September/October, 2003

Oncology Management focuses on reimbursement issues, evidence based medicine, and legislative policies.The late summer announcements by CMS about the proposed 2004 APC payment rules and changes to the RB-RVS payment system underscore the sensitivity and critical nature of topics discussed in this issue of the Journal.  What CMS is proposing should be no surprise to anyone and in fact, something cancer care providers will unfortunately be accustom to in the future. 

This letter was written after the proposed rules were released, but prior to the release of the final rules.  The most significant elements of the proposals include: 

1.  Continued and significant payments reductions in oncology reimbursement under in the APC (hospital based) payment systems.
2.  Declines in payment for selected radiation oncology procedures under both payment systems:

  1. Most notably in APC IMRT dose planning and daily treatments.
  2. APC and freestanding cancer center IMRT treatment delivery.
  3. APC brachytherapy rates.
  4. The difference in payments overall to programs that operate under the APC or resource based systems has narrowed, depending upon procedure mix, to approximately 5% – 10% of each of other.

3.       Under the APC system, a new payment mechanism for “expensive drugs and biologics”.  

There are three clear implications from the proposed rates:

1.       Market consolidation resulting from some hospital based cancer programs, particularly lower volume programs, will no longer be able to afford to operate.  

2.       Hospitals will have to structure and operate their radiation and medical oncology programs on a freestanding basis and will not be able to structure charges to cover hospital overhead (e.g., emergency room, administration, admitting),

3.       Cancer program success and viability will be dependent on a leadership approach (shared and supported by hospital administration) that operates the cancer program with an entrepreneurial perspective, rather than viewing it as a traditional hospital department where the primary goal is to contain costs.

Leadership will also be an important issue to the American College of Oncology Administrators in 2004.  The New Year will bring in a new ACOA president, Marie DeStephano, RN, MSN, OCN, FAAMA and president-elect, Phyllis DeAntonio, RN, MSN, OCN, FAAMA.  College members should feel extremely confident that the ACOA will be directed by these two very experienced and accomplished individuals who are longstanding ACOA members.  The transition to this leadership team began over two years ago, with Marie’s accepting the position of president-elect and Phyllis joining the ACOA board.

The board’s agenda for 2004 will be an active one, given the increasingly challenging times.  The agenda will continue to focus on the College’s creating and delivering value to its members, increased membership, and increased member involvement in College activities and leadership.  Please join me in providing Marie and Phyllis with your support and active participation in the American College of Oncology Administrators.

Best regards,

Joseph M. Spallina, FAAMA, FACHE
American College of Oncology Administrators [email protected]