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