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
Community Oncology Alliance (www.communityoncology.org)
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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!!!
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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?
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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?
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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!!!
Community Oncology Alliance (www.communityoncology.org)
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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.
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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House Letter to HHS Secretary
Community Oncology Alliance (www.communityoncology.org)
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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!!!
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (www.communityoncology.org)
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Increased Political Action
Source: Center for Responsive Politics
Community Oncology Alliance (www.communityoncology.org)
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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
Community Oncology Alliance (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
Community Oncology Alliance (www.communityoncology.org)
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Thank you!Ted [email protected] (cell)www.communityoncology.org