I 

111TH CONGRESS 

1ST SESSION H. R. 2872 

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

beneficiaries by establishing a national demonstration project. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 15, 2009 

Mr. DAVIS of Alabama (for himself, Ms. KILROY, and Mr. ISRAEL) 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 ‘‘Medicare 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, Medicare must transform 

3 the payment system to one based on evidence-based 

4 guidelines and demonstrated quality delivery of care. 

5 (2) An Institute of Medicine report entitled 

6 ‘‘Ensuring Quality Cancer Care’’ recommends that 

7 the following items are essential components in qual8 ity cancer care delivery: 

9 (A) An agreed-upon treatment plan that 

10 outlines the goals of care. 

11 (B) Access to clinical trials. 

12 (C) Policies to ensure full disclosure of in13 formation about appropriate treatment options 

14 to patients. 

15 (D) A mechanism to coordinate services. 

16 (3) Additionally, the report notes the impor17 tance of ensuring quality of care at the end of life, 

18 in particular, the management of cancer-related pain 

19 and timely referral to palliative and hospice care. 

20 (4) According to the Institute of Medicine, the 

21 quality of cancer care must be measured by using a 

22 core set of quality measures. Cancer care quality 

23 measures should be used to hold providers, including 

24 health care systems, health plans, and physicians, 


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1 accountable for demonstrating that they provide and 

2 improve quality of care. 

3 (5) Although two of the critical components of 

4 cancer care are treatment planning and end-of-life 

5 care, none of the 153 quality measures in the Cen6 ters for Medicare & Medicaid Services (CMS) 2009 

7 Physician Quality Reporting Initiative (PQRI) ad8 dresses overall treatment planning or end-of-life care 

9 for cancer patients. 

10 (6) The medical literature suggests that adher11 ence to quality metrics and evidence-based guidelines 

12 help lower costs by reducing use of physician serv13 ices, hospitalizations, and supplemental and expen14 sive drugs.’’ 

15 SEC. 3. MEDICARE QUALITY CANCER CARE DEMONSTRA16 TION PROJECT. 

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

18 Human Services (in this section referred to as the ‘‘Sec19 retary’’) shall establish a quality cancer care demonstra20 tion project under this section (in this section referred to 

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

22 quality metrics and aligning Medicare payment incentives 

23 in the areas of treatment planning and end-of-life care for 

24 Medicare beneficiaries with cancer. 


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1 (b) TEST METRICS AND REPORTING SYSTEMS

2 THROUGH A PAY-FOR-REPORTING INCENTIVE PRO3 GRAM.—Under the QCCD project, the Secretary shall do 

4 the following: 

5 (1) Identify and address gaps in current quality 

6 measures related to the areas of active treatment 

7 planning and end-of-life care by refining the per8 formance measures described in paragraphs (1) and 

9 (2) of subsection (d) relating to active treatment 

10 planning and end-of-life care for clinician-level re11 porting. 

12 (2) Explore the potential to report quality data 

13 through registries or other electronic means for 

14 treatment planning and end-of-life care data, includ15 ing identifying data elements necessary to measure 

16 quality of treatment planning and end-of-life care 

17 and determine how those elements could be collected 

18 through claims data or registries or other electronic 

19 means. 

20 (3) Test and validate identified treatment plan21 ning and end-of-life quality measures through a pay22 for-reporting program with oncologists, which pro23 gram— 


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1 (A) ensures that oncologists are able to ac2 curately report on measures through simple 

3 HCPCS coding mechanisms; and 

4 (B) tests processes of submitting treat5 ment planning and end-of-life measures through 

6 registries or other electronic means. 

7 (c) INCENTIVE PAYMENT.— 

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

9 the Secretary shall provide for a separate payment 

10 under section 1848 of the Social Security Act (42 

11 U.S.C. 1395w–4), to be divided into a baseline pay12 ment amount and an additional payment amount, as 

13 specified by the Secretary, for a treatment planning 

14 code and for an end-of-life code. The amount of such 

15 payments under the project shall be designed to 

16 total $300,000,000 each year. Payments under the 

17 project shall be designed to be paid on an ongoing 

18 basis as claims are submitted. 

19 (2) REQUIREMENT TO SATISFY BASELINE MAN20 DATORY MEASURES TO RECEIVE BASELINE PAY21 MENT.—In order for a physician to receive any pay22 ment under the QCCD project for treatment plan23 ning or end-of-life care, a physician must report in 

24 a manner specified under the project that all of the 

25 baseline mandatory measures described in paragraph 


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1 (1)(A) or (2)(A), respectively, of subsection (d) were 

2 satisfied. 

3 (3) REQUIREMENT TO SATISFY ALL MEASURES

4 TO RECEIVE ADDITIONAL PAYMENT.—In order for a 

5 physician to receive the additional payment amount 

6 described in paragraph (1) under this subsection for 

7 treatment planning or end-of-life care, a physician 

8 must report in a manner specified under the project 

9 that all of measures described in paragraph (1) or 

10 (2), respectively, of subsection (d) were satisfied. 

11 (d) MEASURES.— 

12 (1) TREATMENT PLANNING MEASURES.—The 

13 specific measures related to treatment planning and 

14 any subsequent modifications described in this para15 graph are as follows: 

16 (A) BASELINE MANDATORY MEASURES.— 

17 (i) Documented pathology report. 

18 (ii) Documented clinical staging prior 

19 to initiation of first course of treatment. 

20 (iii) Performed treatment education 

21 by oncology nursing staff. 

22 (iv) Provided the patient with a writ23 ten care plan for patients in active treat24 ment, which advises patient of relevant op25 tions. 


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1 (B) AUGMENTED.— 

2 (i) Implemented practice-endorsed 

3 treatment plan consistent with nationally 

4 recognized evidence based guidelines. 

5 (ii) Documented clinical trial dis6 cussed with the patient, or that no clinical 

7 trial available. 

8 (iii) Documented discussion or coordi9 nation with other physicians involved in 

10 the patient’s care. 

11 (2) END-OF-LIFE CARE MEASURES.—The spe12 cific measures related to end-of-life care described in 

13 this paragraph are as follows: 

14 (A) BASELINE MANDATORY.— 

15 (i) Documented advanced care plan16 ning session with the patient. 

17 (ii) Symptoms assessed and ad18 dressed. 

19 (iii) Recommended the patient to hos20 pice program, whether for institutional or 

21 home-based hospice care. 

22 (B) AUGMENTED.— 

23 (i) Documented no acute care hospital 

24 admissions (including admission to an 

25 emergency room or intensive care unit but 


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1 excluding admission to a hospice or pallia2 tive care unit) within 30 days of death. 

3 (ii) Advanced directive discussion with 

4 the patient documented in the physician’s 

5 records and, if agreed to, inclusion of an 

6 advanced directive in such records. 

7 (iii) Documented that no chemo8 therapy administered within 30 days of 

9 death. 

10 (e) DURATION OF PROJECT.— 

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

12 the demonstration project over a sufficient period (of 

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

14 metrics and reporting methodologies and for anal15 yses. The project shall continue, subject to para16 graph (2), to operate until the Secretary has devel17 oped and implemented under part B of the Medicare 

18 program a payment system that relates payment 

19 under such part for professional oncology services to 

20 performance on measures developed and refined 

21 under the demonstration project. 

22 (2) TRANSITION.—The Secretary shall provide 

23 for a transition period over the course of 2 years 

24 during which oncologists are permitted to transition 

25 from the payment system under the demonstration 


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1 project to the payment system described in para2 graph (1). 

3 (f) PROJECT EVALUATION.— 

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

5 an evaluation of the QCCD project— 

6 (A) to determine oncologist participation in 

7 the project; 

8 (B) to assess the cost effectiveness of the 

9 project, including an analyses of the cost sav10 ings (if any) to the Medicare part A and B pro11 grams resulting from a general reduction in 

12 physician services, hospitalizations, and supple13 mental care drug costs; 

14 (C) to compare outcomes of patients par15 ticipating in the project to outcomes for those 

16 not participating in the project; 

17 (D) to determine the satisfaction of pa18 tients participating in the project; and 

19 (E) to evaluate other such matters as the 

20 Secretary determines is appropriate. 

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

22 the completion of the second year following the com23 mencement of the QCCD project, the Secretary shall 

24 submit to Congress a report on the evaluation con25 ducted under paragraph (1) together which such recVerDate Nov 24 2008 04:15 Jun 16, 2009 Jkt 079200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2872.IH H2872

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1 ommendations for legislation or administrative ac2 tion as the Secretary determines is appropriate. 

Æ 


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