Oklahoma Oncology Meeting

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Oklahoma Oncology Meeting

• Health Care Reform Legislation Update from
  Capitol Hill
• Present and Future Impact on Oncology Practices
• Ted Okon
• Executive Director
• August 18, 2009
• Tulsa, Oklahoma

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Summary

• We will get health care reform legislation
• It is not a pretty process but dont bet against
  it
• Health care reform has the potential to
  fundamentally and severely change cancer care
  delivery and reimbursement like never before
• Emotions will run very hot on reform through
  August and reach a fever pitch in September
• There are many other pressures facing oncology
  outside the arena of health care reform be
  aware of these
• It is essential that all in oncology be involved
  in reaching out to Congress NOW!

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Status of Reform Legislation

• The three House committees have all passed bills.
• The next step is to merge the bills into one
• The Senate HELP Committee has passed legislation
• The all-important Senate Finance Committee has
  not yet produced a draft
• Next Steps September October
• House returns after Labor Day to merge bills and
  vote on one bill
• Senate returns to produce a Finance bill and pass
  it
• Merge two Senate bills and pass one bill
• Merge House and Senate bills and pass it in both
  bodies
• President signs bill into law

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What is Health Care Reform?

• Extending health insurance to the 48 million
  uninsured Americans
• Bringing down the cost of health care
• Make health insurance more affordable for all
• Decrease the costs of providing health care
• Changing how health care is financed/reimbursed
• Push the payment system from quantity-driven,
  fee-for-service to quality-driven,
  pay-for-results
• Push providers together to coordinate care
• Eliminate geographic differences
• Helping providers make more informed medical
  decisions
• Noticeably missing is major tort reform

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Issues Debated

• How much control should the government have over
  healthcare?
• Far left total control one-payer system
• Left enough control to drive down costs public
  plan
• Center enough to provide easier choice
  cooperative
• Right none private payer system
• What is the role of prevention and individual
  responsibility?
• How much should the government help clinician
  decision making or actually dictate what
  decisions will be paid for?
• Comparative Effectiveness Research
• Who pays for health care reform and how?

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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-utilize based on
  churning revenue
• Care is uncoordinated
• Regional differences in cost/outcomes
  unacceptable
• Governments role is to supervise/manage the
  health care system
• Must Read The Cost Conundrum (The New Yorker) by
  Gawande

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Public Plan The Real 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
• This is why public plan backers want to base
  public plan on Medicare rates
• Backers of single-payer system know that this is
  next best option to getting there

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Points of Common Ground

• More Americans need to be insured
• Healthcare costs are out of control
• Government needs to help make insurance market
  become more competitive
• The payment system needs to be transformed
• There is too much churning and duplication of
  services
• There is a primary care crisis

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House and Senate Bills Common Points

• Create an insurance exchange
• Push the reimbursement system towards quality
  versus quantity basis for payment
• Address the pending 21.5 Medicare physician
  payment cut
• Move to transform the SGR basis of payment
• Extend insurance coverage to majority of
  uninsured
• Bonus primary care

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House and Senate Bills Differences

• Public plan
• WM, EL based on Medicare rates
• EC, HELP empowers HHS Secretary to negotiate
  rates
• Finance (will) create health insurance
  cooperatives
• Mandates
• To what extent are individuals mandated to own
  insurance
• To what extent are employers mandated to provide
  insurance
• How to pay for reform
• House bills tax wealthy
• Finance bill (will) tax employer premium health
  plans

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Health Care Reform Oncology Negatives/Positives

• Potential Negatives
• Strong public plan based on Medicare rates
• Cutting oncology payment rates to bonus primary
  care
• Putting oncology as a spoke in ACOs
• Cuts to diagnostic imaging
• Sets in motion moves towards bundling and
  capitation
• Potential Positives
• Partial fix to ASP drug reimbursement by
  eliminating prompt pay discount (H.R. 1392/S
  1221)
• Reform of the SGR that stabilizes but does not
  cut rates
• Additional funding through national quality
  demonstration project (H.R. 2872)
• Allowing oncology to be the hub in ACOs

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Handicapping Health Care Reform

• Whats pushing it?
• It is President Obamas TOP priority!
• American public acknowledges problems
• Big egos and legacies
• Whats pushing against it?
• Republicans
• Democrats
• Shifting mood/concern of the American public
• 68 of Americans rate their insurance as
  good/excellent
• Momentum of shifting PR against

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Other Problems 2010 Medicare MD Fee Schedule

• Payment reductions to medical oncology
• Cuts to infusion room codes (gt20)
• Elimination of consultation codes
• Overall 21.5 cut in all physician services
  payments unless Congress acts
• Payment reductions to diagnostic imaging
• Payment reductions to therapeutic radiation

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More Problems

• 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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Potential Oncology Negative Impact

• Short-term
• Decreased revenue medical oncology, imaging,
  radiation cuts
• Increased operational expenses audits,
  insurance processing, health care reform impact
  on small businesses
• Next-term
• Medicare pulling down all reimbursement
• Shifting even more risk onto oncology practices
• Bundling, capitation
• Limiting oncologist decision making
• Pulling apart oncology integrated care model
• Positioning oncologist as a spoke of care, rather
  than hub
• Losing oncologists relative to patient demand

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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 3
  cancer patients
• Healthcare reform has to correct the problems,
  not exacerbate them
• Public plan cannot be based on Medicare, flawed
  public plan for cancer care
• Severe cuts need to be forestalled
• Oncology has solutions

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 legislative solutions
• H.R. 2872
• H.R. 1392/S. 1221
• Lobbying very hard on Capitol Hill
• Collecting data on clinical/operational
  components of care
• Fight planned Medicare cuts
• Fight for cognitive services not reimbursed
• Unifying community oncology
• Creating greater sharing of information among
  practices
• Creating positive press for community oncology
  and illuminating the crisis
• Making oncology stronger politically

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Oncology Legislative Solutions

• H.R. 2872 Medicare Quality Cancer Care
  Demonstration Project Act of 2009
• National demonstration program on treatment
  planning, care planning, and end-of-life care
• Developed by a task force of practicing medical
  oncologists
• Open to all oncology nationwide
• Provides 300 million in annual funding
• 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 is now in Energy Commerce bill

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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
• Will be using in feedback to CMS and advocacy on
  the Hill

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Unifying Oncology

• 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!

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Oncology Public Relations

• Articles in major papers NYT, WSJ, WP
• OpEds by oncologists in papers around the country
• TV appearances FOX, local outlets
• Social networking

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Build COA PAC
Source Center for Responsive Politics
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Your Involvement is Critical!!!

• Reach out to your Members of Congress
• Ask them to co-sponsor H.R. 2872 and include in
  bill
• Ask them to co-sponsor H.R. 1392/S. 1221 and
  include in bill
• Bring them into your practice
• Generate a state letter to congressional
  delegation
• Complete the Components of Care Survey
• Submit comment letters to CMS on planned 2010
  cuts
• Reach out to your media OpEds, letters,
  interviews
• www.communityoncology.org

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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 Okon
• tokon_at_COAcancer.org
• 203-715-0300 (cell)
• www.communityoncology.org