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CMS Seeks Methods to Appropriately Reimburse High-Quality Cancer Care

CMS Seeks Methods to Appropriately Reimburse High-Quality Cancer Care

In February 2005, Mark McClellan, MD, PhD, head of the Centers for Medicare & Medicaid Services (CMS), appointed Peter Bach, MD, MAPP, an associate attending physician at Memorial Sloan-Kettering Cancer Center, to serve as senior advisor on health care quality and cancer policy. A pulmonologist and intensivist by training, Dr. Bach has a strong reputation for research on quality cancer care, helping develop guidelines for lung cancer and chronic obstructive pulmonary disease (COPD). Cancer Care & Economics (CC&E) spoke to Dr. Bach about his position at CMS and how, among other things, the recent changes in Medicare reimbursement might affect community oncologists.

CC&E: What motivated you to take a position at the Centers for Medicare & Medicaid Services (CMS)?

DR. BACH: The primary motivation was an opportunity to work closely with Dr. Mark McClellan [head of CMS], who I believe has the right vision for the
future of our health care system. By modernizing Medicare, we hope to realize
necessary savings to the program and improve the quality of care for our patient population.

Moreover, Dr. McClellan is very sensitive to the clinical and fiscal challenges oncologists face during this transition. I felt that my research background in
cancer care quality and my clinical experience with cancer patients might help CMS transition into a system in which high-quality care can be appropriately reimbursed.

CC&E: The 2005 Chemotherapy Demonstration Project helped many community oncologists cover the shortfalls brought on by reductions in drug reimbursement. The 2006 project, however, has been criticized as being an insufficient stop-gap. How do you respond?

DR. BACH: The 2005 demo project was successful because it proved that we could use oncology billing G-codes to collect data on patient-physician interactions and cancer care quality. That is the cornerstone of a much larger set of initiatives we are pursuing in 2006, including physician voluntary reporting and the 2006 Oncology Demonstration Project as ways of gathering quality information in the field from doctors.

The 2006 demonstration project is
actually a by-product of what we learned in 2005. We shifted the focus of the 2006 demonstration project from chemotherapy administration to evaluation and management (E&M) encounters that provide us insight into the standards of care oncologists use when evaluating their patients.

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