Medicare Patient Access to Cancer Treatment Act of 2013 - Expresses the sense of Congress that, to ensure the future of community cancer care, 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 (OPD) or physician's office.
Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to the prospective payment system (PPS) for OPD services to require that the payment amount under PPS and physician fee schedules for covered OPD cancer services be a budget neutral combination of the amount otherwise payable under the PPS and the amount otherwise payable under the physician fee schedule for such services.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2869 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 2869
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 setting.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 31, 2013
Mr. Rogers of Michigan (for himself and Ms. Matsui) 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 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 setting.
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 Patient Access to Cancer
Treatment Act of 2013''.
SEC. 2. FINDINGS; SENSE OF CONGRESS.
(a) Findings.--Congress finds the following:
(1) The National Cancer Institute estimates that
approximately 13.7 million Americans with a history of cancer
were alive on January 1, 2012.
(2) About 8 million of the 13.7 million Americans living
with cancer are over age 65, and approximately half of cancer
care spending is associated with Medicare beneficiaries.
(3) National spending on cancer care in 2010 is estimated
at $125 billion.
(4) In 2011, the National Cancer Institute released
projections of the cost of cancer care in the United States,
finding the total cost of cancer care in 2020 is expected to be
$206 billion.
(5) In a 2010 study, Milliman reported that in 2007 a
cancer patient receiving chemotherapy incurred average costs of
approximately $111,000, three times the cost of a coronary
artery disease patient, and six times the cost of a diabetes
patient.
(6) Over the last several years, the United States has been
touted as world leader in providing high-quality cancer care.
(7) United States cancer survival rates are higher than the
average in Europe and Canada for 13 of 16 types of cancer.
(8) Until recently, over 80 percent of United States cancer
patients received care in the community setting.
(9) Over the past several years, the country has
experienced a significant shift of outpatient cancer care
delivery from the physician's office to the hospital outpatient
department.
(10) Reports show that over the past six years, 43
community practices have started referring all of their
patients elsewhere for treatment, 288 oncology office locations
have closed, 131 practices have merged or were acquired by a
corporate entity other than a hospital, and 469 oncology groups
have entered into an employment or professional services
agreement with a hospital.
(11) Over 1,000 clinics or practices have been impacted
over the last 3 years out of a population of only 6,000
oncologists in community practice in the United States.
(12) A 2013 study published by The Moran Company (``Moran
study'') found that, between 2005 and 2011, there was a 150
percent increase in administered chemotherapy in the hospital
outpatient setting for Medicare fee-for-service beneficiaries
(increasing from 13.5 percent in 2005 to 33.0 percent in 2011)
as compared to administration in physician community cancer
clinics.
(13) The Moran study found that, in 2005, almost 87 percent
of Medicare patients were receiving their care in the community
setting, by 2011 only 67 percent were utilizing the community
setting.
(14) The Moran study reports that Medicare payments for
chemotherapy administered in hospital outpatient settings have
more than tripled since 2005 (from $90 million to $300 million)
while payments to physician community cancer clinics have
actually decreased by 14.5 percent.
(15) The Medicare physician fee schedule rate in 2012 for
CPT Code 96413 (Chemo, iv infusion, 1 hr), the most common drug
administration code billed by oncology practices, is $139 but
the payment rate for the same service under the Medicare
hospital outpatient prospective payment system (HOPPS) fee
schedule in 2012 is 50 percent higher at $208.
(16) Utilization-weighted Medicare payment for infusion
services is approximately 55 percent higher at the hospital
outpatient department than in a physician's office.
(17) Medicare proposed in 2012 to pay hospital outpatient
departments 25 percent more for radiation therapy services than
for the same services performed in physicians' offices,
including a 70 percent differential for intensity modulated
radiation treatment (IMRT) and a 188 percent differential for
stereotactic body radiation therapy delivery (SBRT).
(18) One third of hospitals in the United States purchase
chemotherapy drugs through the section 340B program at a
discount of up to 50 percent, resulting in a net cost to such
hospitals that typically is at least 30 percent below
reimbursement rate (which is based on 106 percent of the
average sales price) for community oncologists for such drugs.
(19) Medicare reimburses 70 percent of hospital bad debt
(uncollectable coinsurance).
(20) According to an October 2011 Milliman study, the cost
of treating cancer patients is significantly lower for both
Medicare patients (10 percent lower in copayment amounts, more
than $650 savings a year) and the Medicare program (14.2
percent less, a savings of $6,500 a year per patient) when
provided in community-based cancer settings as compared to the
same treatment in hospital outpatient departments.
(21) The April 1, 2013, sequestration cuts to Medicare
allowed for a 28 percent cut to the services reimbursement in
Medicare part B drugs to community oncologists.
(22) A recent Community Oncology Alliance survey showed
that 69 percent of practices surveyed reported that patient
treatment or operational changes already have been made due to
the sequester cut to cancer drugs, with 49 percent of practices
forced to send Medicare patients elsewhere for treatment, and
62 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 31, 2013.
(23) The June 2013 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 practices, driving up costs for the Medicare
program and for beneficiaries.
(b) Sense of Congress.--It is the sense of Congress that, to ensure
the future of community cancer care, 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 office.
SEC. 3. EQUALIZING MEDICARE REIMBURSEMENT IN HOSPITAL OUTPATIENT
DEPARTMENTS AND PHYSICIANS' OFFICES FOR CANCER CARE
SERVICES.
(a) In General.--Section 1833(t) of the Social Security Act (42
U.S.C. 1395l(t)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (G), by striking ``and'' at the
end;
(B) in subparagraph (H), by striking the period at
the end and inserting ``; and''; and
(C) by inserting after subparagraph (H) the
following new subparagraph:
``(I) payment for covered OPD services that are
cancer care services (as defined in subparagraph (B) of
paragraph (18)) shall be made consistent with
subparagraph (A) of such paragraph.''; and
(2) by adding at the end the following new paragraph:
``(18) Special payment rule for cancer care services.--
``(A) In general.--In the case of cancer care
services that are furnished on or after January 1,
2014, the payment amount for such services under this
subsection and under section 1848 shall be a budget
neutral combination (as determined by the Secretary)
of--
``(i) the amount otherwise payable under
this subsection for such services; and
``(ii) the amount otherwise payable under
section 1848 for such services.
``(B) Cancer care services defined.--For purposes
of this subsection, the term `cancer care services'
means covered OPD services or physicians' services for
which payment is made under section 1848 that are
furnished in conjunction with the diagnosis or
treatment of cancer.''.
(b) Conforming Amendment.--Section 1848(a) of Social Security Act
(42 U.S.C. 1395w-4(a)) is amended by adding at the end the following
new paragraph:
``(9) Application of special rule for cancer care
services.--In the case of physicians' services that are cancer
care services (as defined in subparagraph (B) of section
1833(t)(18)) that are furnished on or after January 1, 2014,
the payment amount for such services under this section shall
be the payment amount for such services determined under
subparagraph (A) of such section.''.
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Introduced in House
Introduced in House
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 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 the Subcommittee on Health.
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