ALEXANDRIA, VaThe Health Care Finance Agencys
plan to reimburse for outpatient Medicare cancer treatment according
to ambulatory payment classifications (APCs) would have a crippling
effect on research and development of new drug therapies and lower
the quality of care for present and future cancer patients,
Congressman Gene Green, Representative of the 29th District of Texas
in the US House of Representatives, said at the Annual Meeting of the
Association of Community Cancer Centers (ACCC).
To assure Medicare patients continuing access to the most
advanced therapies, Rep. Green, a Democrat, has introduced the
Medicare Full Access to Cancer Treatment Bill, which would carve out
cancer treatment from the HCFA plan. Known as HR 1090, the proposed
legislation currently has 25 bipartisan co-sponsors in Congress. Rep.
Green urged ACCC members to contact their own representatives and ask
them to sign on as co-sponsors to improve the bills chances of
gaining hearings and ultimate passage.
By bundling all cancer drugs into a small number of APCs and paying
hospitals only the average cost of these services, the HCFA plan
threatens to pressure hospitals to provide the least expensive
rather than the most effective treatment, he said.
The proposal to reimburse any drugs developed after 1996 at the
lowest rate would discourage their use and would diminish or delay
research and development on new therapies, ultimately denying
the patients of today and those of future generations the most
effective treatments, he said.
To correct this problem, the bill would carve out cancer treatment
from the outpatient prospective payment system (PPS). This
simple yet sensible action would fully protect Medicare
beneficiaries continued access to the best and most effective
cancer care, he said.
In addition to the ACCC, the bills organizational supporters
include the National Alliance of Breast Cancer Organizations, Cancer
Research Foundation of America, Oncology Nursing Society, Lupus
Foundation of America, and Multiple Myeloma Research Foundation.
Other groups, such as ASCO (American Society of Clinical Oncology)
have also recently expressed their support.
Despite the broad support of the oncology community, however, the
bill will not pass unless those who want it actively press for it, he
emphasized. If this bill doesnt pass, those with cancer
and those who treat them are at serious risk, Rep. Green said.
In addition to helping pass the bill, he added, an ever-lengthening
list of congressional co-sponsors will gain the attention of
officials at HCFA, which, like all executive branch agencies, pays
close attention to the views of members of Congress. HCFA
doesnt live in a vacuum, he said.
Managed Care Reform
Turning to other health care issues before Congress, Rep. Green, a
member of the House Commerce Committee, stated that reforming managed
care is the most important issue that we have. As a
co-sponsor of Congressman Dingles proposed Patients Bill
of Rights, Rep. Green called the proposal to make managed care
organizations legally accountable for their treatment decisions the
most controversial part of that bill.
Legislation in his home state of Texas has already established HMO
accountability, and it has worked well, he said. Half of
the external appeals brought in Texas have gone against the care
manager. If such legislation could work in Texas, he said, it could
also work elsewhere.
Since the states cannot unilaterally override the provisions in
the federal ERISA law that shield health plans from
accountability, Rep. Green said, we have to change ERISA
in Congress. If physicians and hospitals are accountable, then
managed care organization should be too.