Medicare Compliance & Reimbursement

Chemotherapy demonstration project peppered with criticism.

Doctors, brace yourselves. Next year may not be any better for cash-strapped practices.

While the House of Representatives is still talking about giving physicians a small pay increase, Senate Finance Committee Chair Chuck Grassley (R-IA) is drafting a bill that would provide a pay freeze instead, according to press accounts.

That's better than the 4.3-percent cut doctors face if Congress doesn't act, but it won't compensate for inflation, experts say.

The Senate bill would impose pay-for-performance on doctors, meaning they'd lose money if they didn't meet quality standards. Grassley wants to save $12 billion from Medicare and Medicaid over five years--more than the $10 billion the 2006 budget resolution calls for--to pay for Hurricane Katrina relief.

Grassley is also gunning for the $300 million chemotherapy demonstration project that pays oncologists to report on their patients' pain, nausea and fatigue. Grassley wrote to President Bush and other senators to say the program should be canceled or fixed, he announced Oct. 13. He unveiled preliminary findings from the HHS Office of Inspector General that the demonstration doesn't benefit patients at all.

"It appears that assessing chemotherapy patients' levels of nausea and/or vomiting, pain and fatigue was already part of the routine care of chemotherapy patients prior to the demonstration," without paying oncologists extra for the service, says the OIG. The agency adds that the demonstration's "haphazard data collection process" yielded unreliable or incomplete results. 

At the recent Supportive Oncology Conference in Chicago, a consortium of cancer experts responded with a study that showed that the demonstration was improving quality of care for cancer patients. The survey found that 40 to 50 percent of cancer care providers believe the program had improved the frequency of severity assessment for pain, nausea and fatigue.

Cancer care providers can't afford to keep treating patients unless they receive the extra funding, argued the Community Oncology Alliance. The project is set to expire on Dec. 31 unless it's extended.

Find it online: Read Grassley's letters at: http://finance.senate.gov/press/Gpress/2005/prg101305.pdf.