Cancer Care Groups Vocalize Opposition to Medicare Drug Payment Proposal

Jacqueline Fellows, March 21, 2016

Cancer Treatment Outlook

What's gotten lost in the debate over adequate reimbursement, say Zon and Pratt, is that patients with cancer are living longer in part because of better drug treatments. ASCO's State of Cancer Care in America: 2016 report celebrates some of those advancements but also warns that access to care in rural areas is a critical issue.

Robin Zon, MD, FACP"It came out of nowhere," says Robin Zon, MD, FACP, vice president at Indiana-based Michiana Hematology Oncology.

According to the report, only 5.6% of oncologists practice in rural areas—where 11% of cancer patients live. "In the last decade, there's been wonderful advancement," she says. "The eye is on the wrong ball. We need comprehensive payment reform. Don't make the doctors carry the burden of the rising drug costs when we had nothing to do with it."

Other organizations believe CMS's proposed payment change is an end-run around Congress. Community Oncology Alliance Executive Director Ted Okon questions why CMS is using the Center for Medicare & Medicaid Innovation to test a new payment model.

"This is using the mandate that Congress gave CMS in creating and funding CMMI," Okon says. "That allows CMS to use CMMI to overturn any law dealing with Medicare that Congress has made. We're testing a mandatory national initiative. That's flat-out wrong."

COA has taken an aggressive stance against the proposal. It has threatened legal and legislative action to stop the proposal from moving forward. Okon says the reimbursement changes are at cross purposes with the Oncology Care Model, CMMI's model that's been three years in the making. Its aim is to improve cost, care coordination, and quality by using performance-based incentives.

"It's designed to address the clinical side of care and give practices the opportunity to improve, but we've been waiting for four months to find out which practices and payers are going to get to participate," Okon says. "I suspect the reason that's been delayed is because of this [new proposal]."

Other specialists are also against the policy change, include rheumatologists and gastroenterologists. The American College of Rheumatology issued a statement criticizing a Medicare reimbursement rate that is already too low.

"It is our hope that the proposed payment methodology changes would not exacerbate the existing access problem and force more patients to receive biologic therapies in the hospital setting, where they will be faced with higher copayments, more expensive facility fees, longer travel times, and administration of complex therapies without the supervision of their rheumatologists."

Jacqueline Fellows

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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