[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2872 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2872

    To improve the quality and cost effectiveness of cancer care to 
    Medicare beneficiaries by establishing a national demonstration 
                                project.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 15, 2009

    Mr. Davis of Alabama (for himself, Ms. Kilroy, and Mr. Israel) 
 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 improve the quality and cost effectiveness of cancer care to 
    Medicare beneficiaries by establishing a national demonstration 
                                project.

    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 Quality Cancer Care 
Demonstration Project Act of 2009''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) In order to ensure the delivery of quality, cost-
        efficient medical care, Medicare must transform the payment 
        system to one based on evidence-based guidelines and 
        demonstrated quality delivery of care.
            (2) An Institute of Medicine report entitled ``Ensuring 
        Quality Cancer Care'' recommends that the following items are 
        essential components in quality cancer care delivery:
                    (A) An agreed-upon treatment plan that outlines the 
                goals of care.
                    (B) Access to clinical trials.
                    (C) Policies to ensure full disclosure of 
                information about appropriate treatment options to 
                patients.
                    (D) A mechanism to coordinate services.
            (3) Additionally, the report notes the importance of 
        ensuring quality of care at the end of life, in particular, the 
        management of cancer-related pain and timely referral to 
        palliative and hospice care.
            (4) According to the Institute of Medicine, the quality of 
        cancer care must be measured by using a core set of quality 
        measures. Cancer care quality measures should be used to hold 
        providers, including health care systems, health plans, and 
        physicians, accountable for demonstrating that they provide and 
        improve quality of care.
            (5) Although two of the critical components of cancer care 
        are treatment planning and end-of-life care, none of the 153 
        quality measures in the Centers for Medicare & Medicaid 
        Services (CMS) 2009 Physician Quality Reporting Initiative 
        (PQRI) addresses overall treatment planning or end-of-life care 
        for cancer patients.
            (6) The medical literature suggests that adherence to 
        quality metrics and evidence-based guidelines help lower costs 
        by reducing use of physician services, hospitalizations, and 
        supplemental and expensive drugs.''

SEC. 3. MEDICARE QUALITY CANCER CARE DEMONSTRATION PROJECT.

    (a) Establishment.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish a 
quality cancer care demonstration project under this section (in this 
section referred to as the ``QCCD project'') for the purpose of 
establishing quality metrics and aligning Medicare payment incentives 
in the areas of treatment planning and end-of-life care for Medicare 
beneficiaries with cancer.
    (b) Test Metrics and Reporting Systems Through a Pay-for-Reporting 
Incentive Program.--Under the QCCD project, the Secretary shall do the 
following:
            (1) Identify and address gaps in current quality measures 
        related to the areas of active treatment planning and end-of-
        life care by refining the performance measures described in 
        paragraphs (1) and (2) of subsection (d) relating to active 
        treatment planning and end-of-life care for clinician-level 
        reporting.
            (2) Explore the potential to report quality data through 
        registries or other electronic means for treatment planning and 
        end-of-life care data, including identifying data elements 
        necessary to measure quality of treatment planning and end-of-
        life care and determine how those elements could be collected 
        through claims data or registries or other electronic means.
            (3) Test and validate identified treatment planning and 
        end-of-life quality measures through a pay-for-reporting 
        program with oncologists, which program--
                    (A) ensures that oncologists are able to accurately 
                report on measures through simple HCPCS coding 
                mechanisms; and
                    (B) tests processes of submitting treatment 
                planning and end-of-life measures through registries or 
                other electronic means.
    (c) Incentive Payment.--
            (1) In general.--Under the QCCD project, the Secretary 
        shall provide for a separate payment under section 1848 of the 
        Social Security Act (42 U.S.C. 1395w-4), to be divided into a 
        baseline payment amount and an additional payment amount, as 
        specified by the Secretary, for a treatment planning code and 
        for an end-of-life code. The amount of such payments under the 
        project shall be designed to total $300,000,000 each year. 
        Payments under the project shall be designed to be paid on an 
        ongoing basis as claims are submitted.
            (2) Requirement to satisfy baseline mandatory measures to 
        receive baseline payment.--In order for a physician to receive 
        any payment under the QCCD project for treatment planning or 
        end-of-life care, a physician must report in a manner specified 
        under the project that all of the baseline mandatory measures 
        described in paragraph (1)(A) or (2)(A), respectively, of 
        subsection (d) were satisfied.
            (3) Requirement to satisfy all measures to receive 
        additional payment.--In order for a physician to receive the 
        additional payment amount described in paragraph (1) under this 
        subsection for treatment planning or end-of-life care, a 
        physician must report in a manner specified under the project 
        that all of measures described in paragraph (1) or (2), 
        respectively, of subsection (d) were satisfied.
    (d) Measures.--
            (1) Treatment planning measures.--The specific measures 
        related to treatment planning and any subsequent modifications 
        described in this paragraph are as follows:
                    (A) Baseline mandatory measures.--
                            (i) Documented pathology report.
                            (ii) Documented clinical staging prior to 
                        initiation of first course of treatment.
                            (iii) Performed treatment education by 
                        oncology nursing staff.
                            (iv) Provided the patient with a written 
                        care plan for patients in active treatment, 
                        which advises patient of relevant options.
                    (B) Augmented.--
                            (i) Implemented practice-endorsed treatment 
                        plan consistent with nationally recognized 
                        evidence based guidelines.
                            (ii) Documented clinical trial discussed 
                        with the patient, or that no clinical trial 
                        available.
                            (iii) Documented discussion or coordination 
                        with other physicians involved in the patient's 
                        care.
            (2) End-of-life care measures.--The specific measures 
        related to end-of-life care described in this paragraph are as 
        follows:
                    (A) Baseline mandatory.--
                            (i) Documented advanced care planning 
                        session with the patient.
                            (ii) Symptoms assessed and addressed.
                            (iii) Recommended the patient to hospice 
                        program, whether for institutional or home-
                        based hospice care.
                    (B) Augmented.--
                            (i) Documented no acute care hospital 
                        admissions (including admission to an emergency 
                        room or intensive care unit but excluding 
                        admission to a hospice or palliative care unit) 
                        within 30 days of death.
                            (ii) Advanced directive discussion with the 
                        patient documented in the physician's records 
                        and, if agreed to, inclusion of an advanced 
                        directive in such records.
                            (iii) Documented that no chemotherapy 
                        administered within 30 days of death.
    (e) Duration of Project.--
            (1) In general.--The Secretary shall conduct the 
        demonstration project over a sufficient period (of not less 
        than 2 years) to allow for refinement of metrics and reporting 
        methodologies and for analyses. The project shall continue, 
        subject to paragraph (2), to operate until the Secretary has 
        developed and implemented under part B of the Medicare program 
        a payment system that relates payment under such part for 
        professional oncology services to performance on measures 
        developed and refined under the demonstration project.
            (2) Transition.--The Secretary shall provide for a 
        transition period over the course of 2 years during which 
        oncologists are permitted to transition from the payment system 
        under the demonstration project to the payment system described 
        in paragraph (1).
    (f) Project Evaluation.--
            (1) In general.--The Secretary shall conduct an evaluation 
        of the QCCD project--
                    (A) to determine oncologist participation in the 
                project;
                    (B) to assess the cost effectiveness of the 
                project, including an analyses of the cost savings (if 
                any) to the Medicare part A and B programs resulting 
                from a general reduction in physician services, 
                hospitalizations, and supplemental care drug costs;
                    (C) to compare outcomes of patients participating 
                in the project to outcomes for those not participating 
                in the project;
                    (D) to determine the satisfaction of patients 
                participating in the project; and
                    (E) to evaluate other such matters as the Secretary 
                determines is appropriate.
            (2) Reporting.--Not later than 90 days after the completion 
        of the second year following the commencement of the QCCD 
        project, the Secretary shall submit to Congress a report on the 
        evaluation conducted under paragraph (1) together which such 
        recommendations for legislation or administrative action as the 
        Secretary determines is appropriate.
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