1.This Act may be cited as the
Medicare Quality Cancer Care Demonstration Project Act of
2009
.
2.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.”
3.Medicare quality
cancer care demonstration project
(a)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 programUnder 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)
(1)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
paymentIn 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 paymentIn
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)
(1)Treatment
planning measuresThe
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)
(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
measuresThe specific
measures related to end-of-life care described in this paragraph are as
follows:
(A)
(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)
(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)
(1)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)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)
(1)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)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.