Dear Colleague:
I am bringing to your attention issues and concerns that have been identified by the Officeof Inspector General (OIG), Department of Health and Human Services regarding a one-yeardemonstration that was implemented by the Centers for Medicare and Medicaid Services (CMS)on Jan. 1, 2005. Under this demonstration, chemotherapy providers are reimbursed $130each time they report on a Medicare patient's chemotherapy symptoms. Medicare beneficiariesare liable for a 20 percent co-payment of $26 every time their provider bills the demonstrationcodes. According to the OIG, beneficiary liability during the first 6 months of the demonstrationwas $22 million. CMS estimates that Medicare and its beneficiaries will spend $300 million in2005.
In August, I requested that the OIG conduct an evaluation of this demonstration. OnSeptember 8, 2005, the OIG responded with its preliminary findings, which I have attached foryour consideration. I believe you will be as troubled as I am by these findings, which include thefollowing:
Prior to the implementation of CMS's demonstration, chemotherapy providers were alreadyassessing their patients' levels of nausea and/or vomiting, pain, and fatigue as part of routine care.Thus, these providers are being paid $130 to simply forward the data that is already collectedduring a routine office visit.
The purpose of assessing patients' levels of nausea and/or vomiting, pain, and fatigue is todetermine suitable treatments for these symptoms; however, data on what treatments providersare using to address the symptoms are not being collected by CMS. Thus, the usefulness of thedemonstration data may be limited.
Oncology practices are using different methods to assess patients' symptoms, which putsthe reliability of the data they are collecting in question.
Attached is my letter to the President requesting that problems with the demonstration beaddressed quickly. I am also asking CMS to find ways to use the money from Medicare and itsbeneficiary to improve the quality of care for cancer patients.
Sincerely,
Charles E. Grassley Chairman, Committee on Finance
Attachments - 2
Source: Ranking Member’s News
