ACCC advocacy agenda addresses reimbursement, care delays, treatment choice
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The Association of Community Cancer Centers has announced its 2023 advocacy agenda, which includes four core focus areas to ensure members can provide quality, equitable cancer care in a variety of therapeutic settings.
“Overall, ACCC is very focused on education advocacy in the cancer space, and its members want to be active in issues that may impact their ability to deliver quality cancer care,” Matt Farber, policy consultant and director of oncology advocacy and professional relationships at ACCC, told Healio. “At the end of last year, our government affairs committee identified our core advocacy goals for the coming year. The committee came up with eight broad areas, and we hyperfocused on a smaller subset of those.”
Farber spoke with Healio about ACCC’s main advocacy goals for 2023 and actions oncologists can take to support these goals.
Healio: Your first agenda item is to protect adequate and stable reimbursement for oncology providers. Why is this an area of focus?
Farber: Providing or protecting adequate and stable reimbursement is a battle that has been fought for quite some time. You could go back to the Medicare Modernization Act when the ASP+6 [average sales price plus 6%] payment system was introduced. For a long time, it was about protecting the +6 payment from a drug reimbursement standpoint, where things like storage, handling and disposal of drugs covered were an issue. Over the years, we saw threats to that from congressional actions like sequestration or, from a regulatory standpoint, from the annual Medicare OPPS [Outpatient Prospective Payment System] and physician fee schedule rules that seemingly cut chemotherapy administration rates or evaluation and management service rates. Those cuts have significant implications for cancer providers. At the end of the day, job number one is to provide quality care for patients, but they have to run a business, too. Reduced reimbursement makes it very difficult to provide that quality care. Last year, through a concerted effort by ACCC members to push back on a number of proposed cuts, the year-end spending bill did delay or reduce some of those cuts to Medicare reimbursement.
Healio: The second goal is reducing delays in care due to utilization management. Can you discuss this?
Farber: This has to do with the difficulties our providers face in getting care to their patients in a timely manner, such as through step edits or fail first policies. It fits into that utilization management bucket overall and causes unnecessary delays. We see delays for things like PET scans, which can really put the brakes on treatment for patients. We want to make sure these delays are not unnecessary or overly burdensome. There are several efforts right now, including a couple of bills introduced at the federal level that we are tracking. There are also quite a few at the state level. A number of states are looking at bills to either eliminate or bring more transparency to prior authorization, which I think is important. Some are following the lead that Texas initiated a couple of years ago with “gold card legislation.” Gold carding is the idea that if your practice is already at 90% in terms of getting approvals for your therapies, you don’t have to go through the normal process. A handful of states are looking to replicate that.
Healio: The third goal is preserving provider and patient choice in anticancer treatment. What does ACCC plan to do in this area?
Farber: The advent of pharmacy benefit managers (PBMs) in the space means that patients and providers have less choice overall. Many times, they are forced to utilize pharmacies that are not the closest or easiest to use. Many of our practices and hospitals have their own pharmacies but aren’t allowed to use them because of these restrictive rules. This goes back to how our members are trying to provide the best quality care they can, but also run a business. Oftentimes, that means having an in-house pharmacy and an IDN (integrated dispensing network), because they know they can get the drugs and therapies to the patient fastest, and they know these patients very well.
We are tracking a number of federal issues that have been brought up around PBM transparency. Some bills reintroduced at the federal level from last year would eliminate copay accumulators and maximizers, restrict white bagging or ensure pharmacy choice.
A lot of state legislatures are also taking up these issues, so we’re trying to work with our state society partners where we can to make sure we’re driving home the stances we want to get out there.
Healio: The fourth objective involves increasing access and coverage around supportive oncology services. How are these services important?
Farber: ACCC is all about the comprehensive cancer center. That means everybody within that center is a member. From the doctors, nurses and social workers to the pharmacists, dieticians and exercise therapists, everybody who is involved in the delivery of cancer care is important to the overall patient. Not all of that work is recognized, and sometimes it isn’t reimbursed. So, whenever we can be supportive of laws at the state or federal level, or work with insurers or employers, we want to emphasize the importance of these services. Focusing on the mental health of patients is important, so anything we can do to ensure that those services are recognized is very important for us.
Healio: What can oncologists do to promote or support these advocacy goals?
Farber: There are many ways [for oncologists] to get involved, and it is vitally important that they do. Most often, the people who are writing the laws do not have real-world experience in dealing with those issues. So, they rely on the experts to educate them on the impact those laws would have.
ACCC has tried to make it as easy as possible for members to have their voices heard. The ACCC website features a legislative action center that allows members to track state and federal legislation, and they can write personalized letters to legislators on certain issues so they can share their stories. The ACCC membership has been very active in using this tool on a number of issues, from year-end spending priorities to PBM reforms to co-pay accumulators. In addition, ACCC hosts a Capitol Hill Advocacy Day each year, where we invite members to come to Washington to meet with their elected officials. Finally, ACCC works closely with state oncology societies to encourage advocacy at the state level, and there has been an increase in that activity, as well.
References:
- ACCC announces its 2023 advocacy agenda (press release). Available at: www.accc-cancer.org/acccbuzz/blog-post-template/accc-buzz/2023/03/07/accc-announces-its-2023-advocacy-agenda. Published March 7, 2023. Accessed March 22, 2023.
- Healio Interview.
For more information:
Matt Farber can be reached at Association of Community Cancer Centers, 1801 Research Blvd., Suite 400, Rockville, MD 20850; email: mfarber@accc-cancer.org; Twitter: @farbs18. Visit the ACCC website at www.accc-cancer.org/home/advocate.
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