The Coming Year…Issues, Challenges, and Creating a United Front

Mark D. Browning, MD
IMOS President

I had the privilege of representing IMOS at the American Society of Clinical Oncology’s (ASCO) Clinical Practice Committee meeting and the Association of Community Cancer Centers’ (ACCC) 16th Annual Oncology Presidents Retreat in Washington, D.C., in January. The various speakers and sessions provided us with several insights about current and future national issues that will influence the practice of oncology and the services we provide to our patients.

Predictions for the next decade indicate that there will be 23 percent more beneficiaries of Medicare benefits, but 13 percent fewer workers paying into the Medicare fund. A 52 percent rise in the cost of medical care is predicted, as this is the first decade that baby boomers may utilize their Medicare benefits.

The opening session of the Retreat featured two broadcast journalists, Fred Barnes and Bill Press, who commented on the presidential primaries and November election. They both indicated that the economy, political change, and the war in Iraq will influence and be influenced by budgetary decisions in the coming year. Each representing a mainstream political party, they disagreed a lot, but they did agree that oncology and medicine are not isolated worlds and will be influenced directly or indirectly by the political changes in 2008.

The Issues. Representatives from several states are active participants in furthering our cause to deliver quality oncology care to our patients and be paid equitably for our services. A physician from Oregon described his representation on the coding board to ensure optimal medical coding for oncology. He has volunteered his time and services to ensure that oncology services are included in the coding process and properly labeled.

Other physician representatives from New Mexico and Florida described the process of starting dispensing pharmacies in their offices. They warned that states have different rules and regulations regarding dispensing, and that we need to be aware of the legal restraints and requirements when considering this addition to our practices. Representatives from other states mentioned many pros/cons of pharmacies/dispensaries that they considered before opening pharmacies: the number of scripts per day needs to be considered for profitability; dispensing varies from oncology drugs, antiemetics, antibiotics, and narcotics with some physicians dispensing all of these drugs, and some dispensing only a portion; co-pays for some patients are formidable and need to be considered, with under-insured patients posing the most difficult challenges for most offices.

The Challenges. Research has greatly advanced the treatment of cancer and will continue to improve it in the future. This is why conducting clinical trials is such a big issue to those of us in oncology. Only about 20 percent of patients have easy access to large medical centers that sponsor many different kinds of clinical trials, but community oncologists care for approximately 80 percent of the oncology patients.

Small practices, in particular, face many challenges when managing clinical trials. NCI-sponsored trials are remunerated at a minimal amount; the amount of remuneration is greater with pharmaceutical-sponsored trials. A trend toward blending these two types is growing. The cost of starting protocols is not remunerated until patients are accrued; these costs can be substantial for some practices especially if there is no or minimal accrual. The cost of follow-up studies for many protocols needs to be scrutinized closely; many studies require frequent scans including PET scans for which insurers may not pay. This needs to be clarified with insurers and state laws prior to accrual of patients. Needless to say, both patients and providers need mechanisms that will assure user-friendly, insurance-supported, and safe clinical trials.

The Centers for Medicare and Medicaid Services (CMS) have updated the number of journals approved to qualify for off-label indications for anticancer treatments. The new journals can be found on ACCC, ASCO, and CMS websites and should expand acceptance of reimbursement for additional off-label treatments. In addition, in the very near future a review will be conducted of drug compendia that are acceptable to CMS for Medicare/Medicaid reimbursement. It is thought that the NCCN compendium will be one of those accepted by CMS to make reimbursement determinations for cancer therapies.

Creating a United Front. The next year will be an exciting one, as it will include events that affect both our personal and our professional lives. Some changes can be foreseen and some cannot. One thing we can do is to work together with the ACCC and ASCO for the optimal care of our patients. Membership in our State Society as well as collaboration on a national level will help us make our voices heard in Washington D.C.

Please join me in recruiting new members into IMOS. And, finally, please mark October 15 for our 2008 Annual Membership Meeting, which will take place at the Indianapolis Hilton downtown. Additional information is forthcoming on the Meetings and Events page on this website.