Oncology Payment Reform 101 for Cancer Care

AdvocatesThursday April 23, 2015

Mark E. Thompson, M.D. and Jeff Mortier

WHERE THE DISCUSSIONS ARE BEING HELD

WHERE CARE IS GIVEN!

This is not Washington!

Patient’s speak out.

Patient’s speak out.

Patient’s speak out.

Medicare Expenses are Rising Healthcare cost must be controlled- not

sustainable as it is Data now shows that there are savings in how

care is delivered We are a country of ingenuity and can figure

out how to solve the cost issue- new models are being developed to provide great care at lesser costs

All of us need to be involved to make certain reform is done right- ADVOCACY!

Why Payment Reform?

VALUE= QUALITY/COSTS

THE NEW MANTRA IN HEALTHCARE REFORM IS VALUE BASED PURCHASIN

Increasing cost of care and diminishing reimbursement for care

The increasing regulatory environment they live in now

The interference of insurers in medical decision making

The time we spend fulfilling the increasing burden of documentation

The intrusion into regulation of how we use EHR’s 340 B Program, inequality in reimbursement

compared with Academic and hospital based care The list goes on and on and on

What bothers your Oncologist

Evolving healthcare advances and increasing costs of delivering the new treatments

The increasing presence and control exerted by insurers and by Medicare policy

The MMA of 2003 The Affordable Care Act The regulatory environment of Healthcare

as it relates to Oncology practice Diminishing reimbursement

How did we get where we are?

We advocate for change Examples of change- integrated care models

like the CMMI COME HOME demonstration project, The COA OMH Model, United Healthcare and Aetna bundle care experiments

We advocate at a Congressional level for rationale change and educate Members and their staff regarding what the real world outside D.C. looks and feels like

We innovate

So what do we do??

WE ADVOCATE!

To maintain the viability of community based cancer care

To fairly reimburse practices for what they do To advocate to level the playing field with

academic centers and hospital based centers for the exact same services

To use the regulatory mechanisms fairly and rationally

For legislation to test models of oncology care that are integrated and cost saving at the same time

What are we advocating for and how?

COA Team on the Hill

Jeff Mortier’s take on Payment reform from a lobbyist and former House staff member

A View from DC

DISCUSSION

Wrap up thoughts

How we do this and how you can engage in payment reform