Proposed changes in Medicare and Medicaid reimbursement have “enormous implications for appropriate cancer treatment,” according to Joseph S. Bailes, MD, winner of this year’s Association of Community Cancer Centers (ACCC) National Achievement Award. Accepting the prize at the ACCC’s 24th Annual National Meeting, Bailes, chairman of the Clinical Practice Committee of the American Society of Clinical Oncology (ASCO), added that he’s very concerned about the proposed changes. But he told of plans to streamline and strengthen ASCO’S public policy apparatus by: establishing a “more constant presence” in Congress; bringing all cancer professionals, advocacy groups, and academics under a single “big tent,” and solidifying ties with the patient community.
Bailes received ACCC’s highest honor in recognition of his “outstanding contributions to community cancer care” at the “national policy level,” which have an “importance equal to or even greater than” those at the “bench or lab,” said ACCC President James L. Wade III, MD, FACP, in introducing Bailes at a special awards luncheon. Bailes broke new ground in bringing together “community and university oncologists, patient advocacy groups and members of Congress to assure patient access to community cancer care,” Wade said.
Shift in Focus Toward Reimbursement Issues
Key to his mission as chairman of ASCO’s Clinical Practice Committee (CPC), Bailes declared, was creating a “policy coordination team second to none” on Capitol Hill and elsewhere in the government. A decade of change in oncology has seen a “reconfigured” CPC, as well as the opening of ASCO’s Washington office and its new regulatory and legislative representation by the Washington law firm of Fox, Bennett, and Turner.
Where a decade ago ASCO concentrated its energies on its annual meeting, which was dominated by academics and medical oncologists, and limited its advocacy efforts to the National Cancer Institute, ASCO has since taken a leading role in efforts to obtain more and better reimbursement for cancer care. It has developed a free-standing, full-time office; developed an active state affiliate program; admitted nonacademics and nonmedical oncologists to leadership roles; and brought more practitioners into the membership. Because of these changes, ASCO was heavily involved in the health insurance reform debate of 1993-1994, Bailes said, adding that services to clinicians now include a hotline to answer questions about reimbursement and symposia on managed care.
Key Future Issues
Looking to the future, Bailes said that “the practice expense issue has to be resolved....You can’t take out one element of payment when the chemotherapy codes are underreimbursed.” Seeing that those codes “are properly reimbursed” is a high priority, he added. “The drug reimbursement issue is not going to go away,” he added. Access to clinical trials, especially industry trials, must be expanded, he said, and ASCO also intends to “continue our dialog with FDA” to facilitate early access to lifesaving therapy and dissemination of off-label drug information.
“Make sure that your patients understand what goes into cancer care,” he told the gathering, adding that patients are the “best PR” for oncology.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
