ASCO is urging Medicare to establish clear information and a process to ensure that patients receive timely access to cost-sharing assistance.
ASCO has submitted comments to the U.S. Senate Finance Committee Chronic Care Working Group regarding the Bipartisan Chronic Care Working Group Policy Options document published in December 2015. The society commended the working group for its efforts to improve the Medicare program for beneficiaries suffering from multiple chronic conditions and made recommendations to improve care management services for patients with cancer as one of their chronic conditions.
In the comment letter, ASCO President Julie M. Vose, MD, MBA, FASCO, emphasized the need—in ASCO’s view—to encourage the use of Chronic Care Management (CCM) services by eliminating copays for such services for Medicare beneficiaries. ASCO asserts that adapting benefits to meet the needs of chronically ill Medicare Advantage (MA) enrollees will also encourage CCM use.
Furthermore, ASCO asserts that adapting benefits to meet the needs of chronically ill MA enrollees will also encourage CCM use. Specifically, current Medicare policy requires MA enrollees who qualify for and wish to participate in clinical trials to receive coverage of trial routine services through traditional fee-for-service (FFS) Medicare, rather than their MA plan. Reverting to the 20% copay required in FFS translates to additional, unexpected cost-sharing for the trial enrollee. Medicare requires that the MA plan provide assistance with the higher cost-sharing, but the process is confusing, and some plans fail to comply or inform the trial participant. At a time when patients should be able to focus on their cancer treatment, they are required to navigate a complex, confusing process. ASCO is urging Medicare to establish clear information and a process to ensure that patients receive timely access to this cost-sharing assistance.
ASCO’s comments also note that existing CCM billing codes are inadequate and counterproductive due to the requirements providers must meet in order to be reimbursed for using them. Oncologists—the letter points out—are among the health care providers that spend the most uncompensated time developing treatment plans and coordinating complex care regimens. The lack of appropriate recognition of these services in the coding and reimbursement system used by Medicare creates significant barriers for patients to these important services.
To read ASCO’s comment letter in its entirety, go to: http://www.asco.org/sites/www.asco.org/files/ccwg_final_letter_1_29_16.pdf. ■
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