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 ihas been the development and implementation of the Oncology Medical Home model, as well as an associated model of oncology payment reform.

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 2014. 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 has brought together community oncology practices in an interactive discussion on how to enhance the quality of care while reducing costs. This is all part of the Oncology Medical Home initiative. Additionally, COA continues to lead on major advocacy, public relations, information projects, and patient-centric initiatives relating to cancer care.

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 did COA accomplish in 2014?

If community oncology is going to survive and prosper we need to innovate, and that is exactly what COA continued to do in 2014. Towards the end of last year, Congresswoman Cathy McMorris Rogers, the 4th highest ranking member of the House of Representatives, released a discussion draft of a bill she will introduce early January 2015 when Congress convenes. The bill is landmark legislation on oncology payment reform that is based on the Oncology Medical Home (OMH) model. COA has worked very closely with the Congresswoman and her staff in incorporating many of the OMH concepts COA has been working on including the following:

  • Oncology Medical Home Accreditation:  COA has worked with the Commission on Cancer to develop OMH accreditation specifically designed for community oncology practices. In the 1st quarter of 2015, 10 community oncology practices will pilot this program by applying for accreditation.
  • Quality/Value Measures:  The COA OMH Steering Committee comprised of payers, providers, patient advocates, and other representatives from the cancer community have identified and endorsed 19 measures that payers have started to accept. These measures are tied into the OMH accreditation.    
  • Patient Satisfaction System:  Close to 35,000 patient satisfaction surveys, developed by COA based on the universal CAHPS survey, have been completed by well over 1,000 community oncologists. More practices are starting to use this tool as a head start to what will be made mandatory by payers, including Medicare.

In addition to this bill, COA has been working with all types of payers on oncology payment reform. In fact, COA hosted a major payer summit in Washington, DC that brought together community oncology practices and payers to discuss established and new payment reform models.  Additionally, representatives from CMS attended and participated, discussing the CMMI model for oncology payment reform. 

As committed COA is to advancing meaningful oncology payment reform for community oncology practices, we are still working very hard to fix the problems plaguing community oncology. Those include the issues with Medicare drug reimbursement, including the sequester cut and the prompt pay discount that artificially reduces drug payments.  We are working with members of Congress on the introduction of new legislation in 2015 to fix these problems. As you hear from the news reports, it is very difficult getting anything done through Congress but COA is fighting hard, especially as the current SGR patch expires in March. We are gratified that CMS changed course and oncology will see payment increases in E&M and infusion services in 2015, and significantly less cuts to imaging and radiation as originally proposed.

Why support COA in 2015?

We have given you just a topline of some accomplishments in 2014 in terms of returning real, measurable value to community oncology. This current year continues to be critical in terms of keeping up the proactive momentum, and making sure we plow the path forward for community oncology in 2015 and beyond in shaping Community Oncology 2.0. Ask yourself — Where would community oncology be without COA fighting for it?  Who else is fighting this hard specifically and dedicated to community oncology?

What are some of the major policy issues that COA will be dealing with in 2015?

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. That work resulted in the oncology payment reform draft bill referenced previously.

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.

COA also believes that the 340B drug discount program needs to be strengthened and focused so that cancer patients in need have access to treatment. There are problems with the program and in this statement developed by the COA Board, including independent and hospital-affiliated oncologists, COA highlights the problems and makes specific recommendations on fixing the program. 

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 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