,i #aacth ,,congress #ast ,session ,h4 ,r4 #bhfi ,,in ,,the ,,house ,,of ,,representatives ,july #ca1 #bjac ,mr4 ,rogers of ,michigan 7for himself and ,ms4 ,matsui7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to establish payment parity under the ,medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting4 #a4 ,short title ,this ,act may be cited as the ,medicare ,patient ,access to ,cancer ,treatment ,act of #bjac4 #b4 ,findings2 sense of ,congress 7a7 ,findings ,congress finds the following3 7#a7 ,the ,national ,cancer ,institute estimates that approximately #ac4g million ,americans with a history of cancer were alive on ,january #a1 #bjab4 7#b7 ,about #h million of the #ac4g million ,americans living with cancer are over age #fe1 and approximately half of cancer care spending is associated with ,medicare beneficiaries4 7#c7 ,national spending on cancer care in #bjaj is estimated at #abe billion4 7#d7 ,in #bjaa1 the ,national ,cancer ,institute released projections of the cost of cancer care in the ,united ,states1 finding the total cost of cancer care in #bjbj is expected to be #bjf billion4 7#e7 ,in a #bjaj study1 ,milliman reported that in #bjjg a cancer patient receiving chemotherapy incurred average costs of approximately #aaa1jjj1 three times the cost of a coronary artery disease patient1 and six times the cost of a diabetes patient4 7#f7 ,over the last several years1 the ,united ,states has been touted as world leader in providing high-quality cancer care4 7#g7 ,united ,states cancer survival rates are higher than the average in ,europe and ,canada for #ac of #af types of cancer4 7#h7 ,until recently1 over #hj percent of ,united ,states cancer patients received care in the community setting4 7#i7 ,over the past several years1 the country has experienced a significant shift of outpatient cancer care delivery from the physician's office to the hospital outpatient department4 7#aj7 ,reports show that over the past six years1 #dc community practices have started referring all of their patients elsewhere for treatment1 #bhh oncology office locations have closed1 #aca practices have merged or were acquired by a corporate entity other than a hospital1 and #dfi oncology groups have entered into an employment or professional services agreement with a hospital4 7#aa7 ,over #a1jjj clinics or practices have been impacted over the last #c years out of a population of only #f1jjj oncologists in community practice in the ,united ,states4 7#ab7 ,a #bjac study published by ,the ,moran ,company 7,moran study7 found that1 between #bjje and #bjaa1 there was a #aej percent increase in administered chemotherapy in the hospital outpatient setting for ,medicare fee-for-service beneficiaries 7increasing from #ac4e percent in #bjje to #cc4j percent in #bjaa7 as compared to administration in physician community cancer clinics4 7#ac7 ,the ,moran study found that1 in #bjje1 almost #hg percent of ,medicare patients were receiving their care in the community setting1 by #bjaa only #fg percent were utilizing the community setting4 7#ad7 ,the ,moran study reports that ,medicare payments for chemotherapy administered in hospital outpatient settings have more than tripled since #bjje 7from #ij million to #cjj million7 while payments to physician community cancer clinics have actually decreased by #ad4e percent4 7#ae7 ,the ,medicare physician fee schedule rate in #bjab for ,,cpt ,code #ifdac 7,chemo1 iv infusion1 #a hr71 the most common drug administration code billed by oncology practices1 is #aci but the payment rate for the same service under the ,medicare hospital outpatient prospective payment system 7,,hopps7 fee schedule in #bjab is #ej percent higher at #bjh4 7#af7 ,utilization-weighted ,medicare payment for infusion services is approximately #ee percent higher at the hospital outpatient department than in a physician's office4 7#ag7 ,medicare proposed in #bjab to pay hospital outpatient departments #be percent more for radiation therapy services than for the same services performed in physicians' offices1 including a #gj percent differential for intensity modulated radiation treatment 7,,imrt7 and a #ahh percent differential for stereotactic body radiation therapy delivery 7,,sbrt74 7#ah7 ,one third of hospitals in the ,united ,states purchase chemotherapy drugs through the section #cdj;,b program at a discount of up to #ej percent1 resulting in a net cost to such hospitals that typically is at least #cj percent below reimbursement rate 7which is based on #ajf percent of the average sales price7 for community oncologists for such drugs4 7#ai7 ,medicare reimburses #gj percent of hospital bad debt 7uncollectable coinsurance74 7#bj7 ,according to an ,october #bjaa ,milliman study1 the cost of treating cancer patients is significantly lower for both ,medicare patients 7#aj percent lower in copayment amounts1 more than #fej savings a year7 and the ,medicare program 7#ad4b percent less1 a savings of #f1ejj a year per patient7 when provided in community-based cancer settings as compared to the same treatment in hospital outpatient departments4 7#ba7 ,the ,april #a1 #bjac1 sequestration cuts to ,medicare allowed for a #bh percent cut to the services reimbursement in ,medicare part ,b drugs to community oncologists4 7#bb7 ,a recent ,community ,oncology ,alliance survey showed that #fi percent of practices surveyed reported that patient treatment or operational changes already have been made due to the sequester cut to cancer drugs1 with #di percent of practices forced to send ,medicare patients elsewhere for treatment1 and #fb percent of practices reported that they will be forced to send ,medicare patients elsewhere for treatment if the sequestration cuts stay in place through ,july #ca1 #bjac4 7#bc7 ,the ,june #bjac report of the ,medicare ,payment ,advisory ,commission highlighted the large disparities in payment in outpatient settings and noted that the payment variations across settings should be addressed quickly due to the fact that current disparities have created incentives for hospitals to buy physician practices1 driving up costs for the ,medicare program and for beneficiaries4 7b7 ,sense of ,congress ,it is the sense of ,congress that1 to ensure the future of community cancer care1 ,medicare reimbursement should be equal for the same service provided to a cancer patient regardless of whether the service is delivered in the hospital outpatient department or physician's office4 #c4 ,equalizing ,medicare reimbursement in hospital outpatient departments and physicians' offices for cancer care services 7a7 ,in general ,section #ahcc7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in subparagraph 7,g71 by striking and at the end2 7,b7 in subparagraph 7,h71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after subparagraph 7,h7 the following new subparagraph3 7,i7 payment for covered ,,opd services that are cancer care services 7as defined in subparagraph 7,b7 of paragraph 7#ah77 shall be made consistent with subparagraph 7,a7 of such paragraph4 2 and 7#b7 by adding at the end the following new paragraph3 7#ah7 ,special payment rule for cancer care services 7,a7 ,in general ,in the case of cancer care services that are furnished on or after ,january #a1 #bjad1 the payment amount for such services under this subsection and under section #ahdh shall be a budget neutral combination 7as determined by the ,secretary7 of-- 7i7 the amount otherwise payable under this subsection for such services2 and 7ii7 the amount otherwise payable under section #ahdh for such services4 7,b7 ,cancer care services defined ,for purposes of this subsection1 the term cancer care services means covered ,,opd services or physicians' services for which payment is made under section #ahdh that are furnished in conjunction with the diagnosis or treatment of cancer4 4 7b7 ,conforming amendment ,section #ahdh7;a7 of ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77 is amended by adding at the end the following new paragraph3 7#i7 ,application of special rule for cancer care services ,in the case of physicians' services that are cancer care services 7as defined in subparagraph 7,b7 of section #ahcc7t77#ah77 that are furnished on or after ,january #a1 #bjad1 the payment amount for such services under this section shall be the payment amount for such services determined under subparagraph 7,a7 of such section4 4