[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2939 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2939

To provide for a pilot program to improve the quality of oncology care 
                            under Medicare.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 18, 2009

Mr. Crowley (for himself, Mr. Rogers of Michigan, Mrs. Capps, Mr. Ryan 
  of Wisconsin, Ms. Eshoo, Mr. Kind, Mr. Thompson of California, Mr. 
    Gordon of Tennessee, Mr. Pascrell, Mr. Tiberi, Ms. Berkley, Mr. 
Blumenauer, Mr. Davis of Kentucky, Mr. Moore of Kansas, Mr. Gene Green 
  of Texas, Mr. Israel, Ms. Schwartz, and Mr. Altmire) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
 and in addition to the Committee on Energy and Commerce, 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 provide for a pilot program to improve the quality of oncology care 
                            under Medicare.

    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 ``Oncology Care Quality Improvement 
Act of 2009''.

SEC. 2. ONCOLOGY CARE QUALITY IMPROVEMENT PROGRAM.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish a pilot 
program (in this section referred to as the ``OCQI program'') under 
title XVIII of the Social Security Act to evaluate the impact of three 
provider-led approaches described in subsection (b) to improve care 
quality and outcomes for Medicare beneficiaries with cancer while 
addressing care cost drivers by creating greater efficiencies in the 
program.
    (b) Approaches Described.--The approaches described in this 
subsection are the following approaches to the delivery of oncology 
care:
            (1) Evidence-based guideline adherence.--Reducing variation 
        in care through adherence to evidence-based guidelines that 
        improves quality and reduces error.
            (2) Patient education and care coordination services.--
        Providing patients with--
                    (A) dedicated educational sessions about the likely 
                effects of their cancers and treatments and how to 
                manage those prior to initiation of treatment, 
                preferably from an oncology nurse; and
                    (B) continuous support throughout their course of 
                care.
            (3) End-of-life planning and counseling services.--
        Providing patients with poor prognoses with end-of-life 
        planning and counseling services with their physicians and 
        nurses in order to empower such patients and their families 
        with the best information available about their options to 
        assist such patients and families in making difficult choices 
        between pursuing potentially ineffective aggressive medical 
        treatments or pursuing hospice care or other palliative care to 
        improve quality of life in their final months.
    (c) Description.--
            (1) In general.--The OCQI program shall be designed in a 
        manner similar to that for the physician group practice 
        demonstration program under section 1866A of the Social 
        Security Act (42 U.S.C. 1395cc-1) and shall provide performance 
        payments to participating oncology groups that implement each 
        of the approaches described in subsection (b) equal to one-half 
        of the program savings generated by the participating group. 
        The other half of program savings shall be retained by the 
        Medicare program.
            (2) Expenditure targets.--Under the OCQI program, the 
        Secretary shall establish per capita expenditure targets for 
        participating oncology groups, taking into account the risk 
        characteristics of the patients involved. Those groups that 
        meet the performance goals established by the Secretary and 
        achieve program savings against the expenditure targets shall 
        receive performance payments described in paragraph (1).
            (3) Limitation on number of participating groups.--The 
        Secretary shall limit the number of groups that may participate 
        in the OCQI program to no more than 75 groups at any time.
            (4) Limitation on duration.--The OCQI program shall be 
        conducted over a 3-year period.
            (5) Limitation on patient selection.--The Secretary shall 
        prohibit groups participating in the OCQI program from 
        selecting the individual patients to be included in the 
        program.
            (6) Penalties to prevent reductions in services.--The 
        Secretary may impose penalties on those groups participating in 
        the OCQI program that the Secretary determines have 
        inappropriately reduced cancer therapies, including supportive 
        care therapies (basing their determination on existing evidence 
        based, medically accurate guidelines). Any such penalties shall 
        be in the form of reductions to performance payments payable to 
        the groups under paragraph (1).
    (d) Advisory Committee; Evaluation.--
            (1) In general.--The Secretary shall appoint an advisory 
        committee composed of representatives of the oncology 
        community, including organizations representing physicians, 
        nurses, and patients, and industry representatives, to 
        collaborate with the Secretary on the creation and 
        implementation of the OCQI program, including the development 
        of appropriate expenditure targets, and to help analyze the 
        data generated by the OCQI program. The advisory committee 
        shall specifically advise the Secretary on the methods for 
        selecting practices in different regions of the United States 
        to particiapte in the OCQI program.
            (2) Evaluation.--In consultation with the advisory 
        committee, Secretary shall evaluate the OCQI program to--
                    (A) assess patient outcomes for patients 
                participating in the program as compared to such 
                outcomes to other individuals for the same health 
                conditions;
                    (B) analyze the cost effectiveness of the services 
                for which performance payments are made under the 
                program, including an evaluation of the cost savings to 
                the Medicare program attributable to reductions in 
                physicians' services, emergency room visits, hospital 
                stays, drug costs, advanced imaging costs, and end-of-
                life care;
                    (C) determine the satisfaction of patients 
                participating in the program; and
                    (D) refine the appropriate level and proportion of 
                the specific performance payments among the three 
                performance components of the program.
    (e) Implementation.--If the Secretary determines that the OCQI 
program has been successful in improving care quality while lowering 
the rate of growth of Medicare program expenditures, the Secretary is 
authorized to include payments for the specific services paid under the 
OCQI program as performance payments as permanent, covered services 
under the Medicare program.
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