The health care reform law passed in 2010 offers the potential to reduce socioeconomic disparities in cancer care and outcomes, but it does not go far enough, according to an American Society of Clinical Oncology policy statement published online August 1.
The statement in the Journal of Clinical Oncology calls for numerous measures, including creation of oncology-based medical homes, automatic qualification of Medicaid-eligible cancer patients for Medicare, an end to Medicare reimbursement cuts for cancer care, requiring insurers to pay for follow-up testing when abnormalities are discovered, and rethinking of penalties for higher readmission rates of vulnerable cancer patients (J. Clin. Oncol. 2011 Aug. 1 [doi: 10.1200/JCO.2011.35.8903]).
"We think it’s time to move beyond documenting disparity in cancer outcomes and start moving toward solutions," oncologist Dr. Blase N. Polite, chair-elect of the American Society of Clinical Oncology (ASCO) Health Disparities Advisory Group, said in an interview.
"When a patient has a cancer diagnosis, time is of the essence," said Dr. Polite of the University of Chicago. "When they have no insurance or poor insurance, it means people are going to die, and we know that."
The statement is not a blanket endorsement of the Patient Protection and Affordable Care Act (PPACA), the authors note. ASCO’s members have differing opinions, but providing quality care to all cancer patients "regardless of racial, socioeconomic, or geographic group, is a priority for all if its members."
Create Oncology Medical Homes
One approach that could help is creating oncology-specific, patient-centered medical homes, according to ASCO’s policy statement.
As written, the health care reform legislation calls for grants to develop and study community-based health teams and patient-centered medical homes that would allow a team of medical professionals, directed by a primary care physician, to provide comprehensive medical services and care coordination to patients.
The approach offers a "tremendous opportunity to develop a comprehensive coordinated strategy to reduce cancer incidence" by improving screening and helping patients implement lifestyle changes to reduce their risk, the society says.
But the approach "does less to ensure the coordination of care once a cancer diagnosis is made," and the legislation does not make it clear whether a cancer-specific community health team under the guidance of an oncologist would be allowed, the authors note.
"Given the unique care requirements for patients with cancer, ASCO believes that any form of integrated community care should allow for cancer-centered services under the direction of oncology professionals," the policy statement says.
Dr. Polite noted that the group wants to work with Congress to develop this concept of an oncology-specific patient-centered medical home.
"Once a patient gets diagnosed with cancer, the oncologist manages their care for a 3- to 4-year period," he said. "These patients require a diverse set of services, and right now they’re provided piecemeal. If we had this, then we could focus on providing the right set of services under one umbrella."
Health care reform also places more resources into federally qualified community health centers, Dr. Polite noted, but those centers don’t always offer good coordination of specialty care. "It does no good to diagnose the patient with cancer if you can’t put them into a qualified treatment center," he said. Therefore, ASCO wants to see community health center–based cancer care programs with oncologists at the helm, he said.
Change Reimbursement Policies
The ASCO policy statement also urges changes in reimbursement for oncologists treating Medicaid patients. It notes that increased Medicaid eligibility in the health care reform legislation has the potential to reduce the number of uninsured by 59%.
However, in part due to the low reimbursement rates that Medicaid offers, "there is convincing evidence that adult patients with cancer who are covered by Medicaid have poor clinical outcomes similar to those of uninsured patients," according to the group’s statement.
Therefore, ASCO is asking federal lawmakers to provide Medicaid patients diagnosed with cancer with immediate, presumptive eligibility for Medicare. In addition, states should reimburse doctors who treat cancer patients on Medicaid at Medicare rates, and there should be no more cuts to Medicare reimbursement rates.
Cover Follow-up Tests
Reforms also are needed in insurance coverage of cancer prevention and screening follow-ups, and on quality of care measures, according to the policy statement.
The health care reform legislation mandates coverage for certain screenings, but it does not expressly require insurers to cover follow-up tests if an abnormality is discovered, according to ASCO. For example, insurers don’t need to cover follow-up diagnostic exams and biopsies if a polyp is discovered during a colonoscopy.
ASCO wants Congress to require insurers to specifically cover appropriate follow-up testing without patient deductibles or copayments.