Legislation Would Carve Out Cancer From HCFA-Proposed APCs

ALEXANDRIA, Va—“The Health Care Finance Agency’s plan to reimburse for outpatient Medicare cancer treatment according to ambulatory payment classifications (APCs) would have a crippling effect on research and development of new drug therapies and lower the quality of care for present and future cancer patients,” Congressman Gene Green, Representative of the 29th District of Texas in the US House of Representatives, said at the Annual Meeting of the Association of Community Cancer Centers (ACCC).

To assure Medicare patients’ continuing access to the most advanced therapies, Rep. Green, a Democrat, has introduced the Medicare Full Access to Cancer Treatment Bill, which would carve out cancer treatment from the HCFA plan. Known as HR 1090, the proposed legislation currently has 25 bipartisan co-sponsors in Congress. Rep. Green urged ACCC members to contact their own representatives and ask them to sign on as co-sponsors to improve the bill’s chances of gaining hearings and ultimate passage.

By bundling all cancer drugs into a small number of APCs and paying hospitals only the average cost of these services, the HCFA plan threatens to pressure “hospitals to provide the least expensive rather than the most effective treatment,” he said.

The proposal to reimburse any drugs developed after 1996 at the lowest rate would discourage their use and would diminish or delay research and development on new therapies, “ultimately denying the patients of today and those of future generations the most effective treatments,” he said.

To correct this problem, the bill would carve out cancer treatment from the outpatient prospective payment system (PPS). “This simple yet sensible action would fully protect Medicare beneficiaries’ continued access to the best and most effective cancer care,” he said.

In addition to the ACCC, the bill’s organizational supporters include the National Alliance of Breast Cancer Organizations, Cancer Research Foundation of America, Oncology Nursing Society, Lupus Foundation of America, and Multiple Myeloma Research Foundation. Other groups, such as ASCO (American Society of Clinical Oncology) have also recently expressed their support.

Despite the broad support of the oncology community, however, the bill will not pass unless those who want it actively press for it, he emphasized. “If this bill doesn’t pass, those with cancer and those who treat them are at serious risk,” Rep. Green said.

In addition to helping pass the bill, he added, an ever-lengthening list of congressional co-sponsors will gain the attention of officials at HCFA, which, like all executive branch agencies, pays close attention to the views of members of Congress. “HCFA doesn’t live in a vacuum,” he said.

Managed Care Reform

Turning to other health care issues before Congress, Rep. Green, a member of the House Commerce Committee, stated that reforming managed care is “the most important issue that we have.” As a co-sponsor of Congressman Dingle’s proposed Patients’ Bill of Rights, Rep. Green called the proposal to make managed care organizations legally accountable for their treatment decisions the “most controversial” part of that bill.

Legislation in his home state of Texas has already established HMO accountability, and it has “worked well,” he said. Half of the external appeals brought in Texas have gone against the care manager. If such legislation could work in Texas, he said, it could also work elsewhere.

“Since the states cannot unilaterally override the provisions in the federal ERISA law that shield health plans from accountability,” Rep. Green said, “we have to change ERISA in Congress. If physicians and hospitals are accountable, then managed care organization should be too.”