CMS announces 2006 Oncology Demonstration Program
Posted by Kate Murphy on November 8th, 2005
On November 2, 2005 the Centers for Medicare and Medicaid Services (CMS) announced the [2006 Oncology Demonstration Program](http://www.cms.hhs.gov/media/press/release.asp?Counter=1717) designed to develop data on quality cancer patient care during visits for evaluation and disease management.
Medicare billing codes will be changed to take a broader outlook on supportive care visits beyond chemotherapy administration. Physicians who see a patient for an evaluation and management service (E & M) will be entitled to an additional $23 payment beyond the payment for the visit if they also iinclude the following information:
+ primary focus of the evaluation and management session
+ current disease state
+ whether current management adheres to clinical guidelines
For instance, the primary focus of the E & M service might be management of side effects, pain control or other palliative service, survelliance for cancer recurrence, or provision of end-of-life care. Doctors will be asked to characterize the spread of the cancer, as it is best known at the time.
Finally, physicians will be asked to report whether or not the patient’s management follows practice guidelines established by either the [American Society of Clinical Oncology](http://asco.org/ac/1,1003,_12-002130,00.asp) or the [National Comprehensive Cancer Network](http://www.nccn.org/professionals/physician_gls/default.asp). Guidelines may be reported as followed or not followed for a reason such a clinical trial protocol, patient preference or desire for a different treatment, or physician disagreement with the guidelines.
In a [Fact Sheet](http://www.cms.hhs.gov/media/press/release.asp?Counter=1717) released by CMS, designers of the demonstration project described its goals:
The 2006 demonstration meets our objective of having oncology payments increasingly focused on patient-centered care, rather than chemotherapy administration. In the 2006 demonstration, data collection and payments are linked to E&M provided by physicians to patients, rather than chemotherapy administration that may occur in the absence of an involved visit between doctor and patient. This demonstration also meets the objective of helping us learn to what extent Medicare beneficiaries are being treated in a manner that yields the best outcomes, understand clinical cancer scenarios where there is not clinical consensus among physicians on the relevance of specific guidelines, and ensure that due emphasis is placed on a multi-disciplinary, comprehensive approach to palliation and end of life care. Also, by focusing on evidence based practices, there is the potential that unnecessary services and tests will be reduced, lowering program costs and yielding better quality of life for Medicare beneficiaries with cancer.
A similar project in 2005 measured patient outcomes for three side effects of chemotherapy — controlling pain, managing nausea and vomiting, and reducing fatigue.
