,i #aac? ,,congress #a/ ,session ,h4 ,r4 #bhfi ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,july #ca1 #bjac ,mr4 ,rog]s ( ,mi*igan 7= himself & ,ms4 ,matsui7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to e/abli% paym5t p>ity "u ! ,m$ic>e program = ambulatory canc] c>e s]vices furni%$ 9 ! hospital outpati5t dep>tm5t & ! physician (fice sett+4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,pati5t ,access to ,canc] ,treatm5t ,act ( #bjac4 #b4 ,f9d+s2 s5se ( ,congress 7a7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,! ,national ,canc] ,in/itute e/imates t approximately #ac4g million ,am]icans ) a hi/ory ( canc] 7 alive on ,janu>y #a1 #bjab4 7#b7 ,ab\t #h million ( ! #ac4g million ,am]icans liv+ ) canc] are ov] age #fe1 & approximately half ( canc] c>e sp5d+ is associat$ ) ,m$ic>e b5efici>ies4 7#c7 ,national sp5d+ on canc] c>e 9 #bjaj is e/imat$ at #abe billion4 7#d7 ,9 #bjaa1 ! ,national ,canc] ,in/itute releas$ projections ( ! co/ ( canc] c>e 9 ! ,unit$ ,/ates1 f9d+ ! total co/ ( canc] c>e 9 #bjbj is expect$ to be #bjf billion4 7#e7 ,9 a #bjaj /udy1 ,milliman report$ t 9 #bjjg a canc] pati5t receiv+ *emo!rapy incurr$ av]age co/s ( approximately #aaa1jjj1 ?ree times ! co/ ( a coron>y art]y disease pati5t1 & six times ! co/ ( a diabetes pati5t4 7#f7 ,ov] ! la/ sev]al ye>s1 ! ,unit$ ,/ates has be5 t\t$ z _w lead] 9 provid+ high-quality canc] c>e4 7#g7 ,unit$ ,/ates canc] survival rates are high] ?an ! av]age 9 ,europe & ,canada = #ac ( #af types ( canc]4 7#h7 ,until rec5tly1 ov] #hj p]c5t ( ,unit$ ,/ates canc] pati5ts receiv$ c>e 9 ! community sett+4 7#i7 ,ov] ! pa/ sev]al ye>s1 ! c\ntry has exp]i5c$ a significant %ift ( outpati5t canc] c>e deliv]y f ! physician's (fice to ! hospital outpati5t dep>tm5t4 7#aj7 ,reports %[ t ov] ! pa/ six ye>s1 #dc community practices h />t$ ref]r+ all ( _! pati5ts else:]e = treatm5t1 #bhh oncology (fice locations h clos$1 #aca practices h m]g$ or 7 acquir$ by a corporate entity o!r ?an a hospital1 & #dfi oncology gr\ps h ent]$ into an employm5t or pr(essional s]vices agreem5t ) a hospital4 7#aa7 ,ov] #a1jjj cl9ics or practices h be5 impact$ ov] ! la/ #c ye>s out ( a population ( only #f1jjj oncologi/s 9 community practice 9 ! ,unit$ ,/ates4 7#ab7 ,a #bjac /udy publi%$ by ,! ,moran ,company 7,moran /udy7 f\nd t1 betwe5 #bjje & #bjaa1 !re 0 a #aej p]c5t increase 9 adm9i/]$ *emo!rapy 9 ! hospital outpati5t sett+ = ,m$ic>e fee-=-s]vice b5efici>ies 7increas+ f #ac4e p]c5t 9 #bjje to #cc4j p]c5t 9 #bjaa7 z comp>$ to adm9i/ration 9 physician community canc] cl9ics4 7#ac7 ,! ,moran /udy f\nd t1 9 #bjje1 almo/ #hg p]c5t ( ,m$ic>e pati5ts 7 receiv+ _! c>e 9 ! community sett+1 by #bjaa only #fg p]c5t 7 utiliz+ ! community sett+4 7#ad7 ,! ,moran /udy reports t ,m$ic>e paym5ts = *emo!rapy adm9i/]$ 9 hospital outpati5t sett+s h m ?an tripl$ s9ce #bjje 7f #ij million to #cjj million7 :ile paym5ts to physician community canc] cl9ics h actually decreas$ by #ad4e p]c5t4 7#ae7 ,! ,m$ic>e physician fee s*$ule rate 9 #bjab = ,,cpt ,code #ifdac 7,*emo1 iv infusion1 #a hr71 ! mo/ common drug adm9i/ration code bill$ by oncology practices1 is #aci b ! paym5t rate = ! same s]vice "u ! ,m$ic>e hospital outpati5t prospective paym5t sy/em 7,,hopps7 fee s*$ule 9 #bjab is #ej p]c5t high] at #bjh4 7#af7 ,utilization-weight$ ,m$ic>e paym5t = infusion s]vices is approximately #ee p]c5t high] at ! hospital outpati5t dep>tm5t ?an 9 a physician's (fice4 7#ag7 ,m$ic>e propos$ 9 #bjab to pay hospital outpati5t dep>tm5ts #be p]c5t m = radiation !rapy s]vices ?an = ! same s]vices p]=m$ 9 physicians' (fices1 includ+ a #gj p]c5t diff]5tial = int5sity modulat$ radiation treatm5t 7,,imrt7 & a #ahh p]c5t diff]5tial = /]eotactic body radiation !rapy deliv]y 7,,sbrt74 7#ah7 ,"o ?ird ( hospitals 9 ! ,unit$ ,/ates pur*ase *emo!rapy drugs ?r\gh ! section #cdj;,b program at a disc\nt ( up to #ej p]c5t1 result+ 9 a net co/ to su* hospitals t typically is at lea/ #cj p]c5t bel[ reimbursem5t rate 7:i* is bas$ on #ajf p]c5t ( ! av]age sales price7 = community oncologi/s = su* drugs4 7#ai7 ,m$ic>e reimburses #gj p]c5t ( hospital bad debt 7uncollectable co9surance74 7#bj7 ,accord+ to an ,octob] #bjaa ,milliman /udy1 ! co/ ( treat+ canc] pati5ts is significantly l[] = bo? ,m$ic>e pati5ts 7#aj p]c5t l[] 9 copaym5t am\nts1 m ?an #fej sav+s a ye>7 & ! ,m$ic>e program 7#ad4b p]c5t less1 a sav+s ( #f1ejj a ye> p] pati5t7 :5 provid$ 9 community-bas$ canc] sett+s z comp>$ to ! same treatm5t 9 hospital outpati5t dep>tm5ts4 7#ba7 ,! ,april #a1 #bjac1 seque/ration cuts to ,m$ic>e all[$ = a #bh p]c5t cut to ! s]vices reimbursem5t 9 ,m$ic>e "p ,b drugs to community oncologi/s4 7#bb7 ,a rec5t ,community ,oncology ,alliance survey %[$ t #fi p]c5t ( practices survey$ report$ t pati5t treatm5t or op]ational *anges already h be5 made due to ! seque/] cut to canc] drugs1 ) #di p]c5t ( practices =c$ to s5d ,m$ic>e pati5ts else:]e = treatm5t1 & #fb p]c5t ( practices report$ t !y w be =c$ to s5d ,m$ic>e pati5ts else:]e = treatm5t if ! seque/ration cuts /ay 9 place ?r\gh ,july #ca1 #bjac4 7#bc7 ,! ,june #bjac report ( ! ,m$ic>e ,paym5t ,advisory ,commission highlight$ ! l>ge disp>ities 9 paym5t 9 outpati5t sett+s & not$ t ! paym5t v>iations across sett+s %\ld be address$ quickly due to ! fact t curr5t disp>ities h creat$ inc5tives = hospitals to buy physician practices1 driv+ up co/s = ! ,m$ic>e program & = b5efici>ies4 7b7 ,s5se ( ,congress ,x is ! s5se ( ,congress t1 to ensure ! future ( community canc] c>e1 ,m$ic>e reimbursem5t %\ld be equal = ! same s]vice provid$ to a canc] pati5t reg>dless ( :e!r ! s]vice is deliv]$ 9 ! hospital outpati5t dep>tm5t or physician's (fice4 #c4 ,equaliz+ ,m$ic>e reimbursem5t 9 hospital outpati5t dep>tm5ts & physicians' (fices = canc] c>e s]vices 7a7 ,9 g5]al ,section #ahcc7t7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77 is am5d$-- 7#a7 9 p>agraph 7#b7-- 7,a7 9 subp>agraph 7,g71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,h71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] subp>agraph 7,h7 ! foll[+ new subp>agraph3 7,i7 paym5t = cov]$ ,,opd s]vices t are canc] c>e s]vices 7z def9$ 9 subp>agraph 7,b7 ( p>agraph 7#ah77 %all be made consi/5t ) subp>agraph 7,a7 ( su* p>agraph4 2 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#ah7 ,special paym5t rule = canc] c>e s]vices 7,a7 ,9 g5]al ,9 ! case ( canc] c>e s]vices t are furni%$ on or aft] ,janu>y #a1 #bjad1 ! paym5t am\nt = su* s]vices "u ?is subsection & "u section #ahdh %all be a budget neutral comb9ation 7z det]m9$ by ! ,secret>y7 (-- 7i7 ! am\nt o!rwise payable "u ?is subsection = su* s]vices2 & 7ii7 ! am\nt o!rwise payable "u section #ahdh = su* s]vices4 7,b7 ,canc] c>e s]vices def9$ ,= purposes ( ?is subsection1 ! t]m canc] c>e s]vices means cov]$ ,,opd s]vices or physicians' s]vices = :i* paym5t is made "u section #ahdh t are furni%$ 9 conjunction ) ! diagnosis or treatm5t ( canc]4 4 7b7 ,con=m+ am5dm5t ,section #ahdh7;a7 ( ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#i7 ,application ( special rule = canc] c>e s]vices ,9 ! case ( physicians' s]vices t are canc] c>e s]vices 7z def9$ 9 subp>agraph 7,b7 ( section #ahcc7t77#ah77 t are furni%$ on or aft] ,janu>y #a1 #bjad1 ! paym5t am\nt = su* s]vices "u ?is section %all be ! paym5t am\nt = su* s]vices det]m9$ "u subp>agraph 7,a7 ( su* section4 4