This article is more than 5 years old. Information may no longer be current.
Treatment and management guidelines will standardize cancer care
The Centers for Medicare and Medicaid Services will refer to NCCN and ASCO guidelines for the 2006 demonstration program.
WASHINGTON — When the National Comprehensive Cancer Network (NCCN) releases updated clinical practice guidelines, oncologists should pay close attention. The NCCN’s guidelines provide many benefits to physicians and their patients.
These guidelines standardize treatment recommendations in oncology and restore decision-making authority to practicing oncologists, said William T. McGivney, PhD, chief executive officer of the NCCN.
Furthermore, they provide a basis for the establishment of coverage policy and provide a centerpiece to the 2006 Centers for Medicare & Medicaid Services (CMS) quality demonstration in oncology, McGivney explained at the First Annual Community Oncology Conference.
Oncologists are not the only professionals that refer to the NCCN guidelines. The Clinical Policy Council at Aetna reviewed the NCCN clinical guidelines for the treatment of prostate cancer. Under Principles of Radiation Therapy, the NCCN recommends that clinicians employ 3-D conformal or intensity-modulated radiation therapy.
After reviewing the guidelines, Aetna determined that intensity-modulated radiation therapy for prostate cancer should be considered medically necessary and should therefore be available for reimbursement.
CMS demonstration program
CMS refer to the NCCN guidelines, as well. CMS have launched the 2006 Oncology Demonstration Program: Improved Quality of Care for Cancer Patients Through More Effective Payments and Evidence-based Care. Under the demonstration program, physicians will report the status of each patient’s cancer and whether they are managing patients according to the NCCN or ASCO guidelines.
“NCCN and ASCO appreciate the opportunity to communicate the views of the oncology community on appropriate care to CMS and to all others who make decisions that influence the availability of and access to important drugs, biologics, devices and procedures,” according to the NCCN Web site. “The NCCN will work closely with all organizations to help shape programs that are efficient, effective and equitable.”
The demonstration program will include CMS G codes assigned to the management of various cancer diagnoses and areas of supportive care (see table).
The oncology community will determine what constitutes appropriate care, McGivney said. There will be CMS codes for disease stage, purpose of clinical visit and appropriate management options. This will allow for more efficient evaluation of care, public reporting of performance data and perhaps pay for performance. – by Rebekah Cintolo
For more information:
- McGivney WT. Quality care: translating clinical guidelines into practice. Presented at: First Annual Community Oncology Conference; Jan. 26-28, 2006; Washington.