Community Oncology Alliance ()

Community Oncology Alliance (www.communityoncology.org)

Ohio Oncology Meeting

Healthcare Reform and the Impact on the Practice of Oncology

Ted Okon

Executive Director

November 9, 2009

Sandusky, Ohio


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Summary We will get health care reform legislation

It is not a pretty process but the president and his party faces Armageddon if it does not pass

Health care reform has the potential to fundamentally and severely change cancer care — like never before

There are immediate impacts as well as impacts “around the corner”

This is now all about the 2010 elections — Politics, politics, politics

It is essential that OHIO practices be as unified and involved as possible!!!


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Status of Reform Legislation House approved health care reform bill (220-215)

Passed by 3 votes — 39 Democrats voted against; 1 GOP for Kucinich & Boccieri only OH Dems voting “no”

The two Senate committees have passed bills Senate leadership is working on merging two bills Merged Senate bill may not come up for a vote till right

before/after Thanksgiving

Next Steps — Till Christmas (or beyond): Senate votes on its bill Conference Committee to merge Senate and House bills Vote on one final bill Send to the president for signing


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Beliefs Shaping the Debate The US healthcare system is more driven by profit

than patient best interests Physicians and hospitals over-diagnose/treat based

on churning revenue Care is uncoordinated Regional differences in cost/outcomes unacceptable Government’s role is to supervise/manage the health

care system Must read — The Cost Conundrum (The New Yorker) by

Gawande


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House Health Care Reform Legislation — H.R. 3962 1,990 pages of law; 400,000 words

Cost over $1 trillion

Increases coverage from 83% to 96% Provides subsidies in 2013 to extend coverage Mandates individuals to purchase coverage Bans insurers from denying coverage However, estimated penalties of $167 billion over 10 years to

individuals and businesses not purchasing insurance

Establishes insurance “exchanges” for individuals and small businesses Creates a government-run public plan Crackdown on insurer “unjustified premium increases” Eliminates insurers antitrust exemption


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House Health Care Reform Legislation (continued)

Expands Medicaid up to 150% of the FPL. Pushes Part B towards bundling of services, care coordination,

and greater empowerment of CMS to make payment changes How it is paid for:

$460 billion in new income taxes on individuals $400 billion in Medicare & Medicaid cuts $13 billion in limiting contributions to FSAs Industry fees and other taxes


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Lessons from H.R. 3962 “Do or Die” for Democrats to pass health care reform Big issues of contention:

Public plan Abortion Illegal immigrant health care coverage

Pelosi last minute deal on abortion sealed the vote Pro-abortion did not block the vote but livid

Democrat “no votes” came from moderate-conservative districts — 2010 most vulnerable list This was in reaction to Tuesday night and a preview of 2010

Sets up “Who will blink?” scenario in the Senate and House — moderates or liberals?


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Senate Bill — Best Guess Not yet finalized but indications of how it will differ from House bill Almost everyone must obtain coverage through employer, on their own, or

through the government Employers not required to provide insurance but business with 50+ employees

must pay a fee if government subsidizes Tax credits for certain individuals and small businesses No denial of coverage Creates state/regional co-ops and public plan (???) Initiatives to fundamentally transform the Part B payment system

Initiatives to bundle care and force coordination Providers with top 10% highest costs docked a 5% penalty Greater Medicare control in independent (?) entity

Paid for by taxes and fees Individuals who do not purchase insurance Premium insurance plans Insurance companies, drug companies, and device manufacturers


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Public Plan — The Great Debate Government needs to offer a “public” insurance plan

Concept is to provide a low cost option that will keep private insurers honest

• Will act as a magnet forcing private insurers to decrease costs in order to compete

• Accordingly, will force insurers to lower provider payments Liberals want a “strong” public plan based on Medicare

rates +5% This will eventually lead to government control or simply a

one-payer system Moderates want a public plan where HHS negotiates rates

with providers… or no plan at all Topic of great debate in the House and Senate


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The “Doc Fix” — Political Hot Potato Senate attempted to pull the “doc fix” out of health

care reform Voted on S. 1776 to zero out the 21.5% cut and repeal

the SGR (but no replacement) 53-47 vote could not overcome a filibuster

House has taken the same approach — H.R. 3961 Update for 2010 would be % increase in the MEI In 2011, creates separate growth rates and conversion

factors for E&M/Preventive Services and all other services

Would only include MD services in the growth rates Cost of $210 billion over 10 years


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Impacts on Oncology Current Impacts

2010 Medicare Physician Fee Schedule• Cuts to drug administration, consult codes, and imaging

Audits and changing payment rules “Around the Corner” Impacts

Greater risk sharing on oncology providers Payments based on the oncologist reducing costs Making the primary care physician the medical home Making oncology providers a spoke in accountable care

organizations (ACOs) Government coming between the oncologist and the patient Stripping services such as imaging out of the practice


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2010 Medicare Physician Fee Schedule Averted severe cuts in 2010 but cuts phased in over 4

years Drug administration payments cut 5% in 2010; 19% by 2013 Elimination of consultation codes — 1% cut in 2010 E&M payments increased by 5% in 2010

Payment reductions to diagnostic imaging 38% phased in over 4 years

Averted major payment reductions to therapeutic radiation Overall 21.5% cut in all physician services payments unless

Congress acts Even then, fixing this may likely reduce drug administration

payments


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Do Not Minimize These RAC audits MIC audits Changes to “incident to” rule restricting use of non-

physician services Comparative Effectiveness Research Additional imaging cuts/restrictions — the next AWP?


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Drivers of Oncology Impacts Fundamental lack of understanding of what is involved in

providing cancer care A belief that specialists drive up the cost of care so put

PCPs in the driver seat — medical home, gatekeeper, etc. Integrated medical practices are driven by profits versus

patient quality of care and convenience Take special note, if you have in-house imaging and

radiation Rapidly escalating costs of cancer care are excessive Focus on costs rather than quality, outcomes by policy

makers Policy makers with little/no experience in medicine


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What Oncology Needs to Do Educate policy markers on the complexity and trends

in cancer care Provide objective data Provide success stories

Provide solutions in leading, rather than be led by policy makers

Fight reimbursement cuts in order to keep the cancer care delivery system viable

Generate more positive press Become more politically engaged and active!!!


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COA Position US has the best documented cancer care in the

world*

We are in the first stage of crisis due to reimbursement cuts

We are entering the second stage of crisis as we lose oncologists to demand By 2020, short an oncologist for every 1 in 4 cancer

patients Healthcare reform has to correct the problems, not

exacerbate them As President Obama says, “Fix what is broken and build

on what works”Source: US Cancer Care Is Number One, National Center for Policy Analysis, Brief Analysis No. 596, October 11, 2007.


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What COA is Doing Providing data and educating policy makers

Components of Care and Oral Oncolytics Studies

Providing legislative solutions H.R. 3675 and H.R. 1392/S. 1221

Fighting Medicare cuts with data and political support Creating greater information sharing and unity

among practices Generating more positive and illuminating press/PR Making community oncology stronger politically


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Collecting Data Components of Care Study

Created a committee comprised of all functional disciplines within community oncology

Identified the clinical and operational components of delivering cancer care

Fielded a survey to quantify the components of care Preliminary results:

• Medicare only covers 55% of cancer care costs

Oral Oncolytics Study Identified barriers to use of oral cancer agents Shaping policy in concert with care delivery


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Educating Over 300 meetings with congressional members and

staff Hill Education Series on Cancer Care

First initiative was Off Label Cancer Drug Use & Compendia in conjunction with ACCC and US Oncology

Next is Components of Care & Medicare Fee Schedule • Inviting all House legislative and health staff• November 18th

Ongoing outreach to CMS/HHS, MedPAC, and others


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Oncology Legislative Solutions H.R. 3675 — National Quality Cancer Care Demonstration

Project Act of 2009 National demonstration program on treatment planning and

follow-up care planning Developed by a task force of practicing medical oncologists Open to all oncology nationwide Provides $300 million in annual funding Summary provision is in Senate Finance bill

H.R. 1392/S. 1221 (Prompt pay solution bill) Important for any payment system based on ASP Adds 2% back to drug reimbursement based on ASP Defense against additional drug reimbursement cuts Provision was in House Energy & Commerce bill


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Fighting Medicare Cuts Congressional staff arranged HHS/CMS meeting for

oncology practice administrators 15 administrators presented data and stories,

highlighting impact on patients and their care Outreach to the White House on the impact of

planned Medicare cuts Letters from Representatives and Senators to HHS

Secretary to forestall implementation of Medicare payment cuts 113 Representatives signed onto one letter to HHS

Secretary


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House Letter to HHS Secretary


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Information Sharing and Unifying Oncology COA website at www.communityoncology.org

News, education, resources, and action items COA Administrators’ Network

Run by and for oncology practice administrators

Goals of networking practices and enhancing information sharing

A unified oncology is a stronger oncology!

Need a state representative from MO!!!


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Oncology Public Relations Articles in major papers — NYT, WSJ, WP

WSJ War on Specialists OpEds by oncologists in papers around the country TV stories/appearances — FOX, local outlets OncologySTAT policy updates Social networking

COA YouTube Channel COA on Facebook OncologyCOA, TedOkonCOA, PatrickCobbCOA


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Increased Political Action

Source: Center for Responsive Politics


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What Ohio Can Do NOW Pull Ohio together in one massive outreach to the

congressional delegation — House and Senate Call attention to the Medicare cuts Outreach to House members/staff on 11/18 Hill briefing Follow-up after briefing

Specific unified outreach to Senator Brown on cuts and prompt pay issue

Come to DC as a group for Hill visits Reach out to your media — OpEds, letters, interviews Oncologists and clinical providers… Help us to develop

proactive solutions for oncology Administrators… get involved with your fellow administrators

through CAN Help build the political clout of oncology through COA PAC


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Support COA Become involved with COA — individually and

practice Contribute to COA!!!

• Funds go towards advocacy, studies, and public relations Contribute to COA PAC!!!

• Oncology needs to strengthen politically Join a COA working committee Join the Administrators’ Network team

Help bring community oncology together


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Thank you!Ted [email protected] (cell)www.communityoncology.org

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