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Washington Update Florida Society of Clinical Oncology (FLASCO)

Washington Update Florida Society of Clinical Oncology (FLASCO). Clifford Hudis , MD President, ASCO Chief, Breast Cancer MedService , MSKCC Professor of Medicine, WCMC. Disclosures. I do not intend to discuss an off-label use of a product during this activity

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Washington Update Florida Society of Clinical Oncology (FLASCO)

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  1. Washington UpdateFlorida Society of Clinical Oncology (FLASCO) Clifford Hudis, MD President, ASCO Chief, Breast Cancer MedService, MSKCC Professor of Medicine, WCMC

  2. Disclosures • I do not intend to discuss an off-label use of a product during this activity • I have not had any relevant financial relations during the past 12 months to disclose (but am on the ASCO BOD).

  3. Good News Mortality Five-Year Survival Source: National Cancer Institute Source: National Cancer Institute

  4. What’s Ahead New Cancer Cases Source: National Cancer Institute

  5. Challenges • Economic pressures • Political turbulence • General disruption across medicine • Sequestration • ICD-10 • PQRS, Meaningful Use • Health Reform • ACOs, shifts in practice environment • Performance based payment • Wave of newly insured • Uncertainty

  6. Repeal SGR Formula SGR Repeal and Medicare Provider Payment Modernization Act of 2014

  7. SGR Rollercoaster Dec 2009: Congress freezes rates for two months. Mar 2010: CMS holds claims. Apr 2010: CMS advises physicians to hold claims Jun 2010: Congress delays cut until November 30 Nov 2010: Congress freezes rates for one month Dec 2010: President signs bill for one-year delay to 25 percent cut. Feb 2011: Congress delays cut with 10-month patch Feb 2012: Congress delays until Jan of 2013 Jan 2013: Congress delays for one year Dec 2013: Congress delays until April 1, 2014 Mar 2014: Bipartisan agreement then failed. Patch # 17 passed

  8. The Big Picture: State Of Cancer Care in America • 530 practices • 8,011 physicians http://www.asco.org/practice-research/cancer-care-america

  9. Top Concerns

  10. Other Concerns • Health Insurance Exchanges • Network adequacy • 90-day grace period • Coverage for cancer care • General dysfunction/confusion

  11. Community Practices At Risk • Likelihood of Practice Change • Private Community Practice, By Practice Size • 25% reduction in private practices since 2012 census • 2/3 of smaller practices anticipate sale, merger or closing in next year—double that reported overall • Small medium practices see >1/3 new patients

  12. Smaller Community Practices • Backbone of U.S. cancer care delivery system • Serve more than one third of all new patients, especially in the South • Nearly two-thirds (63%) of these practices likely to merge, sell or close in the next year

  13. Geographic Challenges:Oncologists Per 100,000 by state

  14. Supply-Demand Perspective 300 New Patients/per year x 1,487 Oncologist Shortage 446,100 New Patients Face Challenges

  15. Taking Action: Health Reform • Essential Health Benefits for cancer patients • State-by-state analysis • Communication with White House on 90-day grace period • Monitoring network adequacy

  16. Taking Action: Payment Reform • Information series on ASCO in Action • CPC workgroup developing/testing alternative models • Joint statement with COA, USON, ION • Oncology medical home • Episode based payments • Close communication with Congressional committees • Representation on CMS technical panel • Working with other medical organizations and the AMA

  17. What You Can Do Help us… Help you!

  18. Research Funding: FY 14 NCI: $4.9 billion

  19. Stagnant Research Budget

  20. Our Message • 2014 increases not a budget victory for medical research • Does not go far enough • Adjusting for inflation, NIH budget below 2013 levels

  21. Outlook for 2015 • Probable request: • $32 bil for NIH • $5.2 bil for NCI • Keeps pace with medical inflation • Not likely to happen

  22. Why Consider Value?Society Focused On Consider Costs of Cancer Care? • Cost affects access and outcomes • Out of pocket costs matter to patients, and affect treatment decisions • Cost matters to payers • Cost matters to society

  23. US Health Spending at 17.7% of GDP is ~50% Greater than Others (and Still Rising) • Projected US Health Spending 2020 → 20% GDP • Kehhan SP, Cuckler GI, Sisko AM, Madison AJ, Smith SD, Lizonito JM, Poisal JA and olfe CJ. National Health Expenditure Projections: Modest Annual Growth Until Coverage Expands And Economic Growth Accelerates. Health Affairs. 2012 Jul;31(7):1600-12.

  24. Higher Spending Does Not Increase Life Expectancy Health Care Expenditures and Life Expectancy (2005) Fuchs VR, Milstein A. N Engl J Med 2011;364:1985-1987.

  25. Patients are Bearing More of the Costs Projected family health insurance premium costs and average household income Household Income Year Annals of Family Medicine: 2012: 10: 156-162

  26. Cost of Cancer Care is Rising • → $125 billion in 2010 • → $175 billion in 2020

  27. Cancer Care Costs Rising Faster than Overall Healthcare Cancer Drugs Cumulative % Increase Cancer Medical Healthcare US GDP Source: Blue Cross Blue Shield Association

  28. Hospitals and Providers a large fraction

  29. Eight of Top Ten Most Expensive Drugs Covered by Medicare are Cancer Drugs Top Ten Medicare Drugs 2012 Millions Ranibizumab $ 1,220 • Rituximab cancer treatment $ 876 • Infliximab injection $ 704 • Injection pegfilgrastim , 6mg $ 642 • Bevacizumab injection $ 624 • Aflibercept 1 mg $ 384 • Denosumab injection $ 347 • Oxaliplatin $ 309 • Pemetrexed injection $ 292 • Bortezomib injection $ 278 • . • Source: Moran Company Analysis of Medicare Physician/Supplier Procedure Summary File, 2012. Includes carrier claims only (physician office and DME). Outpatient Prospective Payment System (OPPS) claims are excluded.

  30. Challenge:Cost Seldom Considered by Stakeholders

  31. Value = What is “Value”? “the regard that something is held to deserve; the importance, worth, or usefulness of something.” Benefit(s) ------------------------------------------------ (Financial Cost + Non-financial Cost)

  32. Defining & Increasing Value: Unique Challenges for Oncology • Sense of urgency as many cancer patients have a poor prognosis and are facing imminent death • Pressures to use newest technologies/treatments • Treatments are expensive, making appropriate cancer care a hardship or unaffordable • Treatments can be highly toxic/life-threatening (secondary expenses) • Providers, patients & families often reluctant to switch to best supportive care, even at the obvious end of life Source: 2009 IOM Report: Assessing and Improving the Value in Cancer Care

  33. Each Stakeholder Has a Role • Providers: trying innovative ways to responsibly control costs while improving quality, through mechanisms such as clinical pathways and adherence to evidence-based medicine • Payers: looking to assure highest and best use of limited resources through the development of innovative benefit designs and pay for performance mechanisms • Patients: mobilizing to promote access through initiatives such as uniform patient assistance programs, patient navigation, and education of individuals and families about the cost of care • Manufacturers: finding ways to innovate in the most cost-effective and efficient way possible

  34. ASCO’s Efforts to Lower Costs, Increase Value • Promoting Adherence to Evidence-Based Medicine: ASCO Guidelines • Participating in & Promoting “Choosing Wisely” • Commitment to Quality Improvement: QOPI • Working with Payers: Integration of Quality Measures into Reimbursement Decision-Making • Cultivating a Learning Healthcare System: CancerLinQ • Establishing Clinically Meaningful Outcomes in Cancer Research • Payment Reform • The Value in Cancer Care Task Force

  35. Taking Action: Cost and Value • Value Task Force developing framework • Sharing with CPC and State Affiliate Council • Presentation at annual meeting • Drug Cost Summit • Industry • Providers • Payers • Patients

  36. The Way Forward • Cost control + no quality monitoring/measurement = inappropriate care • Payer-driven quality efforts must include improved outcomes • Promising initiatives • Solution: Quality measurement, meaningful and feasible to healthcare providers

  37. Growth in QOPI Since 2006

  38. Whatever the path… • Fee for service unlikely to remain dominant model • Prospective payment models are the trend • Shifts reward from volume to efficiency • Risk will move from over- to under-utilization • Because of this, require strong quality measurement programs • Need a national program created by—and meaningful to—oncology professionals • Working to qualify QOPI as means of reporting to Medicare • PQRS historically not meaningful in oncology • QOPI developed by oncology professionals • Aim is to avoid each payer creating their own • eQOPI anticipated by fall 2014 • CancerLinQ in 2015

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