National Oncology Conference—Keep the Conversation Going

Featured speaker Peter Bach, MD, MAPP, delivers the opening presentation of the ACCC National Oncology Conference.

By Amanda Patton, ACCC, Communications

From the opening presentation by featured speaker Peter Bach, MD, MAPP, to the final sessions focused on cancer survivors and the workplace and providing survivorship services on a shoestring budget—last week’s ACCC National Oncology Conference covered challenges large and small facing cancer programs and practices across the country.

Macro challenges—occurring at the health system and population health level—are well known to the oncology community. Among these are the high cost of cancer drugs and new therapies, the transformative shift in payment from volume to value, workforce shortages, reimbursement constraints, and the many issues tied to ever-increasing demands for data collection and reporting.

Micro challenges—occurring at the service line and individual provider and patient level—range from adapting delivery infrastructures to meet the evolving treatment landscape, to determining  metrics to track and how to best to communicate these to leadership, to ensuring patient access to supportive care services that remain unreimbursed, to fostering a holistic, patient-centric culture of care.

Common themes across conference sessions and conversations: Collaboration, integration, evidence-based medicine, and value.  Five key takeaways from the conference:

Cancer programs and providers must collaborate outside the box and across the care continuum.
Attendees heard first-hand from programs that are already making this work—from implementing virtual tumor boards, to engaging primary care physicians in survivorship care, to collaborating across disciplines to provide cancer prehabilitation services, and more.

There are formal & informal operational pathways to create integrated delivery networks with stakeholders for quality patient care.
Panelists in the Advancing Quality Care session agreed: to achieve a truly integrated delivery network transparency and trust between all partners is needed.

Oncology programs are increasingly turning to dynamic dashboards to demonstrate value to payers and patients.
Solutions and tools may exist outside the oncology service line. Reach out to the data analytics team or business intelligence team within your organization. Take advantage of or adapt existing resources and tools.

From personalized medicine to immuno-oncology, cancer treatment is undergoing a transformative shift.
For both providers and the patients they serve, the value proposition presented by genomic medicine is that it allows clinicians to make better therapeutic decisions.

Patients are key stakeholders in healthcare integration efforts.
“Successful integration will depend on aligned patient-centered care, patient-focused care, and patient engagement,” said ACCC President Elect Jennie Crews, MD, in the panel discussion on Advancing Quality Care.  Panelists touched on the findings included in a new ACCC white paper released at the National Oncology Conference that outlines forward-looking essential steps to ensure quality patient care in the increasingly integrated healthcare environment.

ACCC encourages members to keep the conversation going by sharing your key conference takeaways in our members-only online community ACCCExchange.

Save the date and join us in Washington, D.C., March 2-4 for the ACCC Annual Meeting: CancerScape 2016.

National Oncology Conference: Framing Issues & Finding Answers

ACCC President Steven D’Amato, BSPharm, BCOP, welcomes attendees to National Oncology Conference

by Amanda Patton, ACCC, Communications

Featured speaker Peter Bach, MD, MAPP, addressed a packed room in the opening session of the ACCC National Oncology Conference on Oct. 22, in Portland, Oregon.  Dr. Bach is Director, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center.

Dr. Bach’s remarks centered on four prime issues challenging oncology today: the cost of cancer drugs, the need for oncology to do a better job on comparative outcomes research, the 340B drug pricing program, and the importance of incorporating end-of-life care into cancer program services.

Finding a rational way to address drug costs matters on both the macro level [in terms of the impact of healthcare costs nationally] and on the micro level at point of care when “drugs are being left at the pharmacy counter because patients can’t afford the copay,” he said.

 

Conference sessions throughout the day focused on challenges and innovative solutions that can have powerful micro- and macro-level impacts on cancer programs and providers, and the patients they serve: From “how to” sessions on benchmarking salaries, applying lean principles for staffing, establishing a virtual tumor board, distress screening, and preparing for alternative payment models, and more, to a big picture session on Advancing Quality—from Oncology Medical Homes to Integrated Delivery.  One cross-cutting takeaway message: work across disciplines and siloes—think about how to collaborate outside the box and across the care continuum.

Stay tuned for more conference highlights. Follow conference on Twitter at #ACCCNOC.

Predictions for Cancer Care in 2014

By Matt Farber, MA, Director, Provider Economics and Public Policy, ACCC

To celebrate the New Year in 2012, I wrote a forward-looking blog with month by month predictions of what would happen in Congress and with Medicare during the coming year, and how those changes would affect community cancer care. For 2013, I decided to put the crystal ball aside (although some of my predictions for 2012 were pretty spot on—click here to see how I did), and shared some New Year’s Resolutions focused on getting involved with grassroots activities to spotlight key issues facing oncology in 2013. This year, I can’t resist gazing into the crystal ball again and coming up with some predictions, although as always, I make no guarantees….

SGR Reform: Throughout 2013 the cost estimates for a permanent SGR fix continued to decrease, with the cost now standing at roughly $120-150 billion. Three congressional committees have introduced SGR-fix legislation, and two committees have passed their proposed legislation  with overwhelming support. Still, cost remains the sticking point, and the question of how Congress will pay for a long-term fix remains as yet unanswered. While I do not have any suggestions for that, I do believe Congress will act and pass a long-term SGR fix in 2014. Here’s why:

1. Universal support—Everyone in Congress hates the SGR, and would like this flawed formula to go away.
2. Similar bills—The  House and Senate versions of the SGR-fix legislation are very similar,  therefore there is less chance of disagreement between the chambers.
3. Low cost—$120 billion is still a lot of money, but given that the previous cost estimates were north of $300 billion, the current price tag of $120-$150 billion is a relative bargain.
4. Senator Baucus’s retirement—Senator Baucus (D-MT) will be leaving the Senate in 2014. Fixing the SGR has been a long-time goal for the Senator, so I think we will see a renewed push to get this done.

Sequestration: With the budget deal framework agreed to in December 2013, Congress is rolling back many of the scheduled cuts due to sequestration; however, the Medicare cuts are not included in those rollbacks. Therefore, the 2% reduction to Medicare payments, including drugs, will remain in place. In fact, Congress has even extended the sequester for two more years, so the Medicare cuts are now scheduled to run until 2023. In 2014, ACCC and other organizations will ramp up their efforts to have drugs removed from the sequester cuts by supporting HR 1416 and advocating for this bill to be attached to a larger legislative vehicle, such as the bill to extend the debt ceiling, which is slated for debate in February and March. In order for ACCC to succeed, we need our members to call their elected officials and let them know what the 2% reductions have meant to them and their patients. Congress needs to hear how these cuts are impacting all patients.

Oral Parity: The effort to pass oral parity legislation in every state continues in 2014, with more states taking up the issue. Many states, including Missouri and Michigan, will be carrying over their 2013 debate on this issue, and ACCC and its partners will be advocating for passage of this important legislation. The effort to pass oral parity on the national level took a giant step in the right direction with the introduction of a Senate companion bill (S. 1879) in December 2013. ACCC will work with its partners in the PEAC and SPEAC coalitions to further support these efforts.

Marketplaces: Open enrollment for the insurance marketplaces kicked off in late 2013, and in 2014 coverage under these plans will start. After a very bumpy rollout, patients who signed up for insurance will now have coverage through these plans. The concerns that ACCC has expressed regarding adequate coverage for cancer patients remain in 2014. Many of the plans offered through exchanges may require high out-of-pocket costs, or may leave certain physicians, treatments, or hospitals out of network. ACCC will continue to work with partners on projects such as the Cancer Insurance Checklist to help educate patients and providers on the best plans for cancer patients.

My final prediction is that 2014 will be an exciting year for the oncology community. ACCC will continue to provide resources to its members and to be their voice with lawmakers. This year, as every year, we need your help. Sign up to participate in our Capitol Hill Day on March 31, 2014, being held as part of the ACCC 40^th Annual National Meeting. Attend our spring regional meetings in Minneapolis, Salt Lake City, and Columbus to keep up to date on the latest trends in reimbursement and policy. And as always, if you have any questions, please contact me at mfarber@accc-cancer.org.

Senate Introduces Oral Parity Bill

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

On Thursday, December 19, 2013, Senators Al Franken (D-MN) and Mark Kirk (R-IL) introduced The Cancer Treatment Parity Act of 2013, a Senate companion bill to HR 1810, the House oral parity legislation.  This is great news because all bills must pass both the House and Senate before going to the President for signature. Now, with a version of oral parity legislation in each chamber, momentum on this issue is accelerating.

This is really just a case of technology outpacing policy. Private insurance companies create inequity by charging higher out-of-pocket rates for oral anti-cancer drugs picked up at the pharmacy than for drugs that are infused by a cancer care provider in the physician office setting. When patients receive an IV infusion, they are responsible for a co-pay, generally around $30.  However, when a physician prescribes an oral drug to be filled by the pharmacy, the patient is responsible for some percentage of the total drug cost—in the  case of oral chemotherapies, this can be thousands of dollars per month out of pocket. The proposed oral parity legislation would prohibit insurance companies from charging patients more than the IV-infused rate, no matter the form of administration.

While oral chemotherapies make up a small portion of the oncology drug market currently, that rate is increasing.  Some estimate that oral anti-cancer medications make up 30% or more of the oncology development pipeline.  This is why it is important to pass federal oral chemotherapy legislation now.  The Association of Community Cancer Centers will continue to be on the front line of this issue, and we will keep our members updated.

A Budget Deal Is On the Table—But Possible Sequester Extension Looms

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

The bipartisan Congressional Budget Conference Committee came to an agreement on the federal budget on Tuesday, which is now scheduled to be voted on by all of Congress on Friday.  The budget deal is not sweeping change, but it takes small steps towards compromise—something that has been eluding a gridlocked Congress for years. Some of the small steps include no new tax increases and a reconfiguration of part of the sequester that had significant impacts on domestic spending in 2013.

The good news: The deal funds the federal government through 2015. The bad news: Although it eliminates some of the cuts imposed by sequestration, the deal not only keeps the sequester in place for Medicare, it also proposes to extend the sequester for another two years. By doing this, the Conference Committee’s compromise budget would create about $28 billion in savings through 2023—just  by keeping the 2% across-the-board Medicare sequester in place for two years longer than originally called for in the Budget Control Act of 2011.  (The Budget Control Act was the law that enabled sequestration to be enacted when the bipartisan, bicameral debt “super committee” failed to agree on $1.2 trillion in savings.)

The possibility that the sequester may be prolonged is troubling news for community oncology, especially coming on the heels of newly released ACCC survey data showing the impact of sequestration on providers and their patients. This most recent survey of ACCC members shows that the sequester is affecting more cancer programs than initially thought, and is having an impact on all cancer patients.

But the struggle over the sequester is far from over. First, the budget must pass the House and Senate.  And even if it does, ACCC is still continuing to fight for legislation that would exempt cancer drugs specifically from the sequester, HR 1416.  This bill has gained much bipartisan support, and we will continue to work for the passage of this legislation.

All of this serves to underscore the importance of continued communication with members of Congress about how the sequester is affecting your cancer program and your patients. This is a developing issue so stay tuned for more information about the budget and other deals that are in the works for an upcoming congressional vote, like the SGR.