can team - community oncology alliancecommunityoncology.org/pdfs/canmeeting120816.pdf ·...

CAN TEAM

A Peak at 2017…

Capitol Hill, Oncology Issues & COA Priorities

Ted Okon

Monthly CAN Call

12/8/2016

1

CAN Co-Chairs

▪ Kim Woofter• Michiana Hematology Oncology

• [email protected]

▪ Maryann Roefaro• Hematology Oncology Associates of Central New York

• [email protected]

mailto:[email protected]


Reminders

▪ The audio portion of the call will be recorded. Playback instructions will be sent later.

▪ Callers will be muted once the call begins. Toggle between mute and unmute with *6.

▪ Please do not place our call on “hold” while unmuted.

Welcome!

▪ Naycherie Alvira• Cancer Care Center of Frederick

▪ Shirley Lee

• Skyline Urology

▪ Colin Chambers • Advanced Centers for Cancer Care

▪ Part B “Experiment” effectively dead

• Outgoing Administration can still introduce the final rule but an

exercise in futility

▸ Both incoming Trump Administration and Congress can kill it

• Proves once again that a hard, dedicated fight can win the day

▪ CVS Caremark has reversed its decision to kick dispensing

practices out of network

• Not letting new practices in but we are trying to tackle that

▪ HHS/CMS/CMMI turned on its head

• Entire overhaul of political leadership; more severe than ever before

• “Career” staff besides themselves; resumes filling the air

What We Know For Sure

5© 2016 Community Oncology Alliance

▪ Involved in spearheading multiple letters from Congress to CMS

▪ Major national radio ad campaign supported by print and digital ads, mailers, SM targeting

specific members of Congress

▪ Developed/hosting 2 dedicated websites for providers & patients

• www.cancerexperiment.org

• www.StopCMSCuts.com

▪ Major OpEd campaign

▪ Generating national and local media coverage

▪ Worked with congressional committees on

several approaches to stopping this experiment

on seniors’ cancer care

▪ Met with CMS/CMMI leadership

▪ Testified at 2 congressional hearings

▪ Made it an election issue with 3 major Senate campaign ads about it

What COA Did


http://www.cancerexperiment.org/

http://www.stopcmscuts.com/

© 2016 Community Oncology Alliance

Print & Digital Ads In DC Metro Market

▪ Obamacare is in the crosshairs for repeal and replace but…

• What exactly will get repealed?

▸ Will it include CMMI?

○ What happens to the OCM?

• What exactly will replace it?

▸ When will it be replaced?

○ Right away?

○ 1-2 years?

○ 3 years?

• Will the GOP come together on what to repeal and replace?

• What will and can the Democrats do?

• How will it get repealed and replaced without 60 votes in the

Senate?

What We Don’t Know For Sure


▪ How will the new political order in DC differ from the old order

in terms of cancer care?

• Should be less likely to advance policy and regulations that foster

more consolidation of healthcare, including oncology

• Should be more prone to strip away regulation

• Should be more receptive to the issues impacting community

oncology

▸ Why?

○ Part B

○ Sequester

What We Don’t Know For Sure But Can Guess


▪ Fixing aspects of Medicare drug reimbursement

• Revisiting the sequester cut

• Prompt pay discount issue

▪ Keeping the hospitals “honest”

• 340B

▸ Tied to addressing the drug price issue

• Payment site neutrality

▪ Keeping the PBMs really honest

• DIR Fees

• Playing doctor

• Self serving steerage

▪ Advancing oncology payment reform

What Are COA Priorities in DC for 2017



▪ Fix ASP-based reimbursement

• Stop the sequester cut from being applied to cancer drug payment

• Eliminate prompt pay discounts from the calculation of ASP

▪ Neutralize hospital payment advantages and aggression

• 340B fixes

• Site neutral payments

▪ Stop PBMs from dictating treatment

• Roll back DIR fees and create greater transparency

▪ Advance oncology payment reform

• Support reintroduction of H.R. 1934 and S. 3122

• Make it work!!!

Top Legislative Priorities for COA in 2017


▪ 340B in the crosshairs – Question is, “How long

does the bubble expand?”

• There is actually legislative language to increase

transparency and accountability

▪ HOPPS final rule out implementing first step in

site neutral payments

• Result of the Bipartisan Budget Act of 2015

• CMS held pretty firm in actually operationalizing

payment cuts (50% or so)

• Gave in on existing (grandfathered) facilities

expanding services and still billing under hospital

fees

• Hospitals fought to get some relief in CURES bill

• More push-back on hospital consolidation of

practices and financial impact at federal and state

levels

Site Neutrality & 340B

▪ CVS Caremark moved to shift all dispensing practices to “out of network” for

Medicare Advantage plans effective January 2017

• Indications were that Express Scripts was ready to follow CVS lead

• Massive practice, media, and state/federal legislative effort stopped CVS

• CVS recently reversed its decision; still not allowing new dispensing practices into the

network

• COA not letting up with letter to CMS (now outgoing) head Andy Slavitt

▪ Absurd (and I mean ABSURD) DIR fees

• Charge what they want, how they want, when they want

▪ Express Scripts tightening ”formulary” and steering business to Accredo

▪ With more oral oncolytics coming out of the pharma R&D pipeline, expect

more attempts to capture this business

• They will go after not only dispensing practices but those with retail pharmacies

PBM/Specialty Pharmacy Issues


▪ Hired legal firm specializing in pharmacy issues to fight for

community oncology

• Legal letter to CVS

• White paper on PBMs featuring CVS

decision

• State and federal congressional outreach

on CVS

• Patient outreach on CVS

• DIR white paper in the works

• Much more

What is COA Doing?


PharmacyBenefitManagers’AttackonPhysicianDispensing

andImpactonPatientCare:CaseStudyofCVSCaremark’sEffortstoRestrictAccessto

CancerCare

Preparedby

FrierLevitt,LLC

CommissionedbytheCommunityOncologyAlliance

August2016


▪ Make the OCM successful – in spite of CMMI!

▪ Develop the OCM 2.0

• What the OCM should be

• Universal model that can be adapted by payers and employers

▪ Dialogue/Outreach more to employers on oncology payment

reform

▪ Aggressively expand COA’s patient advocacy network

▪ Create greater identify for community oncology

• I AM Community Oncology

Top Practice-Facing Priorities for COA in 2017

▪ Private insurers have already started years ago• United, Aetna, Anthem, Priority, etc.

▪ Medicare COME HOME project already done

▪ Oncology Care Model (OCM) is now rolling• 196 practices implementing it (or trying!)

• Payers at all different levels of readiness

▪ MACRA final rule out and the implementation clock is ticking• Need to make choices now

▪ Both sides of the political aisle want “value” in payment for medical

services and drugs

▪ Community oncology needs to be even more agressive in moving on

payment reform!!!

Oncology Payment Reform


▪ Help practices make the OCM really work

• Have 70% of the practices networked

▪ Provide materials to help facilitate implementation

▪ Created peer-to-peer information exchange

• Dedicated listserv

• Affinity groups

• Meetings and calls

▪ Brought on very experienced experts (Kavita Patel,

MD, Basit Chaudhry, MD, Laura Long, MD)

▪ Proactive outreach to CMMI on implementation

issues

▪ Evolve the model as needed so it actually works and

can be used elsewhere

• OCM 2.0

• Create an AAPM version

▪ Use House (H.R. 1934) & Senate (S. 3211) bills to

leverage CMMI

COA Oncology Care Model (OCM) Strategy


▪ MIPS is going to be a real crapshoot in terms of where you land

• Can’t just ignore it because a severe downside penalty (9%!) is out there in later

years

• Make a wise decision for 2017 because that’s the baseline measurement year for

2019

• Get your house (practice) in order NOW!

▸ Understand what you will be measured on and put new procedures in place as needed

• Putting your head in the sand is the worse thing you can do!

▪ Future of community oncology may be in advanced alternative payment models

(AAPMs)

• Good news is they offer 5% bonuses plus upside of the model savings

• Bad news is you are going at risk

• Need to incorporate actuarial expertise into your thinking

• Can’t put your head in the sand on this one either!

My Thoughts on MACRA – MIPS and AAPMs


2017 Community Oncology Conference


Thank You!

21

Ted Okon

[email protected]

Twitter @TedOkonCOA

www.CommunityOncology.org

www.MedicalHomeOncology.org

www.COAadvocacy.org (CPAN)

www.facebook.com/CommunityOncologyAlliance

© 2016 Community Oncology Alliance


http://www.communityoncology.org/

http://www.medicalhomeoncology.org/

http://www.coaadvocacy.org/

http://www.facebook.com/CommunityOncologyAlliance

can team - community oncology alliancecommunityoncology.org/pdfs/canmeeting120816.pdf ·...

Documents