Medicare Cuts, the Nursing Shortage, and Cancer Research Funding Decreases: How You Can Make A Difference Ruth Dennison, RN Carole Edwards, RN Ilisa M Halpern, MPP ONS 31 st Annual Congress Boston, Massachusetts May 4, 2006
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The Medicare Modernization Act Cut approximately $11.5 billion from oncology care over the next 10 years. Changed 95% of Average Wholesale Price (AWP) based reimbursement to 85% of AWP in 2004 and moved to Average Sales Price (ASP) + 6% for 2005 and beyond. Provided $500 million for practice expenses in 2004, which decreased to $460 million in 2005, and provided no additional funds for 2006 and thereafter. In other words, MMA boosted reimbursement for essential cancer care services by 32% in 2004, then decreased these payment amounts by 29% from 2004 to 2005, and decreased them again to zero in 2006. Medicare does not pay for a number of items and services involved in the provision of quality cancer care.
Medicare Modernization Act (MMA) Survey of Oncology Nurses 2004 (ONS) 2005 (Global Access Project) Findings consistent: Many Medicare beneficiaries without secondary payor are being referred to HOPDs Some beneficiaries with some treatment regimens are being referred to HOPDs Nurses are spending more and more time with administration/paperwork/"doing the math" Most of the fears have not yet come to fruition (e.g., widespread closing of satellite clinics)
2006 Cancer Care Demonstration Focuses on physician evaluation and management visits for established patients with certain types of cancer: breast cancer chronic myelogenous leukemia colon cancer esophageal cancer gastric cancer head and neck cancer multiple myeloma non-hodgkin s lymphoma non-small cell/small cell lung cancer ovarian cancer pancreatic cancer prostate cancer rectal cancer
2006 Cancer Care Demonstration Uses G-codes G to gather more specific information relevant to the quality of care for cancer patients, including their treatments; the spectrum of care they receive from their doctors; and whether or not the care represents best practice. Physicians who elect to participate will receive an additional $23 demonstration payment for reporting one Medicare G-code G describing each of the following three factors (three codes in total) in conjunction with a level 2, 3, 4, or 5 established patient office visit: (1) primary focus of visit, (2) adherence to practice guidelines established by American Society of Clinical Oncology (ASCO) and/or National Comprehensive Cancer Network (NCCN), and (3) current disease state. Nurse practitioners cannot bill independently due to a limitation in the CMS billing system; however, they can bill incident-to to a physician visit.
FY 2007 Health and Human Services Budget Overall HHS Budget Medicare 55.5% Medicaid 28.6% Other Mandatory Programs 0.4% TANF 2.5% Children's Entitlement Programs 2.9% Discretionary Programs 10.1%
FY 2007 Health and Human Services Discretionary Budget Discretionary Programs SAMSA 5% NIH 41% Administrative and Other 28% FDA 3% HRSA 9% CDC 9% I.H.S. 5%
Congress: The Basics 435 House Population Based More Populous States Have Larger and Less Populated States Have Smaller Delegations Serve Two Year Terms and All 435 Seats Are Up for Election Every Two Years A Member Represents a Local District 231(R)-201(D) 201(D)-1(I) 1(I) 2 Vacancies 100 Senate Two Per State Both Senators Represent the Entire State Serve Six Year Terms and 1/3 of the Senate Is Up for Election Every Two Years 55(R)-44(D)-1(I)
KEY COMMITTEES & CAUCUSES House Appropriations (LHHS) Energy & Commerce (Health Subcommittee) Ways & Means (Health Subcommittee) House Cancer Caucus House Nursing Caucus Senate Appropriations (LHHS) Health, Education, Labor & Pensions Finance Committee Senate Cancer Coalition
I M JUST A BILL, I M ONLY A BILL Bill Introduced (#) Reference to Committee Reference to Subcommittee Reported Out Favorably Full (House/Senate) Chamber Repeat in Other Chamber If they differ, then. Conference Committee President Enacts or Vetoes
AUTHORIZATION vs. APPROPRIATING Nurse Reinvestment Act Authorization (August 2002) Expands and Creates Programs Needs To Be Reauthorized (2008) Appropriations (Each Year) Funds Programs Sept. 30th/Oct. 1st Fiscal Year
COMMUNICATION: TOP 10 TIPS 1. Be Clear 2. Be Honest 3. Give Evidence (Not too much) 4. Repeat the Point 5. Include a Personal Example 6. Discuss Positive Effects of Taking Action/Consequences of Not Taking Action 7. Be a resource & offer to help 8. Thank/Spank 9. Give Local Data 10. Follow-Up 3
Advocates Come in Many Forms & Take Action in Many Ways Meetings at District/State Offices Meetings on Capitol Hill Attendance at Town Hall Meetings Testifying at hearings Letters to the Editor/Op-ed Pieces Establishing a close relationship with elected officials and/or their staff taking the time to become acquainted with Members of Congress and their staff helps ensure that when you email, call, write, or visit in the future that your input is valued and counted even more
What Counts? All emails, faxes, letters, calls, postcards, petitions, etc. are counted. Personal, handwritten letters suggest a high level of priority and importance (send by fax). Phone calls and emails allow you to weigh-in in quickly on an urgent matter. If you establish yourself as an advisor/counselor and a key constituent, your voice will count even more!
PUTTING ADVOCACY INTO ACTION Know Who Represents You Register & Vote Visit the ONS LAC www.onslac.org Sign up for ONSTAT Today Read Politically Speaking in ONS News Stay Up-to to-date through the CHEAR Find Local Offices of Your Members of Congress & Visit Them Call, Fax, Email Your Policy Makers Get to Know the Congressional Staff Invite Policymakers to Visit You Respond to ONS Action Alerts
ONS Health Policy Associates Gardner Carton & Douglas Washington, DC Ilisa Halpern Paul, MPP ihalpern@gcd.com or ipaul@gcd gcd.com 202/230-5145 Christine Williams Murphy, MA cwilliams@gcd.com,, 202/230-5159
ONS Legislative Action Center http://www.ons.org/lac/ OR http://www.onslac.org/