Cancer care is dependent on money and planning. In order to manufacture drugs, build hospitals, run medical schools and pay for treatment, thousands of men and women spend their careers organizing, designing and legislating health care. In light of the ongoing financial crisis in medicine, it behooves us to have some understanding of the politics. Today’s blog presents brief bullets of critical legislative issues.
-Cancer treatment and the debt negotiations
As a subchapter to the confrontational negotiations in Washington regarding raising the dept ceiling, negotiators may reduce Medicare chemotherapy reimbursement. The negotiators are proposing, in an effort to come to a budget deal, $3 billion dollars in cuts for chemotherapy drugs. National oncology societies are concerned this may lead to further closings of cancer treatment facilities, and decrease access for seniors to cancer therapy.
-PhRMA drug discounts
A White House backed proposal to require pharmaceutical companies to discount drugs for the poorest of Medicare’s patients is under attack in the House. The proposal would require drug companies to give rebates for certain brand name drugs. This would apply only to seniors eligible for both Medicare and Medicaid (so called “dual eligible”). Proponents state the bill would save the government $50 -100 billion dollars per year, but it is labeled by opposing lawmakers as price fixing and a thinly disguised tax.
-Cancer drug shortages
Increasing drug shortages and manufacturing delays are affecting large numbers of patients. In 2009, shortages affected 166 medications. This year, by June, delivery of 156 drugs was delayed or stopped. 99.5 percent of hospitals report shortages, as do all oncology practices. The FDA blames the shortages on manufacturing problems and increasing numbers of drugs that are simply not lucrative to produce. The American Society of Clinical Oncology’s (ASCO) President Michael Link, MD discussed the increasing problem at a Capital Hill briefing this week, describing the situation as a “crisis in care.”
-Deep cuts in imaging reimbursement stopped
Over the last several years cuts in Medicare and Medicaid payment rates for diagnostic imaging have been proposed and partially enacted. In June, as part of the Trade Adjustment Assistance Agreement, a 30% reduction for radiology procedures was proposed. However, after lobbying from the American Medical Association (AMA) and industry representatives, the Senate Finance Committee removed the cuts from the Trade bill.
– ACOs failing
Seen as part of the solution for the health care crisis, the Affordable Health Care Act established Ambulatory Care Organizations (ACOs). However, the proposed rules distributed for comment this spring were overwhelmingly complex. Most health care providers dropped plans to implement ACO networks. Medicare/CMS received comments and will release the final rules in August. Whether the changes will allow more then a few health care providers to participate is unknown. Insiders contend that the restrictive rules were designed to exclude all but a pre-picked group of providers.
-Pre-existing condition protection takes affect
On May 31, the Pre-Existing Condition Insurance Plan (PCIP) became available. This Federal policy makes health care available to anyone who has difficulty getting health care coverage because of prior illness. This coverage will last until 2014 when it will become illegal for insurance companies to discriminate because of a pre-existing condition.
-SGR still a problem
In the confusion of the Dept Crisis it must not be lost that Congress has still not fixed the disastrous formula known as the SGR (Sustainable Growth Rate). Congress has delayed fixing the flawed Medicare cost-of-living calculation for the last decade and instead simply patched it for months at a time. If not fixed this year (or, sadly, patched) this will result in a cut for physician reimbursement on Jan 1, 2012 of 29.5%. Given the history of similar cuts in Medicaid it is likely most doctors will stop seeing Medicare patients. An alliance of organizations is begging Congress for a permanent fix in the SGR.
-Cuts in FDA funding
In June, the House cut the 2012 FDA Budget by $285 million (11.6% reduction). ASCO, the Community Oncology Alliance (COA) and the Office of Management and Budget (OMB) indicated this would “severely limit” access to safe and new medications, as well as put food and other medicinal products in jeopardy. It is not clear what the Senate will do.
-Pancreatic cancer funding bill
The Pancreatic Cancer Action Network has proposed that Congress pass the Pancreatic Cancer Research & Education Act (S. 362/R 733). This bill, which is co-sponsored, by NJ Senators Lautenberg and Menendez, would require the National Cancer Institute to develop a long-term comprehensive strategic plan to cure Pancreatic Cancer.
EMR roll out delayed
-Electronic Medical Records (EMRs) are the key to the future of high quality, data driven, coordinated and affordable health care. Confusion about financial incentives and support from Medicare/CMS and Washington for these programs is delaying implementation. Doctors are worried about investing 10s of thousands of dollars in EMR systems and being penalized for their use or not reimbursed for their cost. Medical organizations are lobbying CMS/Medicare to be clear in the rules for EMRs and urging Congress to continue support for these vital systems.
-End of life legislation
New Jersey S2197/A3475 passed both houses and if signed by the Governor will create the “Physician Orders for Life-Sustaining Treatment Act (POLST).” Broadly supported by health care providers and patient advocacy groups, the bill creates a widely available POLST form. This will allow a patient, while they are still competent, to instruct physicians on details of medical care. If the patient does become incapacitated, the POLST orders are used. The patient’s Power of Attorney can change the POLST orders. Viewed as a way to give patients with serious illness control over their lives, POLST forms have been successful in other states. This form is an addition to an Advanced Directive, which is less specific.
-UN meeting in fall
In what health policy experts are hoping will be a landmark meeting, the United Nations will sponsor a High Level Meeting on Non-Communicable Diseases in New York in September. The goal of the UN Conference is to design a 21st Century global health agenda for cancer, diabetes, cardiovascular disease, stroke and chronic lung disease. Given that cancer researchers foresee an explosion of cancer in the third world over the next 50 years, because of industrialization, expansion of smoking, increase in obesity and other factors, this gives the world a chance to prepare and prevent.
Much ado about much.