The Community Oncology Alliance (COA) submitted comments on health care reform legislation relating to cancer care.  In separate letters to President Obama, House Speaker Pelosi, and Senate Majority Leader Reid, COA President Patrick Cobb submitted a 3-page document that was approved by the COA Board of Directors. You can access the COA comments at www.communityoncology.org under Immediate Action Needed.

COA believes that meaningful health care reform is essential for current and future generations of Americans, especially the escalating number of people with cancer. We concur with and applaud those aspects of health care reform legislation that expand insurance coverage, eliminate lifetime payment caps, and ban coverage discrimination based on preexisting conditions.  Certainly, no American faced with the daunting challenge of fighting cancer should have to forego treatment because of insufficient insurance coverage or funds.  

Unfortunately, proposed health care reform legislation comes up woefully short in addressing a growing crisis in cancer care.  The United States has the best cancer care delivery system in the world; however, Medicare is increasingly broken when it comes to cancer care.  Most notably, the substantial and unrealistic reimbursement cuts and shortfalls relating to essential cancer care services threaten to dismantle the delivery system.  With only 17 business days remaining before the end of the year, community oncology practices have no idea what their cash flow will look like from Medicare.  A 21.2% general Medicare fee cut still looms, which will contribute to and increase a 5% cut to drug administration services, a 1-2% cut in consultations, and cuts to diagnostic imaging.  

Rather than following the President’s guiding principle of health care reform to “fix what is broken and build on what works,” public policy is doing the exact opposite. A broken Medicare system is worsening the crisis and simply cannot be expanded or serve as a model for health care reform. 

Health care reform needs to fix cancer care and not break it further.  Community oncology has already accepted the challenge of appropriately evolving the payment system.  However, health care reform needs to empower oncology professionals, not hinder change because of unrealistic public policy.

In the statement on health care reform, COA urges the Congress to act now in health care reform to address the cancer care crisis as follows:

• Stop implementation of Medicare reimbursement cuts to cancer care, especially the payment reduction to cancer drug administration and oncology diagnostic imaging.
• Stop the 2010 21.2% Medicare reimbursement payment cut impacting all physician-related services and fix the broken Medicare payment system based on the SGR formula.
• Stop cutting cancer care reimbursement further by using cuts to pay for primary care bonuses.
• Fix the problem of artificially low Medicare drug reimbursement by including the “prompt pay” solution in health care reform legislation.
• Enact real-world solutions to enhancing quality cancer care while controlling costs by including H.R. 3675 in health care reform legislation.  This is a patient-centric solution to health care reform proactively developed by oncologists.
• Eliminate the 20% Medicare co-payment requirement for cancer drugs.

On a broader basis, health care reform needs to motivate and empower greater personal health responsibility.  Significantly bending the cost curve downward will result from decreasing the demand for medical services in conjunction with appropriately evolving the payment system — not from simply cutting and bundling provider payments.

Community oncology is innovating change, both in terms of enhancing the quality of care delivered and controlling costs, as it has already demonstrated.  However, oncology needs to be empowered by public policy, not pressed into survival mode.

We will soon be providing specific materials and messages for community oncology to be engaged in the health care reform debate at this critical time.