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Dr. Bailes Updates MMA Issues, Congressional Activity

Dr. Bailes Updates MMA Issues, Congressional Activity

ABSTRACT: Although the Medicare Modernization Act (MMA) is into its third year, the full effects of this legislation on the oncology community are still a matter of speculation. To bring our readers up to speed on current MMA issues, Cancer Care & Economics (CC&E) spoke with CC&E editor, Joseph S. Bailes, MD. Dr. Bailes is interim executive vice president and chief executive officer of the American Society of Clinical Oncology (ASCO). He also serves as co-chair of ASCO's Government Relations Council.

CC&E: Does ASCO maintain a working relationship with the Centers for Medicare & Medicaid Services (CMS)?

DR. BAILES: Yes, ASCO interacts regularly with CMS. It's in the best interest of the oncology community for the Society to have a positive working relationship with agencies such as CMS that develop policies affecting cancer care. One thing to remember is that, as a general rule, where Medicare goes, so go the private payers. That is why it is very important to set the best policy you can with the federal government, because the private payers tend to follow this policy.

CC&E: The 2006 CMS Demonstration Project (see articles on page 32) is projected to yield about $150 million in additional payments to community oncologists, about half of the 2005 Demonstration Project's yield. How will this cut affect community oncologists?

DR. BAILES: Unlike the 2005 Project, which paid oncologists for collecting data on patients' symptoms per chemotherapy encounter, the 2006 Demonstration Project is tied to levels 2 to 5 of E&M (evaluation and management) services, so there are a lot more individual payments involved. We don't have significant data on the '06 Project's net effect because practices are currently being reimbursed for claims they filed in January and February. The carriers seem to be implementing the payment system correctly, but it will probably be mid-year before community practices have a handle on its true economic impact.

CC&E: What is the current status of the pay-for-performance initiative and will ASCO's National Initiative on Cancer Care Quality (NICCQ) help reach a consensus on assessing quality measures?

DR. BAILES: The American Medical Association (AMA) has an agreement, so to speak, with Congress to develop measures for the proposed pay-for-performance initiative using the NICCQ validated quality measures and National Comprehensive Cancer Network (NCCN) practice guidelines. So far we have developed quality measures in breast and colorectal cancer, so on our end we're ahead of the process.

CC&E: How will the transition to pay-for-performance occur?

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