June 2, 2008

TOPS Advocacy Survey: Dual Eligibility and its Effects on Patients and Providers

What’s the Initiative?
TOPS wants to ensure access to critical cancer therapies for our patients most in need.  By definition, cancer patients eligible for healthcare coverage under both Medicare and Medicaid are poor, aged, and/or have a significant disability, and would appear to be the most unfortunate cancer patients in our state.

Facilities serving cancer patients who have both Medicare and Medicaid (TennCare) coverage are not receiving the 20% copayment that TennCare is supposed to pay to providers.  Although the State’s policy  is legal, this means that the 20% copay balance either falls on the Medicaid patient, who cannot afford to pay, or on providers, who have to absorb it.  As a result, some patients may decide to forego  treatment.  Likewise, some providers that cannot afford to cover these lost costs may have to decide to either prescribe a second choice therapy or refer these patients to settings such as hospital out-patient centers, which are costlier and may be further away from their homes.

TOPS members are well aware of these issues and the predicament their practices face when treating dual eligible patients.  Members also know about the many efforts of TOPS leaders to influence TennCare and state officials to update the state’s 1993 Medicaid drug schedule and change the current policy that permits TennCare to abandon the responsibility of paying its share of the costs for chemotherapy medications for dual eligible patients.

Why Legislation?
After years of appealing to TennCare and other state officials and after conferring recently with the Tennessee Medical Association, the TOPS Board of Directors believes that its best option is to go to legislators and ask them to correct this broken policy for cancer patients.  Currently TOPS is studying a proposal it received from one of the lobbying firms in Nashville: JohnsonPoss Government Relations. JohnsonPoss is a full-service government relations firm that focuses its efforts solely on Tennessee state government, both legislative and administrative.

What’s Proposed?
The JohnsonPoss proposal contains two stages:

• Stage 1 would take place the second half of this year, roughly from mid-June to mid-December of 2008.   It would consist of gathering information from TOPS members, who represent the majority of oncologists in the state of Tennessee, and beginning to build relationships with legislators.  At the end of Stage 1, JohnsonPoss would evaluate the legislative climate, the information received from TOPS members, and the ability of TOPS members to engage in pre-legislative activities, and advise TOPS whether it should proceed to implementing Stage2, take another, non-legislative course of action, or discontinue its efforts altogether.  Stage 1 would cost approximately $30,000 ($5000/month for six months) to be paid for by TOPS.

• Stage 2 would be the lobbying effort taking place during the 2009 legislative session.  It would be guided by the information collected and the relationships fostered in Stage 1.  It would cost approximately the same amount as Stage 1 and be paid for by TOPS.

What Would I Have to Do?

Specifically, TOPS members would be asked to provide data to JohnsonPoss on the following:

• Percentage of practice population that is dual eligible, Medicare/Medicaid
• The approximate amount or range of the 20% copayment each practice has to write off for dual eligible patients receiving treatments in their practices
• Whether your practice has to refer dual eligible patients to hospitals.  If so, are hospitals accepting these patients?  What percentage of dual eligible patients have you referred to hospitals for treatment?

This information would be collected by JohnsonPoss to determine the significance of the problem for Tennessee oncologists and dual eligible cancer patients.  It also would be used by JohnsonPoss to advocate on behalf of TOPS and cancer patients in Tennessee who are dual eligible.  Please note, no patient-specific information will be collected, and TOPS will not collect or analyze any of the information.

TOPS members also would be asked to participate in some of the following advocacy activities:

• Learn about grass-roots lobbying (writing letters to legislators, serving as an expert to legislators in explaining current cancer treatments and reimbursement methodology for such treatments, for example)
• Meet with state representatives and senators from your district to gain their support of the initiative
• Donate to legislators’ campaign funds or hold a fundraiser or meet and greet for a candidate seeking election or reelection to a seat in the legislature

Take Our Survey

I would like to hear from you by COB on Friday, June 13, regarding your support of this initiative. Click here to download the survey and fax it to the TOPS Executive Office at 301.770.1949.

TOPS prides itself in its advocacy on behalf of cancer patients and its members; however, TOPS also is sensitive to the reality of the political process and the time, effort, and information needed to wage a successful campaign.  On behalf of the TOPS Board of Directors, I thank you for your input to this important decision.  As always, if you would like to discuss this matter or any others concerning TOPS, please feel free to contact me at (615) 591-4764.

Sincerely,

Patrick B. Murphy, M.D.
President
Tennessee Oncology Practice Society