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Dr. Bailes Looks at CMS Quality of Care Reporting Project and Healthcare-Related Legislation for 2007

Dr. Bailes Looks at CMS Quality of Care Reporting Project and Healthcare-Related Legislation for 2007

ABSTRACT: Since the Medicare Modernization Act (MMA) of 2003 was signed, the Centers for Medicare & Medicaid (CMS) has initiated a series of fairly dramatic structural changes in reimbursement policies covering drugs and services provided in cancer care. Cancer Care & Economics (CC&E) recently spoke with Joseph S. Bailes, MD, co-chair of the American Society of Clinical Oncology's (ASCO) Government Relations Council. Dr. Bailes elucidated some of the upcoming issues facing cancer specialists in today's changing political environment.

CC&E: The Oncology Demonstration Projects of '05 and '06 were well received by the oncology community. Does CMS plan to initiate a similar volunteer program in the future?

DR. BAILES: Although ASCO urged Congress and the Administration to continue the program, CMS did not commit to a 2007 demonstration project. However, during the lame duck session, Congress passed a conversion factor update that amounts to an increase of 1.5% in physician payments for reporting quality measures through the CMS Physician Voluntary Reporting Program (PVRP), which is now known as the 2007 Physician Quality Reporting Initiative (PQRI). ASCO will be working with CMS to ensure a smooth transition to the new program. [See article on page 50 for more on this new program.]

CC&E: How does ASCO view the merit of the PQRI?

DR. BAILES: We're hopeful that it will have a positive effect on cancer care practices. In theory, just like the demonstration projects, under PQRI physicians can elect to participate; however, if you don't elect to participate, you don't get the 1.5% bonus payment. CMS is using these initiatives to establish a broader system that rewards healthcare providers for recommended care. In other words, PQRI could be a preliminary step in the move toward P4P [pay for performance]. Clearly our docs are ahead of the curve in that they've had 2 years of experience reporting quality measures that resulted in payment, so this is not going to be new to them.

CC&E: Has ASCO's work on the Hill raised awareness about the problem of underwater drugs?

DR. BAILES: It's a challenge, but I think we are gaining ground. This year, ASCO worked with leaders in Congress to advance a bill introduced by Rep. Ralph Hall (R-Tex) to correct this, but unfortunately we couldn't get it added in the lame duck session. We've been meeting with the new leadership, and we will certainly reintroduce that bill. Hopefully we'll convey to the newly elected Democrats the importance of fixing this problem.

CC&E: Are the proposed reimbursement cuts in imaging services a concern with ASCO?

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