ASCO’s mission is conquering cancer through research, education, prevention, and delivery of high-quality patient care. Although less visible than other ASCO activities, each year the Society spends a significant amount of time and resources advancing its mission through legislative policy.
[image:1:right]“The way we pay for cancer care, the incentives we put into those payments, and how we encourage enrollment in clinical trials are all part of ASCO’s mission,” said Blase N. Polite, MD, MPP, of the University of Chicago Medical Center and chair of ASCO’s Government Relations Committee. “Oncologists can go out there and do the best job they possibly can, but if we aren’t involved in the payment models, regulations, and incentives, we are not going to achieve our mission of delivering high-quality cancer care to all patients. Federal and state policy, regulated insurance, the way insurance is provided, and genetic testing all come into the public and legislative sphere. If we didn’t have a strong voice in that, then we would never achieve our goal.”
The ASCO Daily News spoke with Dr. Polite about two of ASCO’s major advocacy efforts in 2014: repeal of the sustainable growth rate (SGR) formula used to set Medicare physician payments, and supporting the House of Representatives Energy and Commerce Committee’s 21st Century Cures initiative.
The SGR formula, created in 1997 as a replacement for the Medicare Volume Performance Standard, was designed to control growth in aggregate Medicare expenditures for physicians’ services.
“However, if the formula was applied without any changes, the physician community would have been looking at cuts in Medicare reimbursement of 21% this year, and nobody in Congress or in the country believed that was a good idea,” Dr. Polite said.
Each year the federal budget assumed that the 20% or greater cuts were going into effect, Dr. Polite said. It would have cost an estimated $140 billion-$170 billion over a 10-year period to get rid of those cuts. Congress passed a series of short-term “patches” over the last few years to sustain the SGR formula, but a long-term solution was needed.
ASCO long advocated for repeal of SGR. In 2014, the Society helped get the bipartisan, bicameral SGR Repeal and Medicare Provider Payment Modernization Act of 2014 through the House Energy and Commerce, House Ways and Means, and Senate Finance Committees.
“We worked long and hard with these committees on the concept and language and were very happy with what they produced because the bill was in line with what ASCO was trying to move forward with, which was a stronger focus on quality, payment tied to quality and value, as well as a move to new, innovative payment models that take the needs of each specialty into account,” Dr. Polite said.
In late March, this hard work paid off when the House voted 392-37 to scrap Medicare’s SGR formula. In mid-April, the Senate followed suit voting 92-8 for what is now known as the Medicare Access and CHIP Reauthorization Act of 2015. Among other changes, the new legislation gives physicians an annual 0.5% increase in Medicare reimbursement for the next 4 years. As of this writing, the bill was on its way to President Barack Obama’s desk, with the President indicating his intentions to sign it into law.
21st Century Cures
The second major focus of ASCO’s advocacy efforts throughout 2014 was the advancement of the 21st Century Cures initiative. Initiated by the House Energy and Commerce Committee, the 21st Century Cures initiative takes a comprehensive look at therapeutics development. Topics include basic scientific discovery, streamlining drug and device development, delivering new therapies, and developing tools to help physicians and patients.
The Senate’s Health, Education, Labor, and Pensions (HELP) Committee has launched a similar initiative called Innovation for Healthier Americans and has held a hearing to examine the process in place for drug and medical device discovery and development and whether public policies can be better aligned to support this innovation.
In a February 23 letter from ASCO President Peter Paul Yu, MD, FACP, FASCO, to HELP Committee leadership, ASCO highlighted the role CancerLinQ™, its new rapid-learning data system, will have in harnessing “vast amounts of usable, searchable, real-world cancer information into a powerful database” and contributing “to high-quality, personalized cancer care.” As with the House effort, ASCO highlighted the need to modernize the clinical trials system, deliver value in care, and ensure robust funding for the National Institutes of Health and the U.S. Food and Drug Administration.
“21st Century Cures is one of the most important legislative initiatives going on in health care that very few people have heard of,” Dr. Polite said. “21st Century Cures begins by asking, in a world of electronic records and big data with rapidly expanding personalized medicine, do we have the health care infrastructure and health care rules in place that allow the biomedical world to really capitalize on these rapid changes, while at the same time putting protections in place to make sure patients are not harmed by this new and rapid technology?”
As part of the 21st Century Cures initiative, the House Energy and Commerce Committee has, as of this writing, issued four white papers and held nine hearings or roundtables examining drug innovation, incentives for therapeutics development, modernization of clinical trials, personalized medicine, barriers to developing evidence, and the perspectives of patients.
ASCO has continued to monitor the committee’s efforts and submitted comments on three of its white papers in 2014.
“ASCO has been involved in almost daily discussions with committee staff to help turn this initiative into legislation and is working in a parallel process with the Senate,” Dr. Polite said. “As this legislation moves forward we are going to be reaching out to our members asking for support.”
ASCO’s ACT Network allows its members to:
- Send a message using the pre-drafted editable alerts,
- Find phone numbers and mailing addresses for elected officials,
- See how members of Congress vote on the key issues, and
- Draft a message to email or send by letter to a member of Congress.
“These types of bills are very technical and require Congress to get interested in moving them forward,” Dr. Polite said. “It is our job to educate our members of Congress and make them aware that these are issues that they need to pay attention to.”