Questions About COA

Questions About the Community Oncology Alliance

Why support the Community Oncology Alliance (COA)?

In summary because COA is the only non-profit organization dedicated solely to community oncology. In addition to advocating on Capitol Hill and beyond for community oncology, COA is committed to helping community oncology practices navigate these difficult times. This includes networking practices in order to unify community oncology and strengthen its position, as well as providing authoritative, timely information on a variety of topics critical to community oncology. A major initiative for COA is the development and implementation of the Oncology Medical Home model.

COA relies on the support of its oncology members. This support has allowed COA to successfully reduce and stop further Medicare payment cuts to cancer care in 2012. In fact, COA was successful in turning a Medicare payment cut to cancer care into an increase. Additionally, COA was very engaged in pushing for a serious patch — and more importantly, an actual fix — to the deeply flawed sustainable growth rate (SGR) that threatens seniors’ access to cancer care.

As you will read further, COA is engaged in not only stopping further cuts to cancer care, but also in taking a proactive role in securing more appropriate payment under new system. Furthermore, COA is bringing together community oncology practices in an interactive discussion of how to enhance the quality of care while reducing costs. This is all part of the Oncology Medical Home initiative. Additionally, COA is also working on major advocacy, public relations, information projects, and patient-centric initiatives.

Community oncology needs to be represented and fight for all of the patients who count on us for their cancer care. Your support enables us to make your voice heard during this critical phase of health policy evolution, to provide you with timely, practical information, and to help community oncology practices work together to enhance cancer care.

What is the overall agenda of COA for 2014?

During the past year, COA has pursued two broad strategies:

  • Fighting back against any payment cuts impacting community oncology and advocating for increased reimbursement
  • Developing proactive strategies to evolve the payment and care delivery system in the United States, both relating to government and private payers

During 2014, COA will continue to pursue these two broad strategies, with special emphasis on proactive initiatives. Simply put, if community oncology does not lead, it will be led, most likely to its detriment. Notably, we have major initiatives in place dealing with the Oncology Medical Home and Medicare Payment Reform. Community oncology practices need to work together to define and implement new models that will protect and foster patient care, while keeping practices economically viable and healthy.

There are many more initiatives COA has underway, including the COA Administrators’ Network, which has provided a vehicle for oncology practice administrators to share information. Additionally, we have successfully used the media in generating positive stories, articles, and OpEds about community oncology and the crisis facing cancer care. A major effort has been made to educate advocates about the crisis facing cancer “care,” which is a major obstacle to finding a cancer “cure.” This effert is made possible by the expansion of the COA Patient Advocacy Network (CPAN).

What are some of the major policy issues that COA will be dealing with in 2014?

In general, COA believes that the Medicare system is broken. Medicare payment cuts to oncology are unsustainable and dismantling the cancer care delivery system. This situation is worsened by the underlying flawed sustainable growth rate (SGR) formula, which is the basis of Medicare reimbursement. COA calls for the Congress to repeal the SGR and allow community oncology to implement Medicare payment reform. COA believes that ensuring the delivery of quality health care is critical in treating cancer patients. We also recognize the responsibility of making cancer care as effective and cost-efficient as possible. In terms of proactive initiatives, the COA Payment Reform Task Force has worked hard on ways of evolving the payment system in concert with the Oncology Medical Home. During 2013, COA shared its developing payment reform model with members of Congress and congressional staff and this can be seen in the legislation crafted by the Congress to address the SGR and implement alternative payment models.

COA believes that CMS should not be applying the Medicare sequester cut to the underlying cost of cancer drugs. As a result, COA has asked members of Congress to advance legislation (H.R. 1416) to stop CMS from applying the sequester cut to cancer drugs.

COA strongly supports legislation that eliminates prompt payment discounts from the calculation of Average Sales Price (ASP). Prompt payment discounts from the manufacturer to the distributor are financing decisions that are not passed on to community cancer clinics. However, inclusion of these prompt pay discounts artificially reduces all drug reimbursement rates based on ASP. Fixing the prompt payment problem is specific to drug reimbursement and only addresses the tip of the iceberg of problems associated with reimbursement for drugs and essential cancer care services.

COA also supports payment parity in cancer care, regardless of where the service is provided -- clinic or hospital. Unfortunately, CMS has ignored the recommendations of MedPAC and members of Congress and is doing the exact reverse -- creating payment disparity that is increasing the cost of cancer care to Medicare, seniors, and taxpayers.

Finally, COA believes that cancer drug shortages should be completely eliminated in the United States. This will only happen until Medicare payment for drugs is stabilized. Pricing instability is providing economic disincentives for generic manufacturers to produce drugs and to adequately maintain plant/equipment. We do not have shortages of brand name cancer drugs. The shortages are with generic injectable drugs. COA supports legislation that will bring price stability to Medicare for these low-cost, generic, injectable drugs.  

What has COA done since its creation in 2003 on behalf of community cancer care?

COA was instrumental in fighting for significant reimbursement increases as part of the MMA. There were those involved in crafting the MMA who were intent on reducing Medicare drug reimbursement to ASP + 2-3% and only increasing services reimbursement by $150 million. COA provided data and successfully fought to get this increased to ASP + 6% and over $550 million in services reimbursement. Also, COA secured additional Medicare funding in 2005 in the form of the $300 million demonstration project and the 2006 demonstration project. Currently, COA is working on legislative solutions to key problems associated with Medicare drug and services reimbursement. Overall, COA has awakened the consciousness of community oncology about the importance of reaching out and interacting with Members of Congress. Community practices all across the country have now formed close relationships with their Members of Congress and have hosted Members in their practices to see cancer care through the eyes of a cancer patient.

During the fall of 2009, COA engaged community oncology to fight the Medicare oncology-specific payment cuts that the Centers for Medicare & Medicaid Services planned to make in 2010. As a result of this effort, payment cuts in 2010 of 22% for drug administration services were averted. COA continued to fight these payment cuts and, as a result, there were no oncology-specific Medicare cuts during 2011.

During 2012, COA was successful in turning Medicare payment cuts to medical oncology and hematology into reimbursement increases. COA was also actively involved in fighting against significant payment cuts to diagnostic imaging and therapeutic radiation. COA has worked with Congress in bringing forth solutions to the drug shortage crisis. 

COA has brought together oncology practice administrators in a network that allows for information sharing via a closed list serv, dedicated administrator website, and monthly calls/webinars.

The major initiative underway for the past year has been the development and implementation of the Oncology Medical Home model. This has already allowed practices to move forward in evolving their practices in terms of quality and value delivered. COA has launched a new website dedicated to the Oncology Medical Home.

What resources does COA have to fight for community oncology?

Over 100 individuals from the cancer community — oncologists, administrators, mid-level providers, oncology nurses, and survivors — volunteer their time on a regular basis to govern COA and serve on committees that ensure that COA is serving the interests of community oncology. Additionally, COA retains a full-time and consultant staff to manage COA, provide services to member practices, and to lobby the Congress and Administration. As importantly, COA empowers community oncology practices across the United States to advocate for their patients. It is this grassroots approach that empowers an ongoing lobbying campaign in Washington, DC. In this era of healthcare cost containment, the combined approach of grassroots and professional lobbying is essential to stopping the dismantling of community oncology.

How is COA governed?

COA is a non-profit, 501 (c).6 organization that is controlled by community oncologists. COA has an Executive Committee of Officers that reports to a Board of Directors, comprised of representatives from community oncology, who direct the management of COA by its Executive Director.

How is COA funded?

COA is funded by the membership contributions of community oncology practices. Additionally, COA has corporate members that are currently comprised of pharmaceutical and distribution companies. Corporate membership is intended to foster communications and education among those individuals and entities with an interest in protecting the quality, affordability, and accessibility of the community cancer care delivery system in the United States. COA maintains a strict policy of independence from commercial influences, such as those related to specific companies, products, or services. The COA Board of Directors enforces this policy. Fundamentally, a mission of fostering and protecting the quality, affordability, and accessibility of cancer care for all Americans governs every COA policy and endeavor. Funds are used for education, projects, advocacy, staffing, and to maintain an office in Washington, DC.




Community Oncology Alliance
1101 Pennsylvania Avenue, N.W.
Suite 700
Washington, DC 20004
(202) 756-2258