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ASCO Examines Impact of Health Care Reform on Cancer Care Disparities; Makes Recommendations for Closing Gaps

Newswise - ALEXANDRIA, Va. - To help address serious racial and economic disparities in cancer prevention, diagnosis, and treatment in the United States, the American Society of Clinical Oncology (ASCO) today released a policy statement that outlines specific provisions of 2010 Patient Protection and Affordable Care Act that have the potential to reduce these 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.

• Allowing for cancer-centered services to be at the direction of oncology professionals in community health centers and medical homes where many seek medical care.

"The Affordable Care Act provides a foundation for meaningful progress in eliminating disparities in health care," said ASCO President Michael P. Link, MD. "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."

Key Recommendations from ASCO's Policy Statement

By increasing Medicaid eligibility, the Affordable Care Act has the potential to reduce the number of uninsured by 59 percent. However, 23 million individuals are estimated to be uninsured by 2019.

Oncologist Mary De Shields, MD, who practices in Maryland's Eastern shore, learned first-hand that insurance coverage is one of the greatest factors accounting for disparities in care. "When I first came from Philadelphia to practice here, I spoke to many uninsured patients and people at church and community gatherings about the importance of cancer screening and prevention. When Maryland implemented screening programs, I began to see fewer patients with late stage cancers. Greater access to screenings and follow up testing improved outcomes for patients in my community," Dr. De Shields said.

But a major concern of ASCO is that, evidence shows that with low reimbursement, cancer patients on Medicaid fare no better than patients who have no health insurance.

In Brooklyn, N.Y., Gina Villani, MD, MPH, serves a limited-income patient population that is about 85 percent minority. Dr. Villanni said, "I worry about care coordination and low Medicaid reimbursement rates that often force providers to neglect the underinsured."

• Reimbursing doctors who treat cancer patients on Medicaid at Medicare rates.

In addition, separate from the Affordable Care Act, ASCO and other medical societies are calling on Congress to ensure that Medicare to fix a flawed payment formula known as the Sustainable Growth Rate, to ensure that patients have continued access to quality cancer care in the years ahead.

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.

"Many of my patients can't afford copayments of five dollars or less for life saving medications, so they certainly can't afford to pay for follow up medical testing," Dr. De Shields said.

Provisions in the Act direct the Secretary of Health and Human Services (HHS) to support the development of curricula for cultural competency programs, and 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.

Dr. Villani said, "For many of our patients, the system can be overwhelming, especially when English is not the native tongue. So my hospital has instituted changes to make the facility more inviting and to provide extra support for patients who need help coordinating and navigating their care."

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 on improving the quality of cancer care over the last ten years. ASCO launched its national, data-driven quality improvement program, the Quality Oncology Practice Initiative® (QOPI) in 2006 after five years of research and development. 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, over 700 practices participate.

Dr. Villani said her hospital is interested in pursuing ASCO's QOPI program. "Regardless of insurance coverage, patients deserve high quality care. By highlighting areas where my practice can improve, we can work together to provide better care," she said.

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."

To request a copy of the full policy statement, contact Steve Hahn at 571-483-1374 or steve.hahn@asco.org.

The American Society of Clinical Oncology (ASCO) is the world's leading professional organization representing physicians who care for people with cancer. With more than 30,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. For ASCO information and resources, visit www.asco.org. Patient-oriented cancer information is available at www.cancer.net.

Source: NewsWise