strongly about this bill, I encourage you to contact your Representatives.

  3. Terry Cook said, on August 9, 2013 at 10:23 am

    Please keep in mind that not all hospitals receive 340B status.

  4. Ronald Barkley said, on August 9, 2013 at 11:00 am

    Health Reform – the Affordable Care Act (ACA) – challenges us all to think innovation in care process re-design, asset re-deployment and care management across the continuum of care with an objective of reduction in the cancer “spend.” Oncologist-hospital alignment, such as service line consolidation co-management and clinical integration are fundamental to achieving such objectives. Given our current volume-based fee-for-service environment, such oncology alignment relationships frequently result in short term economic aberrations, such as site-of-care reimbursement differentials. We should caution against “knee-jerk” legislation aimed at short term reimbursement “fixes” that might undercut the very service consolidation/clinical integration that opens the door among providers to rationalize care processes, begin to understand true operating costs (as opposed to a claims history definition of “cost”) and prepare for the real target, which is the convening of risk among oncology/cancer care providers in the form of bundled/episodic payments and/or sub-capitation of cancer care services. Ron Barkley, MS, JD.

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