Health Policy Reports

Biweekly newsletter of stories impacting community cancer care.
January 9, 2024

Health Policy Report – January 9, 2024

The Network Submits Comments to HHS/ONC on Information Blocking Disincentives Proposed Rule

On Tuesday, January 2, The Network submitted comments to the Office of the National Coordinator for Health Information Technology (ONC) at the Department of Health and Human Services (HHS) on its proposed rule, entitled “21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking.” The proposed rule details the first steps taken by ONC under the 21st Century Cures Act to deter information blocking activities by health care providers. 

Specifically, the proposed rule establishes disincentives for health care providers, including MIPS-eligible clinicians, ACOs, and certain eligible hospitals and critical access hospitals, who have engaged in information blocking, meaning that they’ve interfered with the use of electronic health information. Under the rule, providers that have participated in information blocking are disqualified from benefits under programs administered by the Centers for Medicare & Medicaid Services (CMS). 

In its comments, The Network expressed its concern that the practice of information blocking to control patient referrals is not directly addressed in the rule and noted that it continues to see hospitals engage in information-blocking type behavior to control referrals.

“We encourage CMS/ONC to categorically state this behavior is information blocking and consider future guidance or rulemaking to prohibit it. Without doing so, the penalties in this proposed rule will leave out a deceptive practice that will impact patient care,” The Network concluded. 

The Network also provided an example of several oncologists who recently left a hospital system in a small market to create an independent group practice. These physicians had been ingrained in the community for years and were focused on maintaining unfettered patient access throughout the transition. After this occurred, the hospital system set up multiple onerous roadblocks to prevent referring physicians at the hospital from making referrals to external providers for newly diagnosed patients.

The Network urged HHS/ONC to categorically state this behavior is information blocking and consider future guidance or rulemaking to prohibit it.

To read The Network’s comments, CLICK HERE. 

To read more, CLICK HERE.

OHC Holds Advocacy Day at the State Capitol

On Wednesday, December 6, The US Oncology Network’s Government Relations team partnered with OHC for an advocacy day at the Ohio State Capitol in Columbus, Ohio. During meetings with lawmakers, Dr. Randy Drosick, Dr. Suzanne Partridge, Dr. Patrick Ward, Dr. Ameet Patel, and Caleb Burdette, PharmD discussed critical issues impacting patient access to timely care including white bagging mandates. 

Specifically, advocates urged support for HB 156, a bill that would prevent pharmacy benefit managers (PBMs) and insurers from imposing white bagging policies within state-regulated health plans. During a House Insurance Committee hearing, Dr. Drosick shared his insight on how white bagging undermines the standard of care, leads to harmful treatment delays, produces significant waste, and negatively impacts patient outcomes. His testimony and subsequent engagement with the committee members laid a crucial foundation for informed health care policy discussions.

The OHC Advocacy Day at the State Capitol was a resounding success, thanks to the dedication and collaborative efforts of distinguished physicians, staff, and leadership from OHC and the legislative leaders who participated. 

To read more, CLICK HERE.

To read an OHC practice priority one pager, CLICK HERE. 

To watch Dr. Drosick’s testimony, CLICK HERE.

To read HB 156, CLICK HERE. 

Rocky Mountain Cancer Center Hosts Colorado State Representative Anthony Hartsook (R-Parker) to Discuss White Bagging Mandates

On Wednesday, December 20, The US Oncology State Government Relations team, alongside physicians and administrative from Rocky Mountain Cancer Centers (RMCC) Lone Tree Clinic, welcomed state Representative Anthony Hartsook for an educational site visit. The purpose was to spotlight the crucial role of community-based cancer care in Colorado communities. During the visit, the practice underscored its commitment to providing high-value care, close to patient’s homes, at a lower cost compared to treatment in a hospital setting.

This visit also provided the opportunity to discuss one of RMCC’s key policy priorities: the need to prohibit pharmacy benefit managers (PBMs) from mandating that patients receive their clinician-administered drugs through white bagging. With his background as a former lieutenant colonel in the US Army, Rep. Hartsook was very impressed by the Lone Tree clinic’s capacity to deliver treatment in an organized and efficient manner, with limited interruption to patient’s daily routines. Upon learning about white bagging’s potential disruption to clinic operations and patients’ treatments, Rep. Hartsook expressed concern and aligned with RMCC’s object to safeguarding the patient-physician relationship.  

Leaving the visit with a strong understanding of RMCC’s care delivery and the significant challenges facing community oncology in Colorado, Rep. Hartsook emerged as a key ally for future policy initiatives. As a prominent Republican member of the Colorado House Committee on Health Care, RMCC is excited to work with Rep. Hartsook on legislation that aims to prohibit white bagging mandates and all other legislation that impacts cancer patients and providers during the 2024 legislative session.

Dr. Lalan Wilfong Offers Insight on Implementation of the Enhancing Oncology Model (EOM)

In an interview with the American Journal of Managed Care (AJMC), Lalan Wilfong, MD, Senior Vice President of Payer and Care Transformation at The US Oncology Network, highlighted the challenges facing practices participating in the Enhancing Oncology Model (EOM), a successor of the Oncology Care Model (OCM). 

In the interview, Dr. Wilfong highlighted beneficial components of the EOM, including its emphasis on electronic patient-reported outcomes and social determinants of health. However, Dr. Wilfong noted that the EOM provides small Monthly Enhanced Oncology Service (MEOS) payments, forcing practices to focus only on those patients that are in the model. In addition, Dr. Wilfong noted that with the way that the EOM is currently designed, participating practices may not meet thresholds for success in the Merit-based Incentive Payment System (MIPS). 

“EOM is definitely a successor to OCM. However, I don’t think that means that it will be a success,” Dr. Wilfong concluded. “It is challenging, though, to think that this will truly change the needle like OCM did in community oncology practices.” 

The US Oncology Network has 12 practices representing more than 1,000 physicians that are participating in EOM, representing over 70% of the physicians participating in the new model, illustrating The Network’s commitment to value-based care models.

To watch the video interview with Dr. Wilfong, CLICK HERE.

Final Rule on Retroactive Application of DIR Fees Takes Effect

On Monday, January 1, the final rule to limit the retroactive application of direct and indirect remuneration (DIR) fees took effect. In the past, pharmacy benefit managers (PBMs) could charge DIR fees after the fact, but with the new rule in place, DIR fees will be reflected in the price that the patient pays at the pharmacy counter. 

Though the Biden administration noted that this will likely lower costs for patients, many pharmacies remain concerned that the change will lead to cash flow issues, as they will be forced to pay fees from 2023, on top of the new 2024 fees that must be paid up front. 

Though pharmacy owners have pleaded with the Biden administration to make PBMs establish payment plans to give pharmacies extra time to pay, the federal government has said it can’t compel such arrangements, but “strongly encourages” them. 

To read the final rule, CLICK HERE. 

Congress Returns, Seeks to Address Unfinished Health Care Business Ahead of Jan. 19 Funding Deadline

The House and Senate have both returned to session, leaving lawmakers with a long list of unfinished health care business that needs to be addressed before the looming government funding deadline on January 19th. 

The January 19th deadline may be the last chance for major health policy until a post-election lame duck session. But so far, there haven’t been any decisions on which health care policies may be included in a January 19 package. 

Delays to Medicaid DSH funding cuts for hospitals and community health center funding appear to be the most likely agenda items. PBM transparency requirements and site neutral measures included in the Lower Costs, More Transparency Act, which the House passed in December, are also likely to be discussed in negotiations. However, it remains unclear whether these provisions will be added to any final package, as the Senate has advanced its own, more sweeping PBM proposals and has expressed skepticism over site neutral payment reform. 

Meanwhile, many are pushing for at least some relief to the 3.37% Medicare physician payment cut that took effect on January 1—despite widespread opposition from physicians, lawmakers, and a wide cross-section of healthcare stakeholders.

Prior to the holiday break, the American Medical Association (AMA) and the Medical Group Management Association (MGMA) both separately urged Congress to pass bipartisan legislation to prevent the cuts, which threaten to jeopardize the stability of the healthcare system and patient access to care, from coming into effect. Specifically, the groups called for lawmakers to pass the Preserving Seniors’ Access to Physicians Act of 2023 (H.R.6683).

The AMA also called on Congress to use the $2.2 billion in sequester cuts for physicians included in the Medicare Improvement Fund as outlined by the FY 2024 National Defense Authorization (NDAA) to fund the complete reversal of the 3.37% cut.

To read the AMA’s press release on H.R. 6683, CLICK HERE.

To read the MGMA’s letter to Congressional leaders, CLICK HERE.

To read more about the Preserving Seniors’ Access to Physicians Act of 2023 (H.R.6683), CLICK HERE.

Bipartisan Group of Senators Urge Biden Administration to Ban Copay Accumulators

On Wednesday, December 20, a bipartisan group of nearly 20 senators, led by Sens. Tim Kaine (D-VA) and Roger Marshall (R-KS), sent a letter urging the Biden Administration to enforce a federal rule limiting the use of harmful “copay accumulators,” which exacerbates many patients’ ability to afford the prescription drugs they need.

The letter, submitted to the Secretaries of the Departments of Labor, Treasury, and Health & Human Services, highlighted how preventing copay assistance from counting towards a patient’s deductible or out-of-pocket maximum can be a “profit-seeking tactic” that frustrates patients and makes it harder for them to access their doctor-prescribed medications.

Referencing the U.S. District Court for the District of Columbia’s recent decision to strike down a 2021 rule that permitted the use of copay accumulator adjustment programs, the senators urged the Biden Administration to abide by the court’s decision not to seek an appeal, and “adopt policies from the 2020 Notice of Benefit and Payment Parameters that strike the right balance of preserving a plan’s ability to control costs while also putting the patient first.”

Finally, the senators also highlighted bipartisan legislative solutions, such as the Help Ensure Lower Patient (HELP) Copays Act (S.1375), that would permanently prohibit the use of copay accumulators and require health plans and pharmacy benefit managers (PBMs) to count the value of copay assistance towards a patient’s deductible or out-of-pocket maximum.

To read Senator Kaine’s press release about the letter, CLICK HERE.

To read the text of the letter, CLICK HERE.

To read the U.S. District Court for the District of Columbia’s decision on copay accumulator assistance programs, CLICK HERE.

To read the text of the Help Ensure Lower Patient (HELP) Copays Act (S.1375), CLICK HERE.