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 Com-
merce, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To provide for a pilot program to improve the quality of 
oncology care under Medicare. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Oncology Care Quality 
Improvement Act of 2009’’. 
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SEC. 2. ONCOLOGY CARE QUALITY IMPROVEMENT PRO-
GRAM. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall establish a pilot program (in this section 
referred to as the ‘‘OCQI program’’) under title XVIII of 
the Social Security Act to evaluate the impact of three 
provider-led approaches described in subsection (b) to im-
prove care quality and outcomes for Medicare beneficiaries 
with cancer while addressing care cost drivers by creating 
greater efficiencies in the program. 
(b) APPROACHES DESCRIBED.—The approaches de-
scribed in this subsection are the following approaches to 
the delivery of oncology care: 
(1) 
EVIDENCE-BASED
GUIDELINE
ADHER-
ENCE.—Reducing variation in care through adher-
ence to evidence-based guidelines that improves qual-
ity and reduces error. 
(2) PATIENT EDUCATION AND CARE COORDINA-
TION SERVICES.—Providing patients with— 
(A) dedicated educational sessions about 
the likely effects of their cancers and treat-
ments and how to manage those prior to initi-
ation of treatment, preferably from an oncology 
nurse; and 
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(B) continuous support throughout their 
course of care. 
(3) END-OF-LIFE PLANNING AND COUNSELING 
SERVICES.—Providing patients with poor prognoses 
with end-of-life planning and counseling services 
with their physicians and nurses in order to em-
power such patients and their families with the best 
information available about their options to assist 
such patients and families in making difficult 
choices between pursuing potentially ineffective ag-
gressive medical treatments or pursuing hospice care 
or other palliative care to improve quality of life in 
their final months. 
(c) DESCRIPTION.— 
(1) IN GENERAL.—The OCQI program shall be 
designed in a manner similar to that for the physi-
cian group practice demonstration program under 
section 1866A of the Social Security Act (42 U.S.C. 
1395cc–1) and shall provide performance payments 
to participating oncology groups that implement 
each of the approaches described in subsection (b) 
equal to one-half of the program savings generated 
by the participating group. The other half of pro-
gram savings shall be retained by the Medicare pro-
gram. 
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(2) EXPENDITURE TARGETS.—Under the OCQI 
program, the Secretary shall establish per capita ex-
penditure targets for participating oncology groups, 
taking into account the risk characteristics of the 
patients involved. Those groups that meet the per-
formance goals established by the Secretary and 
achieve program savings against the expenditure tar-
gets shall receive performance payments described in 
paragraph (1). 
(3) LIMITATION ON NUMBER OF PARTICIPATING 
GROUPS.—The Secretary shall limit the number of 
groups that may participate in the OCQI program to 
no more than 75 groups at any time. 
(4) LIMITATION
ON
DURATION.—The OCQI 
program shall be conducted over a 3-year period. 
(5) LIMITATION ON PATIENT SELECTION.—The 
Secretary shall prohibit groups participating in the 
OCQI program from selecting the individual patients 
to be included in the program. 
(6) PENALTIES TO PREVENT REDUCTIONS IN 
SERVICES.—The Secretary may impose penalties on 
those groups participating in the OCQI program 
that the Secretary determines have inappropriately 
reduced cancer therapies, including supportive care 
therapies (basing their determination on existing evi-
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dence based, medically accurate guidelines). Any 
such penalties shall be in the form of reductions to 
performance payments payable to the groups under 
paragraph (1). 
(d) ADVISORY COMMITTEE; EVALUATION.— 
(1) IN GENERAL.—The Secretary shall appoint 
an advisory committee composed of representatives 
of the oncology community, including organizations 
representing physicians, nurses, and patients, and 
industry representatives, to collaborate with the Sec-
retary on the creation and implementation of the 
OCQI program, including the development of appro-
priate expenditure targets, and to help analyze the 
data generated by the OCQI program. The advisory 
committee shall specifically advise the Secretary on 
the methods for selecting practices in different re-
gions of the United States to particiapte in the 
OCQI program. 
(2) EVALUATION.—In consultation with the ad-
visory committee, Secretary shall evaluate the OCQI 
program to— 
(A) assess patient outcomes for patients 
participating in the program as compared to 
such outcomes to other individuals for the same 
health conditions; 
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(B) analyze the cost effectiveness of the 
services for which performance payments are 
made under the program, including an evalua-
tion of the cost savings to the Medicare pro-
gram attributable to reductions in physicians’ 
services, emergency room visits, hospital stays, 
drug costs, advanced imaging costs, and end-of- 
life care; 
(C) determine the satisfaction of patients 
participating in the program; and 
(D) refine the appropriate level and pro-
portion of the specific performance payments 
among the three performance components of 
the program. 
(e) IMPLEMENTATION.—If the Secretary determines 
that the OCQI program has been successful in improving 
care quality while lowering the rate of growth of Medicare 
program expenditures, the Secretary is authorized to in-
clude payments for the specific services paid under the 
OCQI program as performance payments as permanent, 
covered services under the Medicare program. 
Æ 
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