Ohio Oncology Meeting

1
Ohio Oncology Meeting

• Healthcare Reform and the Impact on the Practice
  of Oncology
• Ted Okon
• Executive Director
• November 9, 2009
• Sandusky, Ohio

2
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!!!

3
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

4
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
• Governments role is to supervise/manage the
  health care system
• Must read The Cost Conundrum (The New Yorker)
  by Gawande

5
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

7
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-conservativ
  e 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?

8
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

9
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

10
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 EM/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

12
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
• EM 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

13
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!!!

16
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

19
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

20
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

21
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

22
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

25
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

27
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