Reps. Artur Davis, D-Ala., Steve Israel, D-N.Y., and Mary Jo Kilroy, D-Ohio, have introduced bill HR 2872 to establish a national demonstration project to improve the quality and cost effectiveness of cancer care for Medicare beneficiaries.
The Secretary of Health and Human Services (HHS) would establish a quality cancer care demonstration project. This would be implemented in phases by the Centers for Medicare & Medicaid Services (CMS) with a purpose of establishing quality metrics and aligning Medicare payment incentives in the areas of treatment planning and end-of-life care for Medicare beneficiaries with cancer.
Under the Medicare Quality Cancer Care Demonstration (QCCD) project, the HHS Secretary would do the following:
- Identify and address gaps in current quality measures related to the areas of active treatment planning and end-of-life care by refining the performance measures, by active treatment planning and end-of-life care for clinician-level reporting.
- Explore the potential to report quality data through registries or other electronic means for treatment planning and end-of-life care data, including identifying data elements necessary to measure quality of treatment planning and end-of-life care and determine how those elements could be collected through claims data or registries or other electronic means.
- Test and validate identified treatment planning and end-of-life quality measures through a pay-for-reporting program with oncologists, in which the program: ensures that oncologists are able to accurately report on measures through simple HCPCS coding mechanisms; and tests processes of submitting treatment planning and end-of-life measures through registries or other electronic means.
To be eligible for the project, the baseline mandatory measures would be: documented pathology report; documented clinical staging prior to initiation of first course of treatment; treatment education by oncology nursing staff; and providing the patient with a written care plan for patients in active treatment, which advises patient of relevant options.
The augmented measures would be: implemented practice-endorsed treatment plan consistent with nationally recognized evidence-based guidelines; documented clinical trial discussed with the patient, or that no clinical trial available; and documented discussion or coordination with other physicians involved in the patient's care.
For end-of-life care, the baselines mandatory measures would be: documented advanced care planning session with the patient; symptoms assessed and addressed; and recommended the patient to hospice program, whether for institutional or home-based hospice care.
The augmented measures would be: documented no acute-care hospital admissions (including admission to an emergency room or intensive care unit but excluding admission to a hospice or palliative-care unit) within 30 days of death; advanced directive discussion with the patient documented in the physician's records and, if agreed to, inclusion of an advanced directive in such records; and documented that no chemotherapy administered within 30 days of death.
The bill's authors wrote that the HHS Secretary would conduct the demonstration project "over a sufficient period" (not less than two years) to allow for refinement of metrics and reporting methodologies and for analyses.