Medicare Quality Cancer Care Demonstration Project Act of 2009 - Directs the Secretary of Health and Human Services to establish a quality cancer care demonstration project for the purpose of establishing quality metrics and aligning payment incentives under title XVIII (Medicare) of the Social Security Act in the areas of treating planning and end-of-life care for Medicare beneficiaries with cancer.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2872 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 2872
To improve the quality and cost effectiveness of cancer care to
Medicare beneficiaries by establishing a national demonstration
project.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 15, 2009
Mr. Davis of Alabama (for himself, Ms. Kilroy, and Mr. Israel)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committee on Ways and
Means, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To improve the quality and cost effectiveness of cancer care to
Medicare beneficiaries by establishing a national demonstration
project.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Quality Cancer Care
Demonstration Project Act of 2009''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) In order to ensure the delivery of quality, cost-
efficient medical care, Medicare must transform the payment
system to one based on evidence-based guidelines and
demonstrated quality delivery of care.
(2) An Institute of Medicine report entitled ``Ensuring
Quality Cancer Care'' recommends that the following items are
essential components in quality cancer care delivery:
(A) An agreed-upon treatment plan that outlines the
goals of care.
(B) Access to clinical trials.
(C) Policies to ensure full disclosure of
information about appropriate treatment options to
patients.
(D) A mechanism to coordinate services.
(3) Additionally, the report notes the importance of
ensuring quality of care at the end of life, in particular, the
management of cancer-related pain and timely referral to
palliative and hospice care.
(4) According to the Institute of Medicine, the quality of
cancer care must be measured by using a core set of quality
measures. Cancer care quality measures should be used to hold
providers, including health care systems, health plans, and
physicians, accountable for demonstrating that they provide and
improve quality of care.
(5) Although two of the critical components of cancer care
are treatment planning and end-of-life care, none of the 153
quality measures in the Centers for Medicare & Medicaid
Services (CMS) 2009 Physician Quality Reporting Initiative
(PQRI) addresses overall treatment planning or end-of-life care
for cancer patients.
(6) The medical literature suggests that adherence to
quality metrics and evidence-based guidelines help lower costs
by reducing use of physician services, hospitalizations, and
supplemental and expensive drugs.''
SEC. 3. MEDICARE QUALITY CANCER CARE DEMONSTRATION PROJECT.
(a) Establishment.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall establish a
quality cancer care demonstration project under this section (in this
section referred to as the ``QCCD project'') for the purpose of
establishing quality metrics and aligning Medicare payment incentives
in the areas of treatment planning and end-of-life care for Medicare
beneficiaries with cancer.
(b) Test Metrics and Reporting Systems Through a Pay-for-Reporting
Incentive Program.--Under the QCCD project, the Secretary shall do the
following:
(1) Identify and address gaps in current quality measures
related to the areas of active treatment planning and end-of-
life care by refining the performance measures described in
paragraphs (1) and (2) of subsection (d) relating to active
treatment planning and end-of-life care for clinician-level
reporting.
(2) Explore the potential to report quality data through
registries or other electronic means for treatment planning and
end-of-life care data, including identifying data elements
necessary to measure quality of treatment planning and end-of-
life care and determine how those elements could be collected
through claims data or registries or other electronic means.
(3) Test and validate identified treatment planning and
end-of-life quality measures through a pay-for-reporting
program with oncologists, which program--
(A) ensures that oncologists are able to accurately
report on measures through simple HCPCS coding
mechanisms; and
(B) tests processes of submitting treatment
planning and end-of-life measures through registries or
other electronic means.
(c) Incentive Payment.--
(1) In general.--Under the QCCD project, the Secretary
shall provide for a separate payment under section 1848 of the
Social Security Act (42 U.S.C. 1395w-4), to be divided into a
baseline payment amount and an additional payment amount, as
specified by the Secretary, for a treatment planning code and
for an end-of-life code. The amount of such payments under the
project shall be designed to total $300,000,000 each year.
Payments under the project shall be designed to be paid on an
ongoing basis as claims are submitted.
(2) Requirement to satisfy baseline mandatory measures to
receive baseline payment.--In order for a physician to receive
any payment under the QCCD project for treatment planning or
end-of-life care, a physician must report in a manner specified
under the project that all of the baseline mandatory measures
described in paragraph (1)(A) or (2)(A), respectively, of
subsection (d) were satisfied.
(3) Requirement to satisfy all measures to receive
additional payment.--In order for a physician to receive the
additional payment amount described in paragraph (1) under this
subsection for treatment planning or end-of-life care, a
physician must report in a manner specified under the project
that all of measures described in paragraph (1) or (2),
respectively, of subsection (d) were satisfied.
(d) Measures.--
(1) Treatment planning measures.--The specific measures
related to treatment planning and any subsequent modifications
described in this paragraph are as follows:
(A) Baseline mandatory measures.--
(i) Documented pathology report.
(ii) Documented clinical staging prior to
initiation of first course of treatment.
(iii) Performed treatment education by
oncology nursing staff.
(iv) Provided the patient with a written
care plan for patients in active treatment,
which advises patient of relevant options.
(B) Augmented.--
(i) Implemented practice-endorsed treatment
plan consistent with nationally recognized
evidence based guidelines.
(ii) Documented clinical trial discussed
with the patient, or that no clinical trial
available.
(iii) Documented discussion or coordination
with other physicians involved in the patient's
care.
(2) End-of-life care measures.--The specific measures
related to end-of-life care described in this paragraph are as
follows:
(A) Baseline mandatory.--
(i) Documented advanced care planning
session with the patient.
(ii) Symptoms assessed and addressed.
(iii) Recommended the patient to hospice
program, whether for institutional or home-
based hospice care.
(B) Augmented.--
(i) Documented no acute care hospital
admissions (including admission to an emergency
room or intensive care unit but excluding
admission to a hospice or palliative care unit)
within 30 days of death.
(ii) Advanced directive discussion with the
patient documented in the physician's records
and, if agreed to, inclusion of an advanced
directive in such records.
(iii) Documented that no chemotherapy
administered within 30 days of death.
(e) Duration of Project.--
(1) In general.--The Secretary shall conduct the
demonstration project over a sufficient period (of not less
than 2 years) to allow for refinement of metrics and reporting
methodologies and for analyses. The project shall continue,
subject to paragraph (2), to operate until the Secretary has
developed and implemented under part B of the Medicare program
a payment system that relates payment under such part for
professional oncology services to performance on measures
developed and refined under the demonstration project.
(2) Transition.--The Secretary shall provide for a
transition period over the course of 2 years during which
oncologists are permitted to transition from the payment system
under the demonstration project to the payment system described
in paragraph (1).
(f) Project Evaluation.--
(1) In general.--The Secretary shall conduct an evaluation
of the QCCD project--
(A) to determine oncologist participation in the
project;
(B) to assess the cost effectiveness of the
project, including an analyses of the cost savings (if
any) to the Medicare part A and B programs resulting
from a general reduction in physician services,
hospitalizations, and supplemental care drug costs;
(C) to compare outcomes of patients participating
in the project to outcomes for those not participating
in the project;
(D) to determine the satisfaction of patients
participating in the project; and
(E) to evaluate other such matters as the Secretary
determines is appropriate.
(2) Reporting.--Not later than 90 days after the completion
of the second year following the commencement of the QCCD
project, the Secretary shall submit to Congress a report on the
evaluation conducted under paragraph (1) together which such
recommendations for legislation or administrative action as the
Secretary determines is appropriate.
<all>
Introduced in House
Introduced in House
Referred to House Energy and Commerce
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to House Ways and Means
Referred to the Subcommittee on Health.
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