I 

111TH CONGRESS 

1ST SESSION H. R. 2939 

To provide for a pilot program to improve the quality of oncology care 

under Medicare. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 18, 2009 

Mr. CROWLEY (for himself, Mr. ROGERS of Michigan, Mrs. CAPPS, Mr. RYAN

of Wisconsin, Ms. ESHOO, Mr. KIND, Mr. THOMPSON of California, Mr. 

GORDON of Tennessee, Mr. PASCRELL, Mr. TIBERI, Ms. BERKLEY, Mr. 

BLUMENAUER, Mr. DAVIS of Kentucky, Mr. MOORE of Kansas, Mr. 

GENE GREEN of Texas, Mr. ISRAEL, Ms. SCHWARTZ, and Mr. ALTMIRE) 

introduced the following bill; which was referred to the Committee on 

Ways and Means, and in addition to the Committee on Energy and Commerce, 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 provide for a pilot program to improve the quality of 

oncology care under Medicare. 

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 ‘‘Oncology Care Quality 

5 Improvement Act of 2009’’. 


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1 SEC. 2. ONCOLOGY CARE QUALITY IMPROVEMENT PRO2 GRAM. 

3 (a) IN GENERAL.—The Secretary of Health and 

4 Human Services (in this section referred to as the ‘‘Sec5 retary’’) shall establish a pilot program (in this section 

6 referred to as the ‘‘OCQI program’’) under title XVIII of 

7 the Social Security Act to evaluate the impact of three 

8 provider-led approaches described in subsection (b) to im9 prove care quality and outcomes for Medicare beneficiaries 

10 with cancer while addressing care cost drivers by creating 

11 greater efficiencies in the program. 

12 (b) APPROACHES DESCRIBED.—The approaches de13 scribed in this subsection are the following approaches to 

14 the delivery of oncology care: 

15 (1) EVIDENCE-BASED GUIDELINE ADHER16 ENCE.—Reducing variation in care through adher17 ence to evidence-based guidelines that improves qual18 ity and reduces error. 

19 (2) PATIENT EDUCATION AND CARE COORDINA20 TION SERVICES.—Providing patients with— 

21 (A) dedicated educational sessions about 

22 the likely effects of their cancers and treat23 ments and how to manage those prior to initi24 ation of treatment, preferably from an oncology 

25 nurse; and 


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1 (B) continuous support throughout their 

2 course of care. 

3 (3) END-OF-LIFE PLANNING AND COUNSELING

4 SERVICES.—Providing patients with poor prognoses 

5 with end-of-life planning and counseling services 

6 with their physicians and nurses in order to em7 power such patients and their families with the best 

8 information available about their options to assist 

9 such patients and families in making difficult 

10 choices between pursuing potentially ineffective ag11 gressive medical treatments or pursuing hospice care 

12 or other palliative care to improve quality of life in 

13 their final months. 

14 (c) DESCRIPTION.— 

15 (1) IN GENERAL.—The OCQI program shall be 

16 designed in a manner similar to that for the physi17 cian group practice demonstration program under 

18 section 1866A of the Social Security Act (42 U.S.C. 

19 1395cc–1) and shall provide performance payments 

20 to participating oncology groups that implement 

21 each of the approaches described in subsection (b) 

22 equal to one-half of the program savings generated 

23 by the participating group. The other half of pro24 gram savings shall be retained by the Medicare pro25 gram. 


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1 (2) EXPENDITURE TARGETS.—Under the OCQI 

2 program, the Secretary shall establish per capita ex3 penditure targets for participating oncology groups, 

4 taking into account the risk characteristics of the 

5 patients involved. Those groups that meet the per6 formance goals established by the Secretary and 

7 achieve program savings against the expenditure tar8 gets shall receive performance payments described in 

9 paragraph (1). 

10 (3) LIMITATION ON NUMBER OF PARTICIPATING

11 GROUPS.—The Secretary shall limit the number of 

12 groups that may participate in the OCQI program to 

13 no more than 75 groups at any time. 

14 (4) LIMITATION ON DURATION.—The OCQI 

15 program shall be conducted over a 3-year period. 

16 (5) LIMITATION ON PATIENT SELECTION.—The 

17 Secretary shall prohibit groups participating in the 

18 OCQI program from selecting the individual patients 

19 to be included in the program. 

20 (6) PENALTIES TO PREVENT REDUCTIONS IN

21 SERVICES.—The Secretary may impose penalties on 

22 those groups participating in the OCQI program 

23 that the Secretary determines have inappropriately 

24 reduced cancer therapies, including supportive care 

25 therapies (basing their determination on existing eviVerDate Nov 24 2008 06:05 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2939.IH H2939

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1 dence based, medically accurate guidelines). Any 

2 such penalties shall be in the form of reductions to 

3 performance payments payable to the groups under 

4 paragraph (1). 

5 (d) ADVISORY COMMITTEE; EVALUATION.— 

6 (1) IN GENERAL.—The Secretary shall appoint 

7 an advisory committee composed of representatives 

8 of the oncology community, including organizations 

9 representing physicians, nurses, and patients, and 

10 industry representatives, to collaborate with the Sec11 retary on the creation and implementation of the 

12 OCQI program, including the development of appro13 priate expenditure targets, and to help analyze the 

14 data generated by the OCQI program. The advisory 

15 committee shall specifically advise the Secretary on 

16 the methods for selecting practices in different re17 gions of the United States to particiapte in the 

18 OCQI program. 

19 (2) EVALUATION.—In consultation with the ad20 visory committee, Secretary shall evaluate the OCQI 

21 program to— 

22 (A) assess patient outcomes for patients 

23 participating in the program as compared to 

24 such outcomes to other individuals for the same 

25 health conditions; 


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1 (B) analyze the cost effectiveness of the 

2 services for which performance payments are 

3 made under the program, including an evalua4 tion of the cost savings to the Medicare pro5 gram attributable to reductions in physicians’ 

6 services, emergency room visits, hospital stays, 

7 drug costs, advanced imaging costs, and end-of8 life care; 

9 (C) determine the satisfaction of patients 

10 participating in the program; and 

11 (D) refine the appropriate level and pro12 portion of the specific performance payments 

13 among the three performance components of 

14 the program. 

15 (e) IMPLEMENTATION.—If the Secretary determines 

16 that the OCQI program has been successful in improving 

17 care quality while lowering the rate of growth of Medicare 

18 program expenditures, the Secretary is authorized to in19 clude payments for the specific services paid under the 

20 OCQI program as performance payments as permanent, 

21 covered services under the Medicare program. 

Æ 


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