Representatives of the Community Oncology Alliance (COA) and the American Society of Clinical Oncology (ASCO) were among those that testified about problems with the current system of Part B reimbursement at a hearing held by the House Ways and Means Subcommittee on Health. Written testimony submitted by those who testified at the July 13 hearing, along with a transcript of the session, is available at the COA website.
Frederick M. Schnell, MD, president of COA, testified that services reimbursement has decreased by more than 20% from 2003 to 2006. This is because demonstration projects and transition increases have expired, and new CPT codes for 2006 have been devalued. He cited findings about problems with access to care from the organization’s survey (summarized in a July 13 Practice Manager Insider posting), and concluded that, “Community cancer clinics cannot operate when reimbursement continues to be ratcheted down while operating costs are increased by at least 4% per year.” Some patients go untreated, he told the committee, “…because clinics cannot afford to provide treatment that is reimbursed less than cost.”
He suggested eliminating “prompt payment” discounts from calculation of the average sales price (ASP), removing the 6-month lag in ASP calculation (between price changes and their reflection in the ASP), creating payment codes for services that Medicare does not reimburse (eg, treatment planning, pharmacy facilities), and helping with bad debt remaining when patients cannot pay their 20% Medicare coinsurance. ASCO’s interim executive vice president Joseph S. Bailes, MD, concurred with most of these points.
COA is urging community oncology practices to submit written testimony about these issues. The subcommittee is accepting written testimony until July 27. Instructions about how to submit testimony are available on the subcommittee’s website.
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