[Congressional Record (Bound Edition), Volume 151 (2005), Part 16]
[House]
[Pages 22390-22392]
[From the U.S. Government Publishing Office, www.gpo.gov]




EXPRESSING SENSE OF HOUSE OF REPRESENTATIVES THAT CENTERS FOR MEDICARE 
      & MEDICAID SERVICES BE COMMENDED FOR IMPLEMENTING MEDICARE 
                         DEMONSTRATION PROJECT

  Mr. DEAL of Georgia. Mr. Speaker, I move to suspend the rules and 
agree to the resolution (H. Res. 261) expressing the sense of the House 
of Representatives that the Centers for Medicare & Medicaid Services 
should be commended for implementing the Medicare demonstration project 
to assess the quality of care of cancer patients undergoing 
chemotherapy, and should extend the project, at least through 2006, 
subject to any appropriate modifications, as amended.
  The Clerk read as follows:

                              H. Res. 261

       Whereas chemotherapy for cancer patients is primarily 
     furnished in physician offices and is therefore subject to 
     the revised method for determining payment amounts;
       Whereas in 2005 the Medicare program instituted a 
     demonstration project to assess the quality of care for 
     patients undergoing chemotherapy by collecting data on the 
     impact of chemotherapy on cancer patients' quality of life;
       Whereas the demonstration project is a strong effort to 
     improve the quality of cancer treatment by assessing pain, 
     nausea and vomiting, and fatigue;
       Whereas the demonstration project reflects a foundation to 
     evaluate important patient services moving forward;
       Whereas payment amounts under the demonstration project 
     have mitigated the significant reductions in Medicare support 
     for chemotherapy services that would otherwise have gone into 
     effect;
       Whereas reports by the Department of Health and Human 
     Services and the Medicare Payment Advisory Commission 
     regarding any adverse effects from the changes in the 
     reimbursement method for chemotherapy services are not due 
     until late 2005 and January 1, 2006;
       Whereas the demonstration project achieves the concurrent 
     objectives of collecting data to improve the quality of 
     cancer care and maintaining financial support for cancer 
     chemotherapy pending the completion and review of studies on 
     the recent reimbursement changes;
       Whereas it may be possible to modify the demonstration 
     project to collect additional or different data elements that 
     would make it even more useful in enhancing the quality of 
     cancer care; and
       Whereas it is essential that the access of Medicare cancer 
     patients to chemotherapy treatment be maintained and in the 
     strong interest of patients that the quality of their care be 
     assessed and improved: Now, therefore, be it
       Resolved, That it is the sense of the House of 
     Representatives that--
       (1) the Centers for Medicare & Medicaid Services should 
     extend through 2006 the Medicare demonstration project to 
     assess the quality of care for patients undergoing 
     chemotherapy, and then thoroughly review the merits of the 
     demonstration project;
       (2) the Centers for Medicare & Medicaid Services should use 
     the results of this demonstration project to develop a system 
     to pay for chemotherapy services under Medicare based on the 
     quality of care delivered and the resources used to deliver 
     that care, including physician performance;
       (3) the demonstration project should be modified to 
     accumulate even more useful data relating to the quality of 
     care furnished to Medicare patients with cancer, such as the 
     clinical context in which chemotherapy is administered, and 
     patient outcomes; and
       (4) payments to physicians for participation in the 
     demonstration project should facilitate continued access of 
     Medicare patients with cancer to chemotherapy treatments of 
     the highest quality.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Georgia (Mr. Deal) and the gentleman from Ohio (Mr. Brown) each will 
control 20 minutes.
  The Chair recognizes the gentleman from Georgia (Mr. Deal).


                             General Leave

  Mr. DEAL of Georgia. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous material on the resolution under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Georgia?
  There was no objection.
  Mr. DEAL of Georgia. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise in support of H. Res. 261, a resolution sponsored 
by the gentleman from Texas (Mr. Hall). This resolution commends the 
Centers for Medicare and Medicaid Services for implementing the 
Medicare oncology demonstration project, and requests that it extend 
this successful program. I am pleased to report that due to this 
important demonstration project, the Centers for Medicare and Medicaid 
Services has received valuable data that will serve to better treat 
patients suffering from cancer.
  Cancer is one of the leading causes of death to Americans, and almost 
every American has had their life touched in some way by this horrible 
disease. Simply put, cancer kills. Cancer does not discriminate. It 
takes many forms and effects young and old alike.
  I commend the CMS for their leadership in addressing this effective 
treatment for cancer patients. Specifically, I commend CMS for 
approaching cancer care from a totally different perspective. Providing 
quality cancer care is not just about administering drugs to patients, 
albeit performing this task safely and efficiently is important. 
Providing cancer care includes managing pain, minimizing nausea, and 
limiting fatigue. It means arming clinicians with information and 
evidence-based practice guidelines to obtain the best possible clinical 
outcomes.
  That is what the chemotherapy demonstration has begun to provide 
towards the advancement of cancer care in this country. The 
demonstration initiated last fall by CMS reflects our commitment to 
quality and the use of clinical data to pave the way for enhanced 
quality care, including good clinical outcomes and reduced cost to 
Medicare and Medicaid beneficiaries.
  These are principles which I stand behind, and I commend CMS for 
their work to ensure that cancer patients receive the best possible 
care. This resolution was approved by voice vote by the Committee on 
Energy and Commerce, and I encourage my colleagues in the House to do 
the same this afternoon.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, there may not be a Member of this body who cannot share 
a personal story about cancer. Cancer is a health risk for all of us. 
It has taken friends, family, and others from each of us.
  With the help of a very real Federal commitment to research, through 
coverage and access, through development of new standards and 
innovative treatment, American medicine is fighting cancer on every 
front.
  I am a proud supporter of the National Cancer Institute's 2015 goal 
to eliminate suffering and death due to cancer within the decade. While 
we work to eliminate the cancer threat, the Federal Government is also 
working to make sure that treatment for cancer, specifically 
chemotherapy, is administered in the best possible manner for patients.
  Earlier this year, Medicare implemented a demonstration project to 
collect data and study the quality of care being provided to patients 
undergoing chemotherapy. This project is a vital tool for policymakers 
to use as we work to determine the most appropriate reimbursement 
strategies for this complicated treatment regimen. It is important that 
the administration extend this demonstration through 2006 so we can 
ensure that Medicare beneficiaries and every American has access to 
high-quality treatment.
  Mr. Speaker, I thank the gentleman from Texas (Mr. Hall), the 
gentleman from Texas (Mr. Gene Green), the gentleman from New York (Mr. 
Towns) and others for their work on this resolution. Extending this 
demonstration will maintain an important tool in our country's fight 
against cancer.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I yield 5 minutes to the gentleman 
from Texas (Mr. Hall), the author of the legislation.
  Mr. HALL. Mr. Speaker, I rise today in support of H. Res. 261. This 
bipartisan resolution commends the Center for Medicare and Medicaid 
Services for implementing the Medicare demonstration project to assess 
the quality of

[[Page 22391]]

care of cancer patients undergoing chemotherapy; and it calls on CMS, 
as the chairman has said, to extend this project through the year 2006. 
I am pleased that Members from both sides of the aisle join me as 
cosponsors of this very important resolution.
  Delivering cancer treatment involves more than simply providing 
chemotherapy drugs. Oncologists need to plan drug regimens, educate 
caregivers, and monitor patient symptoms; and they are responsible for 
managing pain, minimizing nausea, and limiting fatigue.
  The demonstration project was critically important to improving 
quality cancer care in 2005. It provided resources to assess a patient 
experiencing chemotherapy side effects, including pain, nausea and 
fatigue.
  The project has achieved three important objectives: collecting data 
to improve the quality of cancer care, maintaining stability in the 
cancer care delivery system, and focusing limited resources in the 
aspect of cancer treatment most difficult for patients.
  Oncologists in America are the lifeline to so many individuals facing 
the greatest challenge of their lives. Hearing the diagnosis of cancer 
is a frightening and lonely experience, and the men and women who 
devote their careers to fighting this disease are the healers these 
patients look to for help. As a Nation, we need to do all we can to 
support these oncologists.
  I would like to thank the American Society of Clinical Oncology for 
working so closely with me and all of us on this resolution. I would 
certainly like to commend the gentleman from Georgia (Mr. Deal), the 
gentleman from Texas (Mr. Barton) and the staff of the Committee on 
Energy and Commerce for working with my office to bring this resolution 
to the floor today.
  Mr. DEAL of Georgia. Mr. Speaker, I yield 3 minutes to the 
gentlewoman from Connecticut (Mrs. Johnson).
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I congratulate the 
gentleman from Georgia (Mr. Deal) and his subcommittee for bringing 
forward this resolution, and the gentleman from Texas (Mr. Hall) for 
introducing it, because it is extremely important to recognize the very 
thoughtful work of this administration in making the most complex and 
difficult change in payment systems that we have frankly ever 
legislated in any sector of Medicare payment policy.
  They had to change both the way the government paid for the drugs and 
the way they paid for the physicians, and changing each system required 
the development of whole new information systems; and then they had to 
coordinate these in such a way that they actually came to the 
oncologists in the right amount at the right time. To ensure that, they 
developed the demonstration project that both will improve quality and 
also ensure that these payments together would maintain the access to 
oncology care that American seniors enjoy and Americans across the 
country enjoy.
  We enjoy greater access to cancer treatment than the people of any 
other country. In making this much-needed, but complex, change in how 
we pay for that cancer care, this administration showed great medical 
understanding, great patient sensitivity, and great dedication to 
ensuring that access to cancer care would in no way be compromised 
while we reformed the way we paid for that care.
  Mr. Speaker, I thank the gentleman from Georgia (Mr. Deal) for a 
solid resolution and congratulate Members on a very difficult job. Very 
well done. I thank publicly Dr. McClellan and all his staff for their 
energy and dedication to this and for the staff of both committees who 
worked very hard to ensure that in different aspects of our 
jurisdiction we brought all of the knowledge we had developed in the 
course of developing these payment changes to the table to work with 
the administration. I thank the committee staff, as well as my own 
staff.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise today in support of H. 
Res. 261. This resolution expresses the sense of the House of 
Representatives that the Centers for Medicare & Medicaid Services 
should be commended for implementing the Medicare demonstration project 
to assess the quality of care of cancer patients undergoing 
chemotherapy, and should extend the project, at least through 2006, 
subject to any appropriate modifications. Further, it commends CMS for 
implementing the Medicare demonstration project to assess the quality 
of care of cancer patients undergoing chemotherapy, and calls on CMS to 
extend the project, subject to any appropriate modifications, at least 
through 2006.
  In brief, this resolution is important because it:
  Encourages CMS to extend the oncology demonstration project, which 
helped preserve patient access to cancer therapies in 2005 by 
maintaining critical resources in the cancer care delivery system.
  The demonstration, currently set to expire at the end of 2005, asks 
about quality of care information such as pain, nausea/vomiting and 
fatigue. This was an important step in measuring outcomes for quality 
cancer care.
  The demonstration helped focus limited resources on symptom 
management and treatment, an aspect of cancer treatment most difficult 
for patients. The Resolution encourages CMS to make refinements, as 
appropriate, to make the data collection even more meaningful for 
patient care.
  As you know, the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA) significantly reformed the way Medicare 
pays for chemotherapy administered in doctors' offices. These reforms 
resulted in considerable reductions in Medicare payments to cancer 
care.
  The Centers for Medicare & Medicaid Services (CMS) following efforts 
by many Members of Congress, the American Society of Clinical Oncology 
(ASCO), patient advocacy groups, and others in the cancer community, 
implemented a one-year demonstration project that provided resources to 
assess the patient experience with chemotherapy side effects. These 
include pain, nausea and vomiting, and fatigue. This demonstration 
project has achieved three important objectives: (1) collecting data to 
improve the quality of cancer care, (2) maintaining stability in the 
cancer care delivery system, and (3) focusing limited resources in an 
aspect of cancer treatment most difficult for patients.
  The demonstration project was critically important to protecting 
quality cancer care in 2005. I encourage Members to support this 
resolution.
  Mr. GENE GREEN of Texas. Mr. Speaker, I rise in support of the 
resolution offered by my friend and fellow Texan, Mr. Hall.
  I am proud to be a co-sponsor of this resolution, which would 
encourage CMS to extend a Medicare demonstration project that has 
maintained cancer patients' access to chemotherapy.
  Approximately 9.6 million men, women, and children in the United 
States are currently living with a diagnosis of cancer.
  Despite the tremendous strides made in cancer research and cancer 
care, the disease unfortunately still ranks as the number two killer in 
the United States, exceeded only by heart disease.
  According to the American Cancer Society, more than 1.3 million new 
cancer cases will be diagnosed this year alone.
  These individuals face a tough road ahead and difficult decisions 
about the path they will take in fighting this disease.
  This year, the Medicare program implemented a demonstration project 
to look at chemotherapy patients and the quality of care they receive.
  A good deal of cancer patients receive life-saving chemotherapy in 
physicians' offices.
  However, the Medicare bill Congress passed in 2003 reduced payments 
to physicians who administer chemotherapy in their offices.
  This demonstration project has temporarily alleviated some of the 
financial strains oncologists were to receive under the Medicare bill--
  And the result is continued patient access to chemotherapy 
administered in the familiar and more-convenient office setting.
  Ultimately, the goal of the demonstration is to improve cancer 
treatment through a better understanding of the patient experience 
under chemotherapy.
  But we don't want to cut off patients' access to chemotherapy before 
we determine how their cancer care could be improved.
  While chemotherapy has literally been a life-saver for countless 
cancer patients, it is not an easy process to endure.
  Patients often experience pain, nausea, vomiting and fatigue while 
undergoing chemotherapy.
  We know a great deal about chemotherapy and its effect on patients, 
but our knowledge base is not complete.
  Unfortunately, the cancer care demonstration project is scheduled to 
end on December 31, 2005.

[[Page 22392]]

  This resolution would encourage the Centers for Medicare and Medicaid 
Services to extend the cancer care demonstration project at least 
through next year.
  By extending this project, CMS would continue to support chemotherapy 
services offered in physician offices.
  At the same time, CMS would continue to build on the information 
already gleaned from the project to improve the quality of care for 
Americans suffering from cancer.
  Mr. Speaker, I thank Mr. Hall for his leadership on this issue and 
encourage my colleagues to join me in supporting this important 
resolution.
  Mr. FERGUSON. Mr. Speaker, I rise today in support of H. Res. 261, 
expressing the sense of the House of Representatives that the Centers 
for Medicare & Medicaid Services should be commended for implementing 
the Medicare demonstration project to assess the quality of care of 
cancer patients undergoing chemotherapy, and should extend the project, 
at least through next year.
  In 2005, CMS implemented a Quality of Life demonstration project to 
assess quality care for cancer patients receiving chemotherapy services 
in an office-based practice. The demonstration project was designed to 
gather data on the effects of chemotherapy on Medicare patients. 
Practitioners participating in the project must provide data and 
document services related to pain control management, minimization of 
nausea and vomiting, and the reduction of fatigue. This program is now 
underway and I strongly support its continuation.
  I would note, however, as the program is currently designed, it only 
applies to patients receiving IV infusion and push chemotherapy, not to 
patients receiving oral chemotherapy. As was originally intended when 
Congress created this demonstration program, it is critical that all 
patients, regardless of the method of chemotherapy treatment, are 
included in the assessment of these key quality of life factors 
impacting their treatment for cancer. As it stands today, the data 
collected under the QOL is incomplete--patients receiving oral 
therapies are not assessed in the same way, and their side effects 
cannot be compared to the side effects of infused chemotherapy. As I 
stated, I strongly support the continuation of this demonstration 
program but I believe CMS should act to ensure that data is collected 
from patients receiving oral drugs as well as injectable drugs.
  Oral chemotherapy treatment can improve the quality of life for 
cancer patients by allowing patients to have chemotherapy at home or 
work without daily visits to the doctor's office or to a cancer 
infusion center. These treatments can also be cost effective as they 
require fewer physician visits and fewer invasive procedures. While 
these treatments are relatively new, more are being developed each year 
and they can provide unprecedented freedom for Americans battling 
cancer. If we are going to collect data and learn how to improve the 
quality of life for those fighting cancer it is my belief that we 
should focus on collecting data on all treatment options--including the 
very promising use of oral drugs.
  Mr. BARTON of Texas. Mr. Speaker, the Chairman of the Ways and Means 
Committee, Chairman Thomas, requested that the attached exchange of 
letters be submitted during the floor debate on H. Res. 261.

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                    Washington, DC, Oct. 17, 2005.
     The Hon. Bill Thomas,
     Chairman, Committee on Ways and Means, Washington, DC.
       Dear Chairman Thomas: Thank you for your letter in regards 
     to H. Res. 261, a resolution ``[e]xpressing the sense of the 
     House of Representatives that the Centers for Medicare and 
     Medicaid Services should be commended for implementing the 
     Medicare demonstration project to assess the quality of care 
     of cancer patients undergoing chemotherapy, and should extend 
     the project, at least through 2006, subject to any 
     appropriate modifications.''
       As the Committee on Ways and Means was named as an 
     additional Committee of jurisdiction upon the resolution's 
     introduction, I acknowledge and appreciate your willingness 
     to not exercise your full referral on the resolution. In 
     doing so, I agree that your decision to forgo further action 
     on the resolution will not prejudice the Committee on Ways 
     and Means with respect to its jurisdictional prerogatives on 
     this legislation or similar legislation.
       I look forward to working with you on this resolution.
           Sincerely,
                                                       Joe Barton,
                                                         Chairman.
                                         House of Representatives,


                                  Committee on Ways and Means,

                                    Washington, DC, Oct. 11, 2005.
     The Hon. Joe Barton,
     Chairman, Committee on Energy and Commerce, Washington, DC.
       Dear Chairman Barton: I am writing concerning H. Res. 261, 
     a resolution ``[e]xpressing the sense of the House of 
     Representatives that the Centers for Medicare and Medicaid 
     Services should be commended for implementing the Medicare 
     demonstration project to assess the quality of care of cancer 
     patients undergoing chemotherapy, and should extend the 
     project, at least through 2006, subject to any appropriate 
     modifications,'' which was ordered reported by the Committee 
     on Energy and Commerce on Wednesday, July 20, 2005.
       As you know, the Committee on Ways and Means has 
     jurisdiction over matters concerning Medicare. This 
     resolution calls for the extension of the Medicare 
     demonstration project to assess the quality of care for 
     patients undergoing chemotherapy, and thus falls within the 
     jurisdiction of the Committee on Ways and Means. However, in 
     order to expedite this legislation for floor consideration, 
     the Committee will forgo action on this resolution. This is 
     being done with the understanding that it does not in any way 
     prejudice the Committee with respect to the appointment of 
     conferees or its jurisdictional prerogatives on this or 
     similar legislation.
       I would appreciate your response to this letter, confirming 
     this understanding with respect to H. Res. 261, and would ask 
     that a copy of our exchange of letters on this matter be 
     included in the Congressional Record during floor 
     consideration.
           Best regards,
                                                      Bill Thomas,
                                                         Chairman.

  Mr. BROWN of Ohio. Mr. Speaker, I yield back the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I yield back the balance of my 
time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Georgia (Mr. Deal) that the House suspend the rules and 
agree to the resolution, H. Res. 261, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the resolution, as amended, was 
agreed to.
  The title of the resolution was amended so as to read: ``Resolution 
expressing the sense of the House of Representatives that the Centers 
for Medicare & Medicaid Services should be commended for implementing 
the Medicare demonstration project to assess the quality of care of 
cancer patients undergoing chemotherapy, and should extend the project 
through 2006, subject to any appropriate modifications.''.
  A motion to reconsider was laid on the table.

                          ____________________