ASCO Examines Impact of Health-care Reform on Cancer Care Disparities

In a new policy statement, ASCO outlines specific provisions of the 2010 Patient Protection and Affordable Care Act that have the potential to reduce cancer care disparities. ASCO’s statement makes recommendations to ensure that such provisions are carried out effectively, and urges additional steps to address systemic issues including insurance reform, quality of care, prevention, research, and diversity in the health-care workforce.

ASCO’s statement, published in the Journal of Clinical Oncology,¹ identifies specific measures to help eliminate cancer care disparities:

• Adopt patient-centered quality improvement initiatives.
• Attract more minority physicians and improving the training of the oncology workforce to meet the needs of racially and ethnically diverse patients with cancer.
• Improve data collection on cancer disparities.
• Ensure access to cancer specialists for all patients who seek treatment at federally qualified community health centers.
• Allow for cancer-centered services to be at the direction of oncology professionals in community health centers and medical homes where many seek medical care.

ASCO President Michael P. Link, MD, explained, “The Affordable Care Act provides a foundation for meaningful progress in eliminating disparities in health care. However, many of its provisions are vague and open for interpretation. In addition, significant progress requires added measures that are not in the new law.”

Improve Insurance Coverage

By increasing Medicaid eligibility, the Affordable Care Act has the potential to reduce the number of uninsured by 59%. However, an estimated 23 million individuals will be uninsured by 2019. Moreover, ASCO remains concerned about evidence showing that with low reimbursement, cancer patients on Medicaid fare no better than patients who have no health insurance.

To ensure that Medicaid patients have consistent access to quality cancer care, ASCO asks policymakers to:

• Provide Medicaid patients diagnosed with cancer with immediate, presumptive eligibility for Medicare.
• Reimburse doctors who treat cancer patients on Medicaid at Medicare rates.

Enhance Prevention and Screening Follow-up

Although the health-care reform legislation mandates that insurers cover certain cancer screenings, it does not expressly require insurers to cover follow-up tests if an abnormality is found. For example, if a polyp is found during a colonoscopy, insurers are not required by law to cover follow-up diagnostic examinations and biopsies. ASCO is calling for Congress to require insurers to cover appropriate follow-up testing without patient deductibles or copays.

Meet the Needs of Diverse Patients

Provisions in the Act direct the Secretary of Health and Human Services to support the development of curricula for cultural competency programs. In addition, effective in 2012, health plans’ summary of benefits and appeals processes are expressly required to be presented in a culturally and linguistically sensitive manner. For example, summaries must be written in plain language to be understood by those with limited English proficiency.

Develop Quality-of-care Measures

The new law also authorizes development of a strategy to develop and test measures to improve quality of care as a means to reduce disparities in health care.

ASCO strongly supports this measure, and has made great progress in improving the quality of cancer care over the past 10 years. ASCO’s Quality Oncology Practice Initiative (QOPI®) is the first national program to help practices improve the quality of care they deliver and to certify outpatient oncology offices for meeting the highest national standards for cancer care delivery. Today, nearly 700 oncology practices participate in QOPI.

Dr. Link explained, “When it comes to closing the disparities gap, quality does matter. A meaningful quality initiative must be based on best practices derived from clinical guidelines, published measures, and collective expert consensus. Care minus quality isn’t much better than no care at all.” ■

Reference

1. Moy B, Polite BN, Halpern MT, et al: American Society of Clinical Oncology Policy Statement: Opportunities in the Patient Protection and Affordable Care Act to reduce cancer care disparities. J Clin Oncol. August 1, 2011 (early release online).