What Healthcare Reform Means for Surgical Oncology

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act. Seven days later, in true amendment style unique only to lawmaking, he signed the Health Care and Education Affordability Reconciliation Act of 2010. Every doctor in America will soon begin to notice the implications of these new laws in their daily practice. Several important provisions impact cancer care and surgical practices, including the creation of new agencies, increased research funding, and changes in the way that patients navigate the system and achieve access to surgical oncologists. In reviewing our new laws, we asked ‘‘What does health reform mean for surgical oncology?’’ We highlight key sections of the new laws that directly impact our field. Funding for Cancer Treatment Research. Beginning this year, $500 million will be appropriated to a new branch of the National Institutes of Health (NIH) called the Cures Accelerated Network. Grants of up to $15 million annually per project will be awarded to perform basic science, translational, and clinical research. This new branch will collaborate with the Food and Drug Administration to expedite approval of new medications and devices. Increased Cancer Screening. Key cancer screenings will now be covered without co-pays, deductibles, or other financial disincentives. Cancer screenings that will be covered will be determined according to highly endorsed Grade A and B recommendations from the U.S. Preventative Services Task Force. These screenings include colonoscopy and Papanicolaou smears. A notable override to these recommendations allows mammography to be covered for patients beginning at age 40 years. In addition, $45 million will be allocated during the next 5 years to the NIH and Centers for Disease Control and Prevention (CDC) for breast cancer research, including development and validation of new screening methods and ways to improve patient education. We anticipate that these changes will lead to an increased number of patients presenting with earlier stage cancers. Funding for Cancer Care Delivery Research. A newly established Patient Centered Outcomes Research Institute will receive more than $150 million annually in funds by 2012 to support research in delivery of care and outcomes. This Institute will function as a nonprofit corporation with a 19-person appointed board, which is neither an agency nor an establishment of the government. Grants will fund health care services research surrounding cancer care and programs that improve quality and safety for cancer care. A focus will be placed on multicenter trials, studies that can produce generalizable findings and collaborations that use electronic health data. Keeping Coverage after a Cancer Diagnosis. The bill prevents a patient from being denied health insurance coverage because of cancer—a common preexisting condition. For children, this ban is immediately in effect; however, it does not take effect until 2014 for adults. In the interim, patients denied coverage because they had or have cancer as a preexisting condition can choose a short-term insurance plan from a government-subsidized, national, high-risk insurance pool. In addition, the bill prevents insurance companies from reducing a patient’s health insurance coverage when they acquire a new diagnosis. Reimbursement of Advanced Imaging. Magnetic resonance imaging (MRI), positive emission tomography (PET), computed tomography, and other imaging machines with an acquisition cost of more than $1 million will be reimbursed at a decreased amount under the assumption that their utilization has increased. To retain a profit, many imaging facilities will likely become more centralized to maintain high volumes with fewer machines. Society of Surgical Oncology 2010