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NCCN Policy Summit: The Impact of Health Care Reform on Academic Oncology Practice

By Jessica DeMartino, PhD, Manager, Health Policy Programs

On July 10, 2014, the National Comprehensive Cancer Network® (NCCN®) hosted the NCCN Policy Summit: The Impact of Health Cancer Reform on Academic Oncology Practice at The Westin Arlington Gateway in Arlington, Virginia. The policy summit was part of the NCCN Oncology Policy Program.

Much of the discussion regarding health care reform and implications for cancer care delivery has focused on the impact on community oncology practice, with much less attention being paid to the impact on academic cancer centers and the patients they serve. The Physician Payments Sunshine Act, passed as part of the Patient Protection and Affordable Care Act (ACA), is designed to bring transparency to financial relationships between physicians, teaching hospitals, and the pharmaceuticals industry. The intention of the summit was to examine the impact of the Sunshine Act on academic physicians, as well as provide a forum for stakeholders to discuss health care reform, as currently conceived and implemented, and to consider its effect on academic cancer centers, including topics such as shift in site of care, narrow networks, and the cost and quality of care delivered at academic cancer centers.

The NCCN Policy Summit featured two roundtable sessions, each commencing with a keynote address. Participating in the first session were keynote speakers, Anita Griner, MBA, PMP, Centers for Medicare and Medicaid Services (CMS); and F. Marc Stewart, MD, Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; followed by a roundtable discussion, The Physician Payments Sunshine Act, including Matt Farber, MA, Association of Community Cancer Centers; Ms. Griner; Diedre Meehan, JD, Johnson & Johnson; Jon Retzlaff, MBA, MPA, American Association for Cancer Research; Samuel Silver, MD, PhD, University of Michigan Comprehensive Cancer Center and American Society of Hematology; Dr. Stewart; and Andrew Zelenetz, MD, PhD, Memorial Sloan Kettering Cancer Center.

Ms. Griner started the session by covering the intent, basics, and implementation of Open Payments, what CMS has termed the Physician Payments Sunshine Act. She highlighted resources and tools that are available to physicians, teaching hospitals, and industry to help them engage in Open Payments. Dr. Stewart followed by presenting five areas of concerns around the Sunshine Act. These include collection of highly detailed and often minimally relevant information, ability of consumer to understand and interpret information, transparency versus translucency of reported data, inhibition of collaboration between academia and industry, and addition of more cost to the health care system.

Following the first keynote address, the panel, moderated by Clifford Goodman, PhD, The Lewin Group, discussed issues raised by the keynote speakers, including use of Sunshine Act data by patients, the ability of the system to identify and remove the outliers, and whether the Sunshine Act will or should change physician behavior. The session concluded with discussion of how success of the program will be defined. The panelists agreed that success is defined by the particular stakeholder.

The summit’s second session focused on the effects of the Affordable Care Act (ACA) on Academic Cancer Institutions.

Recently, researchers from City of Hope Comprehensive Cancer Center, a National Cancer Institute (NCI)-designated comprehensive cancer center in Duarte, California, completed a study of 53,618 patients with breast, cervical, colorectal, gastric, hepatobiliary, lung, oral, or pancreatic cancers, finding that patients treated at NCI-designated comprehensive cancer centers had higher overall survival rates compared to those treated at community cancer centers, even when considering factors such as socioeconomic status, age, and gender.1

"Population-level findings provide evidence that for certain types of cancer, there is a survival benefit to receiving treatment at a specialized cancer center that has received designation by NCI as a 'Comprehensive Cancer Center,'" said Julie Anne Wolfson, MD, MSHS, City of Hope Comprehensive Cancer Center, the lead author for the study. "However, there are a number of factors tied to a lower likelihood of receiving treatment at such a specialized cancer center, including having public or no health insurance, a lower socioeconomic status, being from an African-American or Hispanic background, or living more than nine miles from the nearest cancer center."

A keynote address, delivered by Kavita Patel, MD, The Brookings Institution; and Tim Ferris, MD, MPH, Massachusetts General Hospital Cancer Center, commenced as Dr. Patel presented background on the ACA including the implementation timeline, Medicaid expansion status, and insurance exchange information. She discussed implementation challenges, including website woes, policy cancellations, and lower than expected enrollment, along with an older than anticipated enrollment mix of enrollees. Dr. Patel also touched on the effects of Medicaid expansion and narrow networks on academic cancer centers. Dr. Ferris followed and focused on national spending on cancer care and the rising costs of delivering cancer care. He described programs at Massachusetts General Hospital Cancer Center that are addressing quality and cost.

A roundtable discussion, Effects of the ACA on Academic Cancer Centers, followed and included Christian Downs, JD, MHA, Association of Community Cancer Centers; Dr. Ferris; Louis Jacques, MD, ADVI; Terry Langbaum, MAS, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Donald Liss, MD, Independence Blue Cross; Dr. Patel; Caroline Pearson, Avalere Health; Brian Rosen, JD, The Leukemia and Lymphoma Society; and Dr. Wolfson.

Moderated by Dr. Goodman, the panel discussed in detail narrow networks and their impact on academic medicine and patients with cancer. The panel also focused on the value of academic cancer centers and how the increased costs of those centers can be proven necessary.

A full summary of the NCCN Policy Summit: The Impact of Health Care Reform on Academic Cancer Centers will be published on the NCCN website by October 2014.

For more information on the NCCN Oncology Policy Program, visit NCCN.org/policy.

 

1 J Clin Oncol 32:5s, 2014 (suppl; abstr 6541)