[Congressional Record Volume 146, Number 115 (Monday, September 25, 2000)]
[Extensions of Remarks]
[Pages E1587-E1589]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         TRIBUTE TO ALAN EMORY

                                 ______
                                 

                          HON. JOHN M. McHUGH

                              of new york

                    in the house of representatives

                       Monday, September 25, 2000

  Mr. McHUGH. Mr. Speaker, it is with great pleasure that I rise today 
to pay tribute to Alan Emory, a veteran writer for the Watertown Daily 
Times who is battling pancreatic cancer.
  June 7 marked Alan's 51st year with the Times, 47 years of which he 
spent covering the Capital, earning him the title of Times Senior 
Washington correspondent. As a reporter, Alan has always held himself 
up to the highest standards of journalistic integrity. His readers have 
come to expect objective, accurate and intelligent reporting of events, 
both big and small.
  Alan's readers have also come to expect from him a thoughtful 
understanding of the issues and events that affect our everyday lives. 
Through his weekly Sunday column, Alan has touched the lives of many by 
relating his own experiences, which enlighten and inspire, motivate and 
comfort. One such experience is his battle with cancer. In his weekly 
column, he recounts this very personal ordeal with his usual candor, 
and never before have his sense of humor, his courage, and his humanity 
been more clearly demonstrated to all

[[Page E1588]]

those who have come to know him personally and through his articles.
  This is not Alan's first brush with cancer. in 1991, he had been 
diagnosed and treated for prostate cancer. Experience, however, has not 
made the second time any easier. There were weeks of tests. There were 
unforeseen health complications that delayed surgery. There were 
innumerable pills to take, complicated doctors' orders to follow, and 
long trips back and forth to the hospital.
  Yet--through all this--Alan's spirit, optimism, and courage are 
undiminished. He is gracious and humble as ever and, in his weekly 
articles, he has thanked his friends, family, and his readers for their 
support and prayers.
  Alan's account of his battle with cancer offers hope to all those who 
find themselves in similar circumstances. Fighting a deadly disease can 
be a lonely experience, even with the support of loved ones.
  Alan's articles over the last several months have been important for 
another reason. They were among the first to bring public attention to 
the Health Care Financing Administration's proposed regulation to 
implement severe cutbacks on reimbursement costs to physicians for 
vital outpatient chemotherapy treatment for senior patients. The 
attention that Alan's articles brought to the issue, and the subsequent 
pressure that his readers brought to bear upon public officials, were 
crucial in bringing the Clinton administration to put off plans to 
reduce payments for cancer drugs. I joined with my colleagues in 
writing the Clinton administration objecting to the proposed cutbacks, 
which I felt would put Medicare beneficiaries with cancer unnecessarily 
at risk by denying adequate reimbursement for essential drug therapy. 
Thankfully, the Administration reconsidered its position and ultimately 
decided not to reduce payments to doctors.
  In sharing his experience, Alan not only shares his optimism and his 
spirit, he has helped prevent a potentially devastating regulation from 
coming into effect. Because of their significance in this regard, I ask 
that copies of Alan's stories, those on his own battle with cancer, as 
well as those on the Medicare cancer cutbacks, be printed in their 
entirety in the Record.
  Mr. Speaker, I rise today to pay tribute to a great journalist, and 
more importantly, a good friend, Alan Emory. He has touched the lives 
of thousands--many of whom will never get the opportunity to thank him 
for all he has done in the course of his career. From all of us, I say 
thank you, Alan.

             [From the Watertown Daily Times, July 2, 2000]

        Payment Change May Spell End Of Outpatient Chemotherapy

                            (By Alan Emory)

       The Clinton Administration giveth and it taketh away.
       The president makes a big deal of wanting the federal 
     Medicare program to cover the cost of many prescription drugs 
     for senior citizens who cannot afford them. He has pressed 
     Congress to pass legislation providing for that help.
       He says nothing, however, about a regulation issued by 
     Health and Human Services Secretary Donna Shalala that runs 
     flatly contrary to what he is asking from Congress.
       That rule, by the Health Care Finance Administration which 
     would take effect Oct. 1 unless scrapped by her department or 
     blocked by lawmakers--would effectively end vital outpatient 
     chemotherapy treatment of senior cancer patients in the 
     offices of oncologists and, perhaps later, in hospitals.
       It would be achieved by cutting back severely on 
     reimbursement costs to physicians. In other words, at a time 
     of huge budget surpluses likely over the next decade, the 
     folks with green eyeshades and blue pencils would come out on 
     top at the expense of patients.
       From all appearances, analyses by experts have found that 
     by swallowing 5 percent of chemotherapy drug costs, 
     oncologists and hospitals get a fair reimbursement. But the 
     new HCFA regulation would increase that shortfall to as much 
     as 13 percent, effectively pressuring physicians to 
     discontinue their chemotherapy office procedures, dismiss 
     nurses and send patients to long lines at hospitals, assuming 
     the hospital can continue to treat them.
       There is a very good chance the hospitals might decide to 
     close down their outpatient treatment services, too, in which 
     case the patients would have no idea where to obtain their 
     drugs.
       About 60 percent of chemotherapy is now delivered in 
     doctors' offices, a more comfortable environment for patients 
     and a setting where they and their doctors and nurses can 
     have a satisfactory relationship.
       The compensation doctors receive would, on Oct. 1, be 
     determined by an average wholesale price of the drugs set by 
     a Justice Department ``red book'' for 20 drugs to treat 
     cancer, and the pressure is on to lower that figure even 
     more.
       Letters to Congress have stressed that oncologists deserve 
     an increase above that price, not a reduction, and they point 
     out that many hospitals and doctors cannot obtain the needed 
     drugs at those prices.
       This is not the story of greedy drug manufacturers boosting 
     prices to the point where some Americans travel to Canada to 
     obtain medication at reasonable prices. It is not a story of 
     doctors and hospitals pocketing huge markups. It is one about 
     a reduction in compensation for doctors that may be cut even 
     more to a point where the welfare of senior citizen cancer 
     patients is endangered.
       Basically, some surveys find, chemotherapy administration 
     is essentially a break-even proposition in hospitals. More 
     losses could persuade them to shut down their outpatient 
     cancer programs.
       This obviously is not Congress's intent in moving on 
     prescription drugs, but lawmakers appear to have been 
     influenced by the stories of profiteering on non-cancer 
     drugs. It is highly likely, according to local medical 
     groups, that many oncology offices will close down or reduce 
     size and staff.
       The oncologists have a compelling argument. They cite the 
     large cost of providing chemotherapy in a setting that is not 
     adequately reimbursed under Medicare. Shutting down their 
     operation would force patients to shift to hospitals, where 
     costs would be greater and timely treatment imperiled.
       Furthermore, hospital bureaucracy is a far cry from the 
     convenience and comfort involved in office chemotherapy.
       This does not contradict the need to strike a balance 
     between providing adequate cancer care and controlling the 
     cost of that care. However, substantial reduction in 
     reimbursement cannot but damage quality care.
       Many government experts--though, apparently, not Ms. 
     Shalala--understand oncologists do not receive adequate 
     reimbursement for cancer drugs and administering 
     chemotherapy. It is repugnant to force cancer patients into 
     hospitals because Medicare rules threaten the financial 
     viability of treatment in a doctor's office.
       The losers, says one medical organization, will be cancer 
     patients who may lose access to quality cancer care in the 
     setting that is most convenient and appropriate for them.
       Oncologists argue that Medicare's payment for chemotherapy 
     administration ``is only a fraction of what is necessary to 
     cover expenses.'' They cite requirements for specially 
     trained nurses, special equipment and considerable time, 
     entirely aside from the strong preference Medicare patients 
     have for the office treatment.
       Sen. Daniel Patrick Moynihan, D-N.Y., as the ranking 
     minority member of the Senate Finance Committee, which 
     supervises Medicare, is in a position to help solve the 
     problem.
       Either Congress or the White House can halt this 
     devastating move on Medicare cancer treatment, but the Oct. 1 
     deadline is looming ever larger.

                                  ____
                                  

            [From the Watertown Daily Times, Sept. 9, 2000]

     Moynihan Applauds as Medicare ``Backs Off'' Payment Reductions

                            (By Alan Emory)

       Washington.--Sen Daniel Patrick Moynihan late Friday hailed 
     a Medicare decision not to reduce payments to doctors that 
     would have threatened treatments for up to 750,000 senior 
     citizens with cancer.
       The New York Democrat, senior minority member of the Senate 
     Finance Committee, which has jurisdiction over Medicare, 
     said, in a statement to the Times, that he was ``pleased to 
     learn that the Health Care Financing Administration will not 
     be interfering with the ability of cancer patients to receive 
     chemotherapy in their own doctors' offices.''
       Although Health and Human Services Secretary Donna E. 
     Shalala had proposed a severe cut in Medicare reimbursement 
     for outpatient cancer care, HCFA told members of Congress it 
     has decided not to implement the cuts for 14 oncology drugs 
     and three clotting factors.
       The move, which confirmed what HCFA officials had hinted 
     was in the works, in interviews with the Watertown Daily 
     Times, would protect treatment with drugs ``furnished 
     incident to a physician's services'' and oral anti-cancer 
     drugs.
       HCFA uses figures published by the Justice Department on 
     which to base reimbursement.
       The agency detailed its decision in letters to Chairman 
     Thomas Bliley, R-Va., of the House Commerce Committee and 
     Rep. Fortney Stark, D-Calif., the ranking minority members.
       The first word was contained in a telephone call to the 
     Times from Dr. Robert Berenson, director of the HCFA division 
     in charge of Medicare reimbursement policy.
       The Watertown Times broke the news about the proposed 
     cutback July 2 and reported the possible reversal of policy 
     shortly after that following interviews with HCFA and Senate 
     Finance Committee officials.
       Rep. John M. McHugh, R-Pierrepont Manor, had signed a 
     letter, with colleagues from both parties, to Ms. Shalala, 
     objecting to the cutbacks, according to his deputy chief of 
     staff, Dana Johnson.
       HCFA has told insurance companies and drug companies it had 
     ``concern about access to care related to . . . wholesale 
     prices for 14 chemotherapy drugs'' because of other Medicare 
     payment policies associated with treatment of cancer and 
     hemophilia.
       They were instructed not to consider using current Justice 
     Department data for the drugs to establish Medicare 
     allowances until HCFA had reviewed those concerns and 
     developed alternative policies.

[[Page E1589]]

       Dr. Berenson said his agency would consult with oncologist 
     groups on a substitute policy of payments for nursing help 
     and other office facilities in the application of 
     chemotherapy.
       ``We plan to adjust Medicare allowances under the 
     outpatient prospective system'' for drugs subject to 
     government reimbursement rules, HCFA said, in a statement. 
     Congressional offices expressed satisfaction with what they 
     said was the government's ``backing off'' of the cutbacks.
       Sen. John Ashcroft, R-Mo., has introduced legislation that 
     would bar such cuts until after full congressional hearings 
     and that would require an investigation by the General 
     Accounting Office into the possible impact of a reduction of 
     government aid.
       Physician, patient and other citizen groups had described 
     the original proposal, which could have taken effect Oct. 1, 
     as a severe threat to cancer care.
       No new reimbursement changes are now expected for at least 
     the next four months, during which time HCFA will be 
     redrafting its cancer reimbursement policies.

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