COC ADVOCACY TRACK Overview of National Oncology Issues &
Key COA Initiatives for 2015 Ted Okon Orlando, Florida April 23,
2015
Slide 2
Cancer care landscape continues to consolidate Bad news is
access-to-care issues and higher costs Created by a push and a pull
towards large hospital systems Community oncology practices the
real innovators in healthcare reform Enhancing the quality of
cancer care Making it more efficient and lowering costs COAs focus
in 2015 is two fold: Fix broken aspects of Medicare payment for
cancer care Help community oncology survive and prosper Advocating
for community cancer care more important than ever!!! One-Slide
Summary 2 2015 Community Oncology Alliance
Slide 3
Consolidation of Cancer Care 3 2015 Community Oncology Alliance
2014 2010
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Consolidation Trends 4 2015 Community Oncology Alliance
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Clinics closing in communities, especially rural areas Cancer
patients shut out of networks Consolidation in hospitals cost
patients and insurers (Medicare and private insurers) more
Access-to-Care Problems and Higher Costs 5 2015 Community Oncology
Alliance
Slide 6
Cancer Care Costs More in Hospital Clinics 6 2015 Community
Oncology Alliance Source: Comparing Episode of Cancer Care Costs in
Different Settings: An Actuarial Analysis of Patients Receiving
Chemotherapy, Milliman, August 2013 Study found significantly
higher per-episode cost for chemotherapy drugs, radiation oncology,
imaging (CT, MRI and PET scans) and laboratory services in
outpatient hospitals.
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Push and Pull Causing Consolidation 7 2015 Community Oncology
Alliance Push Declining payment for cancer care Administrative
Burdens: Doctors forced to do more paperwork than treat patients
Obstacles to Patient Care: Insurance company requirements Pull
Hospital Hardball Tactics: Cut off referrals to oncologists 340B
Drug Discount Program
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SGR formula way all doctors are paid by Medicare was just
eliminated One problem down! Specific way Medicare pays for cancer
care broken Prompt payment discounts from drug manufacturers to
drug wholesalers artificially lower payments for cancer drugs
Government budget sequestration further lowers payments for cancer
drugs Government requires more paperwork and reporting than ever
before Think IRS! Insurers lower the cost of cancer care by making
it harder to provide cancer care in the first place Push Problems 8
2015 Community Oncology Alliance
Slide 9
Cancer care has become very, very, very big business for
hospitals Did I say VERY BIG business for hospitals? They make a
lot of money, especially those hospitals eligible for 340B program
Close to 40% (and growing) of all hospitals Hospitals can get
cutthroat, especially by not sending any cancer patients to
community oncology practices Join us or go out of business! Pull
Problems 9 2015 Community Oncology Alliance
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340B Program Once obscure government drug discount program
intended to cover patients who cant pay from falling through the
treatment cracks Now a HUGE program that more are questioning if it
has lost its way in catching patients who cant pay HUGE financial
benefits to hospitals Up to 100% margins on cancer drugs and other
expensive therapies If average oncologist accounts for $4M in
drugs, hospital realizes up to $2M per oncologist Discounts dont go
back to patients 340B hospitals under no obligation to treat all
patients
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340B Program Growth
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Growth in 340B Program 30% CAGR Since 2005
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Some consolidation will keep happening Stronger practices will
survive Community oncology practices are way out in front of
healthcare reform Enhancing the quality of care Increasing
efficiency and decreasing costs Doing more than any other area of
medicine! Cancer is a disease that changes lives What is happening
to community oncology is life changing Future is uncertain but
there is blue sky! What Happens to Cancer Care? 13 2015 Community
Oncology Alliance
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Oncologists and Insurers Working Together 14 2015 Community
Oncology Alliance
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Major Summit on Paying for Cancer Care 15 2015 Community
Oncology Alliance Over 120 providers, insurers, and industry Panels
on new approaches to paying for cancer care Lots of cooperation and
sharing of ideas Eye opener for new insurers Everyone asking for
this to continue And thats what is happening this afternoon!
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Community Oncology Alliance16
Slide 17
Fight Medicare payment cuts to cancer drugs H.R. 696 and S. 506
to fix prompt pay problem H.R. 1416 to stop sequester cut to cancer
drug payment Fight for fix of 340B program Continue to build the
Oncology Medical Home Provide the highest quality care to patients
Increase treatment efficiencies and reduce costs Push for more
cancer care payment pilots Private insurers and Medicare Advocate,
advocate, and advocate some more for community cancer care!!! COA
2015 Agenda 17 2015 Community Oncology Alliance
