I 

111TH CONGRESS 

1ST SESSION H. R. 3675 

To improve the quality and cost effectiveness of cancer care to Medicare 

beneficiaries by establishing a national demonstration project. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 30, 2009 

Mr. DAVIS of Alabama (for himself, Ms. KILROY, Mr. ISRAEL, Mr. 

COURTNEY, and Mr. SCHIFF) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to 

the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL 

To improve the quality and cost effectiveness of cancer care 

to Medicare beneficiaries by establishing a national demonstration project. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘National Quality Can5 cer Care Demonstration Project Act of 2009’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) In order to ensure the delivery of quality, 

2 cost-efficient medical care to patients with cancer, 

3 Medicare should reinforce and expand the use of evi4 dence-based guidelines and the provision of dem5 onstrated quality delivery of care through adjust6 ments in the payment system. 

7 (2) An Institute of Medicine report entitled 

8 ‘‘Ensuring Quality Cancer Care’’ recommends that 

9 the following items are essential components in qual10 ity cancer care delivery: 

11 (A) An agreed-upon treatment plan that 

12 outlines the goals of care. 

13 (B) Access to clinical trials. 

14 (C) Policies to ensure full disclosure of in15 formation about appropriate treatment options 

16 to patients. 

17 (D) A mechanism to coordinate services. 

18 (3) According to the Institute of Medicine, the 

19 quality of cancer care must be measured by using a 

20 core set of quality measures. Cancer care quality 

21 measures should be used to hold providers, including 

22 health care systems, health plans, and physicians, 

23 accountable for demonstrating that they provide and 

24 improve quality of care. 


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1 (4) In its report, ‘‘From Cancer Patient to 

2 Cancer Survivor: Lost in Transition’’, the Institute 

3 of Medicine recommended that individuals with can4 cer completing primary treatment be provided a 

5 comprehensive summary of their care along with a 

6 follow-up survivorship plan of treatment. 

7 (5) The medical literature suggests that adher8 ence to quality metrics and evidence-based guidelines 

9 help lower costs by reducing use of physician serv10 ices, hospitalizations, and supplemental and expen11 sive drugs. 

12 (6) Although treatment planning and follow-up 

13 cancer care planning are recognized critical compo14 nents of cancer care, none of the 153 quality meas15 ures in the Centers for Medicare & Medicaid Serv16 ices (CMS) 2009 Physician Quality Reporting Initia17 tive (PQRI) addresses overall treatment planning or 

18 follow-up care planning for cancer patients. 

19 SEC. 3. MEDICARE QUALITY CANCER CARE DEMONSTRA20 TION PROJECT. 

21 (a) ESTABLISHMENT.—The Secretary of Health and 

22 Human Services (in this section referred to as the ‘‘Sec23 retary’’) shall establish a quality cancer care demonstra24 tion project under this section (in this section referred to 

25 as the ‘‘QCCD project’’) for the purpose of establishing 


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1 quality metrics and aligning Medicare payment incentives 

2 in the areas of treatment planning and follow-up cancer 

3 care planning for Medicare beneficiaries with cancer. 

4 (b) TEST METRICS AND REPORTING SYSTEMS

5 THROUGH A PAY-FOR-REPORTING INCENTIVE PRO6 GRAM.—Under the QCCD project, the Secretary shall do 

7 the following: 

8 (1) Identify and address gaps in current quality 

9 measures related to the areas of active treatment 

10 planning and follow-up cancer care planning by re11 fining the performance measures described in para12 graphs (1) and (2) of subsection (d) relating to ac13 tive treatment planning and follow-up cancer plan14 ning for clinician-level reporting. 

15 (2) Use quality assessment programs of oncol16 ogy professional societies to report quality data to 

17 the extent feasible and explore the potential to re18 port quality data through other registries and other 

19 electronic means for treatment planning and follow20 up cancer care planning, including identifying data 

21 elements necessary to measure quality of treatment 

22 planning and follow-up cancer care planning and de23 termine how those elements could be collected 

24 through claims data or registries or other electronic 

25 means. 


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1 (3) Test and validate identified treatment plan2 ning and follow-up cancer care planning quality 

3 measures through a pay-for-reporting program with 

4 oncologists, which program— 

5 (A) ensures that oncologists are able to ac6 curately report on measures through simple 

7 HCPCS coding mechanisms; and 

8 (B) tests processes of submitting treat9 ment planning and follow-up cancer care plan10 ning measures through registries or other elec11 tronic means. 

12 (c) INCENTIVE PAYMENT.— 

13 (1) IN GENERAL.—Under the QCCD project, 

14 the Secretary shall provide for a separate payment 

15 under section 1848 of the Social Security Act (42 

16 U.S.C. 1395w–4), to be divided into a baseline pay17 ment amount and an additional payment amount, as 

18 specified by the Secretary, for a treatment planning 

19 code and follow-up cancer care planning code. The 

20 amount of such payments under the project shall be 

21 designed to total $300,000,000 each year. Payments 

22 under the project shall be designed to be paid on an 

23 ongoing basis as claims are submitted. 

24 (2) REQUIREMENT TO SATISFY BASELINE MAN25 DATORY MEASURES TO RECEIVE BASELINE PAYVerDate Nov 24 2008 03:13 Oct 01, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3675.IH H3675

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1 MENT.—In order for a physician to receive any pay2 ment under the QCCD project for treatment plan3 ning or follow-up cancer care planning, a physician 

4 must report in a manner specified under the project 

5 that all of the baseline mandatory measures de6 scribed in paragraph (1)(A) or (2)(A), respectively, 

7 of subsection (d) were satisfied. 

8 (3) REQUIREMENT TO SATISFY ALL MEASURES

9 TO RECEIVE ADDITIONAL PAYMENT.—In order for a 

10 physician to receive the additional payment amount 

11 described in paragraph (1) under this subsection for 

12 treatment planning or follow-up cancer care plan13 ning, a physician must report in a manner specified 

14 under the project that all of measures described in 

15 paragraph (1) or (2), respectively, of subsection (d) 

16 were satisfied. 

17 (d) MEASURES.— 

18 (1) TREATMENT PLANNING MEASURES.—The 

19 specific measures related to treatment planning and 

20 any subsequent modifications described in this para21 graph are as follows: 

22 (A) BASELINE MANDATORY MEASURES.— 

23 (i) Documented pathology report. 

24 (ii) Documented clinical staging prior 

25 to initiation of first course of treatment. 


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1 (iii) Performed treatment education 

2 by oncology nursing staff. 

3 (iv) Provided the patient with a writ4 ten care plan for patients in active treat5 ment, which advises patient of relevant op6 tions. 

7 (B) AUGMENTED.— 

8 (i) Implemented practice-endorsed 

9 treatment plan consistent with nationally 

10 recognized evidence based guidelines. 

11 (ii) Documented clinical trial dis12 cussed with the patient, or that no clinical 

13 trial available. 

14 (iii) Documented discussion or coordi15 nation with other physicians involved in 

16 the patient’s care. 

17 (2) FOLLOW-UP CANCER PLANNING.—The spe18 cific measures related to follow-up cancer planning 

19 described in this paragraph are as follows: 

20 (A) BASELINE MANDATORY.— 

21 (i) Documented conclusion of primary 

22 cancer care treatment. 

23 (ii) Documented session with the pa24 tient to provide recommendations for the 


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1 subsequent care of the patient with respect 

2 to the cancer involved. 

3 (B) AUGMENTED.—Provision of a written 

4 document to the patient that— 

5 (i) describes the elements of the com6 pleted primary treatment, including past 

7 symptom management, furnished to such 

8 patient; 

9 (ii) provides recommendations for the 

10 subsequent care of the patient with respect 

11 to the cancer involved; 

12 (iii) is furnished to the individual in 

13 person within a period specified by the 

14 Secretary that is as soon as practicable 

15 after the completion of such primary treat16 ment; and 

17 (iv) is furnished, to the greatest ex18 tent practicable, in a form that appro19 priately takes into account cultural and 

20 linguistic needs of the individual in order 

21 to make the plan accessible to the indi22 vidual. 

23 (e) DURATION OF PROJECT.— 

24 (1) IN GENERAL.—The Secretary shall conduct 

25 the demonstration project over a sufficient period (of 


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1 not less than 2 years) to allow for refinement of 

2 metrics and reporting methodologies and for anal3 yses. The project shall continue, subject to para4 graph (2), to operate until the Secretary has devel5 oped and implemented under part B of the Medicare 

6 program a payment system that relates payment 

7 under such part for professional oncology services to 

8 performance on measures developed and refined 

9 under the demonstration project. 

10 (2) TRANSITION.—The Secretary shall provide 

11 for a transition period over the course of 2 years 

12 during which oncologists are permitted to transition 

13 from the payment system under the demonstration 

14 project to the payment system described in para15 graph (1). 

16 (f) PROJECT EVALUATION.— 

17 (1) IN GENERAL.—The Secretary shall conduct 

18 an evaluation of the QCCD project— 

19 (A) to determine oncologist participation in 

20 the project; 

21 (B) to assess the cost effectiveness of the 

22 project, including an analyses of the cost sav23 ings (if any) to the Medicare part A and B pro24 grams resulting from a general reduction in 


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1 physician services, hospitalizations, and supple2 mental care drug costs; 

3 (C) to compare outcomes of patients par4 ticipating in the project to outcomes for those 

5 not participating in the project; 

6 (D) to determine the satisfaction of pa7 tients participating in the project; and 

8 (E) to evaluate other such matters as the 

9 Secretary determines is appropriate. 

10 (2) REPORTING.—Not later than 90 days after 

11 the completion of the second year following the com12 mencement of the QCCD project, the Secretary shall 

13 submit to Congress a report on the evaluation con14 ducted under paragraph (1) together which such rec15 ommendations for legislation or administrative ac16 tion as the Secretary determines is appropriate. 

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