Events

Videos

Podcasts

Articles

ACCC Annual Meeting, CANCERSCAPE

Jacob Gersh, PhD, lead physicist at the Gibbs Cancer Center & Research Institute, discusses the CyberKnife.

The CyberKnife uses high-energy photons to deliver radiation to tumors, says Gersh. The difference with this tool is the size—the beam that is delivered to the tumor is much smaller than what is traditionally associated with conventional radiation therapy.

Gersh says that because of the CyberKnife’s size, it has very precise and accurate targeting, allowing the dose to be raised as it will not damage as much healthy tissue as traditional radiation would. Additionally, the precision of this tool can reduce the number of treatments a patient must undergo.

Jacob Gersh Discusses the CyberKnife

Kavita Patel, MD, MS, policy analyst, Brookings Institution, discusses the Cancer Drug Coverage Parity Act.

The Cancer Drug Coverage Parity Act requires health plans to provide anticancer medications without changing or replacing benefits to increase out-of-pocket costs, reclassifying benefits to increase costs, or applying more restrictive limitations to oral medications—patient administered&mdash;than to intravenous or injected medications&mdash;physician administered&mdash;as per the bill presented to Congress by Leonard Lance on June 11, 2015.

As with a lot of legislation, this act will most likely never reach the President’s desk, says Patel. However, it is still important, she adds, because it sends a signal throughout Washington, DC that says that the conversation around cancer drugs is continuous, and the needs of patients with cancer are a different, specific issue within healthcare.

Dr. Patel Discusses the Cancer Drug Coverage Parity Act

President Donald Trump may be more successful at negotiating reduced prices for oncolytic drugs than he has been in achieving a revision of the Affordable Care Act (ACA), said Jessica Turgon, MBA, of ECG Management Consultants, this week at the annual CANCERSCAPE meeting of the Association of Community Cancer Centers. She said that changes in 340B Drug Pricing Program rules and the CMS physician payment formula are very possible.

Trump has made it one of his goals to win concessions from the pharmaceutical industry on pricing, and his background as a negotiator may be useful to him, Turgon said. In his Twitter posts, Trump has expressed a strong desire to establish bidding procedures for drugs, although Medicare is prohibited from negotiating drug prices, and Trump is passionate about the issue, potentially more so than he has been about repealing the ACA, Turgon said.

“It may be an easier area for the president to focus on given his background in negotiation,” she said. “How he does it is going to be interesting.”

The president will face a number of challenges on the way to meeting this goal, however. The pharmaceutical industry is opposed to drug price negotiations, Trump will need bipartisan support, and the president is often at odds with the GOP and “flip-flops” on issues, Turgon said.

In his corner, Trump has Thomas Price, MD, serving as secretary of the Department of Health and Human Services (HHS), who may also be effective in bring about drug pricing reform, Turgon speculated.

Finding some way to allow Medicare to begin negotiating drug prices with manufacturers would enable Medicare to exploit its leverage as the largest payer, but there are differing views on the magnitude of federal savings that could be achieved. The Congressional Budget Office has said the effect would be negligible, Turgon said.

Trump has shown interest in raising imports of drugs from countries where costs of medicine are lower. However, pharmaceutical companies are opposed and they could potentially react to such a policy by raising prices and limiting supplies worldwide, potentially harming populations that rely on lower-cost access. “What would the impact of those price changes be globally?” Turgon said.

Generic competition offers promise for countering the cost of brand-name drugs, Turgon added. It has been suggested that the FDA speed generic approvals to bring about more pricing competition, although Turgon said the FDA is already moving drugs through the review process speedily and it’s not clear whether the agency can move faster. Another tactic would be to make it illegal for pharmaceutical manufacturers to contract with makers of competing drugs to stall the market entry of rival drugs, a practice known as “pay-for-delay.” Pay-for-delay costs American consumers as much as $14 billion annually, Turgon said.

The 340B program is a huge potential target for reducing drug expense, but this idea, too, is fraught with potential difficulty. Many participating entities in the medical establishment are financing operations with the sizeable savings and rebates available through 340B. They would be very opposed to having this support pulled away from them, Turgon said. “How would you run your health systems without those revenues coming in?”

To illustrate the scale of the potential opposition, Turgon noted that 340B-covered entities in 2013 numbered 16,500, up from 8000 in 2008. Even so, she said, it’s almost a certainty that some rules will be put in place to limit the growth of 340B.

In March 2017, the Medicare Payment Advisory Commission (MedPAC) released a set of recommendations for improved management of Medicare Part B drug spending. Part B covers infused and injectable drugs. The tab for this spending reached $26 billion in 2016, Turgon noted. One of the MedPAC recommendations includes a change in the current payment formula, which entitles physicians to 100% of a drug’s cost plus a 6% markup. CMS’ efforts to reduce that rate of payment last year were unsuccessful. The recommendations from MedPAC include requiring drugmakers to report average sales price (ASP) data and to pay a rebate to Medicare when ASP reaches a benchmark level.

The ill-fated CMS drug payment model, which would have experimented with cutting ASP-plus-6% to ASP-plus-2.5%, was contested by physicians partly on grounds that the payment formula would not have been adequate to cover their costs. Despite that, MedPAC is an official advisory agency whose recommendations are frequently accepted by CMS, and this latest guidance is not likely to be treated lightly, Turgon said.

An additional recommendation from MedPAC is to establish a single billing code, or payment, for reference biologic drugs and their biosimilar equivalents. Such a policy could cause practices to swing toward use of the cheapest obtainable drug under the single code, while also creating problems for practices whose physicians prescribe drugs that are priced higher than the corresponding payment under the code, Turgon said. Under Price at HHS, such a policy could conceivably come about, she said.

With much uncertainty about the drug pricing policies that will emerge as the Trump tenure unfolds and Price and others, including Seema Verma, newly confirmed head of CMS, begin to exercise their mandate to control spending, it’s incumbent upon practices to protect themselves the best way they can. Turgon said this means adhering to clinical pathways, using evidence-based treatment alternatives, educating prescribing doctors about the costs of drugs, and having cost-of-care discussions with patients. She also recommended reducing wasteful drug use—in particular by choosing infusion bag sizes carefully, and practicing just-in-time delivery by keeping inventory supplies of high-priced drugs as low as possible.

In addition, practices need to develop defensive readiness for what seem to be rising and often arbitrary claims rejections by payers, Turgon said. “What we were seeing at some cancer centers at the turn of the year was 1 in 4 claims were being denied. It takes time, it takes, energy, but making sure that your denial process and your authorization process are fine-tuned would be part and parcel of helping your cancer center run effectively.”

Jessica Turgon, MBA, of ECG Management Consultants says that changes in 340B Drug Pricing Program rules and the CMS physician payment formula are possible. 
 

ACCC Speaker Says Drug Pricing Reform May Gather Momentum

Tricia Strusowski has spent most of her career working as a navigator in the community oncology setting to ensure that patients receive appropriate care, at the right time, and at the right place. Currently, she works with Oncology Solutions, a consulting firm, working to improve and implement nurse navigation programs at treatment centers across the country.

This week at the 2017 annual CANCERSCAPE meeting of the Association of Community Cancer Centers, Strusowski, MS, RN, sat down with 

® to discuss the role of oncology nurse navigators, the important differences these professionals can make, and how their responsibilities tie seamlessly into the value-based care at the heart of CMS’s Oncology Care Model (OCM).

®: What are the essential tasks of an oncology nurse navigator?

: Navigation has really been refined over the last 20 years, and that's how long I've been involved with oncology. We didn't have core competencies back then, but now we do. There are position statements from national organizations and we also have the Commission on Cancer (CoC) standards. A lot has happened.

The roles and responsibilities are mainly about the patient: coordinating the care for the patient and the family across the entire continuum. Providing education and support and performance improvement monitoring is a big piece: letting the patients know about the resources at the cancer centers as well as in the community. We also want to make sure we're educating the patient about clinical trials and providing access to the clinical trials department. We also want to make sure our navigators are involved with tumor conferences, with multidisciplinary centers within the cancer community. And the navigator’s role is very much a patient-centered mission.

The definition is: individualized assistance provided to the patient and family, to reduce barriers, and to increase access to medical and psychosocial care across the entire continuum.

Do those responsibilities differ between a big academic center and a smaller, community setting?

They shouldn't. There are more challenges sometimes for the navigator who is working with 100 new cancer cases per year all by herself. She might have limited resources. However, we all have the same roles and responsibilities and core competencies. There shouldn't be a tremendous amount of difference between locations. 

I tend to always want to help the navigators who are out there on their own, who are trying to figure things out. They were probably hired—maybe not even oriented&mdash;and just told, "Go out and navigate." Well, what does that mean, when you don't have a navigation background? You may have been a bedside nurse, or a chemotherapy nurse, and you may not understand the whole history and responsibilities of navigation.

Is it more important to have a navigator in the community setting?

Community cancer centers are where 80% of patients get their care. They cannot afford to travel to comprehensive cancer centers. Plus, they want to get care in their own backyard. They want to have those services. From my perspective, it's very important that we help navigators and everybody involved with support services to help the patients, because it's such a scary time for anybody diagnosed with cancer, let alone having to travel for 3 hours for treatment, having additional concerns, and lacking resources, such as the money required for expenses.

I support all navigators in their role because it's a challenge no matter where they are, with the number of patients and the caseload and the responsibilities. We try to focus on providing the right care at the right place at the right time. And having that navigator stay 1 step ahead of that patient is a constant challenge.

What is an example of how a nurse navigator can make a difference in the care a patient with cancer receives? 

For a patient with head-and-neck cancer, things have to happen in a particular order. If they don't get dental clearance before they start to receive their treatment, it can be catastrophic. One performance improvement initiative that 1 of the programs I work with started was to make things happen on schedule. For patients with head-and-neck cancer, the dental clearance, on average, was taking about 2-3 weeks. That's a significant delay. It's a worrisome time for the patient, knowing that their treatment hasn't started. Dental clearance must be taken care of before multiple other appointments can occur, before patients can even start their chemotherapy or radiation.

We put a new process in place for that group. We worked with the tumor site team and we looked at the national guidelines and we did a process mapping exercise, to look at barriers and where their opportunities were for improvement. We knew immediately the dental clearance was a concern. So, we created a dental clearance process. The navigator took lead and asked each patient, "Do you have a dentist? Can I contact your dentist so we can expedite the visit?" A problem that went from 2-3 weeks went down to 2 days almost immediately.

And we provided expert support for the community dentists so they could understand why the patients needed to have the dental clearance through our tumor site team. We also created standing order sets. The navigator—no matter who was covering those head-and-neck patients&mdash;provided the same high level of care, which is fantastic.

We also created appointment checklists. The patient could potentially leave with 7-10 referrals, and we provided definitions of the specialists the patient would be seeing. What is a medical oncologist? What is a radiation oncologist? What is a speech and swallowing therapist? What we did is we outlined and defined those terms and explained them so the patient would understand. We also created lists of frequent questions and answers to those questions, to serve as decision aids for patients. Sometimes, they don't even know what to ask their doctors. It could be as simple as, "What is my cancer?” “Where is it?” “What are my treatment options?” “What clinical trials are available?" We empower the patient, which is a huge piece part of helping.

Those are just a few examples of how a navigator can really enhance the care for the patients, as well as the entire cancer program.

How can oncology nurse navigators help achieve the outcomes and quality goals that CMS has set with the OCM?

At the 7th Annual Academy of Oncology Nurse and Patient Navigators, we were in the Evidence of Practice Committee, and we said, "We have core competences, we have the CoC standards, but we don't have navigation metrics." When I go to a program, that's the first thing I assess. Show me your reports, show me your metrics. Some places don't have any—which can be better because we can help them. Some places may have them and I'll ask, "Can you define that for me?" And if there's 3 navigators, I get 3 different definitions. There's no clarity. 

We don't have a lot benchmarks in navigation. Over the last year-and-a-half, we put a proposal together and it was approved by the leadership of the Academy of Oncology Nurse & Patient Navigators. We had experts from across the country. We did a tremendous amount of research. We ended up with over 300 source documents that supported our 35 metrics, based on patient experience, clinical outcomes, and return on investment.

When you cross-reference these metrics with the value-based cancer care of the OCM, they're beautiful. It's a perfect fit. For the first time, we can truly partner and all be on the same page with the same mission and vision, to enhance the care for our patients and families. It's extremely exciting.

Tricia Strusowski, MS, RN, discusses the role of the oncology nurse navigator and how these staffers can help meet outcome and quality standards set by the CMS's OCM.

Clarifying the Role of Oncology Nurse Navigators

Jennie Crews, MD, MMM, FACP, Seattle Cancer Care Alliance Network, is the outgoing president of the Associate of Community Cancer Centers (ACCC). Here she reflects on the highlights of her past year. 

Crews's presidential theme was "empowering patients and engaging providers." The ACCC's Institute for the Future of Oncology focused on patient-centered care. They produced a whitepaper with 7 key elements to providing patient-centered care.

ACCC also worked with the Center for Medicare and Medicaid Innovation (CMMI) to develop legislation as well as educate their members on Centers for Medicare and Medicaid (CMS) initiatives such as the alternative payment models (APM) and the oncology care model (OCM).

The outgoing president of the Association of Community Cancer Centers, Jennie Crews, MD, MMM, FACP reflects on her time as president and the achievements the ACCC made.

Dr. Crews Reflects on the Achievements of the ACCC During Her Presidency

The steep $5.8 billion cut in spending for the National Institutes of Health proposed by President Donald Trump is just an opening gambit in the long negotiations ahead over the 2018 federal budget, said Kavita Patel, MD, MS, a policy analyst with The Brookings Institution who was one of the keynote speakers at the annual CANCERSCAPE meeting of the Association of Community Cancer Centers this week.

In an interview with OncLive®, Patel provided an overview of the Capitol Hill scene as the Trump administration’s first year unfolds with a dramatic attempt to revise healthcare policy. Patel also discussed the potential for a resurgence in the Republican effort to repeal the Affordable Care Act (ACA) and the impact of legislative reform and revision on physicians and patients.

Currently a fellow at the Brookings Institute, Patel previously served as the director of policy for the Office of Intergovernmental Affairs and Public Engagement under former President Barack  Obama. Prior to that time, she was deputy staff director for health under the late Sen Edward M. Kennedy.

: What do you see happening as legislators continue to battle over the Affordable Care Act (ACA)?

: The American Health Care Act (AHCA) [the Republican answer to the ACA] has potentially resurfaced with some comments by House Speaker Paul Ryan and President Donald Trump that they are still going to do something on health care repeal. It's a low likelihood, but there could potentially still be some action or activity around repeal through the budget reconciliation process, which allows them several months to act.

Otherwise, it's now going to be important to have Democrats come out, even just symbolically, with some version of an ACA fix, so it can look as if the things that people are criticizing the ACA for will get solved in some way. A White House with a Republican in it is very unlikely to sign something to improve Obamacare, but that's what I think the next several months will produce. It will be very political, and I don't know how much how much change we’ll see in the healthcare plan. I think we're still going to see the ACA as the law of the land for, honestly, not just the "foreseeable future," which is what Paul Ryan predicted, but probably for the rest of this administration, unless there is a dramatic political shift.

Are you a proponent for removing the individual mandate penalty for not buying insurance under the ACA?

Actually, I think the individual mandate needs to be stronger—there needs to be more of a penalty to not purchase insurance.

There also need to be regulations that transform the federal marketplace into something like California has, where they actively manage the benefits—it’s called an active exchange model. The federal marketplace is not an active model. The exchange doesn't actively say, “We want everyone to get free primary care,” or “We want for everyone to get free preventive care,” even though these things are possible through the ACA.

The third thing is the age rating. Right now, there's a certain limit on how much payers can charge based on someone's age. I think that probably needs to get widened. If that were to happen, it may become a little more expensive for older people to buy healthcare, unfortunately. But I think that's one solution—not to make it attractive, but to make it probably more affordable for younger, healthy people&mdash;which is really what we need to make more people buy healthcare.

What do you see happening with the president’s 2018 budget proposal? Do you think we'll see the cuts that are laid out there, particularly to the National Institutes of Health (NIH)?

Every time a president, especially a first-term president, releases their budget, it's more symbolic than real. But, if Congress wants to increase defense spending or increase certain areas of spending, they're going to have to cut from other areas. Unfortunately, I do think we're going to see some very lean times. Maybe not exactly how President Trump proposed, but I think we're going to see some lean times for organizations like the NIH, the Centers for Disease Control, and other agencies for healthcare research and quality—organizations that have important roles in healthcare. I think it's going to be hard to see increases in those budgets.

Where do the budget situation and the healthcare environment leave patients and providers?

Everybody involved in clinical care is left a little bit confused. For a long time, people were wondering if the ACA was going to pass, then they were wondering if the Supreme Court was going to strike it down. Recently, as late as last week, we were wondering if the AHCA would replace the ACA. Just when doctors are getting ready to do something in response to the ACA, they're getting signals of "Wait a minute! This is going to go away. You don't have to do this anymore."

A lot of patients are worried about whether Medicare is going to be an insurance program that can give them what they need, and I think that's a valid concern. The way we spend money in Medicare is becoming much more costly. Even though the last couple years have seen very modest growth in the Medicare program in terms of cost, there are now projections that it's going to become much more expensive. I think patients are wondering, “Is Medicare going to take care of what I need?” “How will I afford insurance as I get older?” Those are all pretty important concerns. Certainly, I worry about it myself.

I expect that the cost of healthcare, unless we do something really different, is going to continue to rise.

Within the ACA, what provisions and measures are relevant to oncology professionals?

CMS put into place accountable care organizations and the Center for Medicare & Medicaid Innovation. Those are all things that changed the way oncologists are getting paid for care. They're also changing the conversations oncologists are having with patients about cost. A lot of these programs are asking doctors to talk to patients about cost. That's a very different model than we had 10 years ago.

What should we be paying attention to in the coming months?

The big action might be around the FDA and some of the things that are happening right now with reauthorization. For example, the Children's Health Insurance Program has to be reauthorized this year or it expires. There will probably be some negotiations around that. That's an opportunity for a drug pricing conversation.

While at the annual CANCERSCAPE meeting of ACCC, Kavita Patel, MD, MS, comments on uncertainy in the healthcare environment and key policy to be aware of.

Federal Healthcare Policy Is Front and Center at CANCERSCAPE Conference

Cary Presant, MD, FACP, FASCO, City of Hope Medical Center, discusses how clinical trials can be changed to better align with value-based care.

Currently, there is a trend toward changing care from volume-based to value-based. Clinical trials are not value-based, what with the expenses: more testing, more evaluations, more interactions with the clinical trial team and more resources used. 

To adjust for that, there are strategies that can create more value-based clinical trials. Choosing trials carefully, keeping an adequate team caring for the patient throughout the trial process, using resources efficiently, and ensuring buy-in from the entire team can help to adjust the trial system. Adjusting clinical trials currently is necessary as the reliance of value-based care becomes more acute in the future.

Cary Presant, MD, FACP, FASCO, City of Hope Medical Center, discusses clinical trials and value-based care. 

Dr. Presant on Adjusting Clinical Trials to Value-Based Care

The Republican-led Affordable Care Act (ACA) repeal and replace effort has the potential to be revived, but majority leaders may not want to risk further political capital in a battle that could go against them, speakers said this week at the Association of Community Cancer Centers’ (ACCC) CANCERSCAPE annual conference.

The 3-day event at the Renaissance Washington, DC Downtown Hotel opened Wednesday with lobbying on Capitol Hill prior to wide-ranging discussions covering prominent political and practical management issues surrounding the delivery of cancer care in the United States.

“It’s a critical time to make sure that our voices are heard, and we must ensure that, moving forward, patient protections for access to care and affordable care are preserved. Despite events of recent weeks with the failure of repeal, there are still rumblings about reform and replacement of the ACA,” Jennie Crews, MD, president of the ACCC, said.

The keynote discussion included a postmortem on the repeal plan, which Republicans pulled from consideration last week owing to a failure to obtain sufficient House support for passage. “The bottom line was they didn’t have the votes,” said Dan Todd, JD, of Todd Strategy, a Republican strategist who participated in the panel discussion with Kavita Patel, MD, MS, a policy analyst with The Brookings Institution.

Patel said the Republican support issue may have been blamed on the Freedom Caucus and its objections, but in truth, she said, there were diverse opinions among the Republican legislators, all of which factored into the decision to withdraw the repeal measure.

Further, she said, “When [House Speaker] Paul Ryan said Obamacare was the law of the land for the foreseeable future, I interpreted that as, ‘We’re done. We’re not going to be able to take this up.’”

Patel said that despite Ryan’s assessment last week, there remains time for foes of the ACA to attempt another repeal and replace piece of legislation; and indeed, this week Republicans announced that they had restarted negotiations.

Todd said the failure to gain House support hinged upon a false assumption that the only vote that really mattered was the Senate’s. “I think the challenge was they wrote this bill thinking there’s no way they would vote against an Obamacare repeal. I think that was the wrong calculation.” He said an additional mistake was in structuring the bill to pass the Senate without really heeding the dynamics of satisfying House members. “Those in the House really don’t care much about the Senate.”

President Donald Trump may have a seat at the bargaining table during this process, but his ability to make a genuine contribution as a strategist is doubtful, Patel said. “One thing that’s very clear is that whatever your party is, this is a White House that does not have the capacity to understand either the procedure or the process.”

She said that Ryan has greatly leveraged his political muscle in trying to bring about a replacement legislative package and is now inevitably doing a “mental calculus” on how much more he wants to risk. “His job’s on the line,” and this is going to be a factor in whether the repeal effort moves forward, Patel said.

Simultaneously, Democrats are likely working to entice Republican legislators to accept ACA-modification measures as a compromise rather than a complete overhaul, she said.

The health of health exchange markets was also discussed. Todd said the problem is that the mixture of exchange-covered lives is out of balance with the economics of funding the insurance programs sustainably. This has made it necessary for the government to step in with risk-adjustment payments to subsidize these plans. “Effectively it’s a back-end, unfunded mandate. The big question is, will the Trump administration make those payments the way the Obama administration did. My gut tells me no,” Todd said.

Already, the number of health exchange plans is low across much of the United States, making for a “very unhealthy market.” The more payers that pull out of the market, the less stable it will become, Todd remarked. He said that Trump and other Republicans are aware of this and know it’ll eventually force a compromise, but added that even if legislators act now, it may be too late to save the health exchange system.

Patel added that payers who remain involved undoubtedly are making the argument in Washington, DC, that conditions have made it difficult, if not impossible, for them to plan continued health exchange coverage in 2018. “Patients are probably going to suffer until we see something moving forward,” she said. And as time progresses, it will become increasingly difficult for the political majority to pin the failure of the legislation on the Obama administration. “At some point, the Trump administration will own this,” she said.

The discussion included a focus on preserving patient consumer protections, a subject that is near and dear to the ACCC, whose leadership this week urged legislators to maintain protections against benefit limits and the ACA ban on coverage decisions based on pre-existing health conditions, among other ACA protections.

Panelists said that one of hard lessons of the ACA has been how hard it was to get young people to enroll in the coverage plans. Their healthier profiles were expected to balance the risk of enrolling older, sicker people; but the design of the ACA legislation has, in many ways, frustrated that objective. For example, allowing young people to stay on their parents’ plans through the age of 26 has undermined optimal plan recruitment, they said. “You shouldn’t have let them stay on their parents’ plans,” Todd said, adding that removing that privilege would have created a healthier risk pool for the exchanges and brought costs down.

The conversation also touched on drug pricing reform. The panelists said the rising cost of medicine has been a long-running debate that may continue without a near-term solution. “I think drug pricing will continue to be a lot of noise—talk, talk, talk&mdash;and not much action,” Patel said. Todd mentioned the oft-raised idea of importing cheaper medications from Canada. He said that would likely not work for long. Canada has a small drug market “the size of New Hampshire’s,” and the Canadians would quickly react by blocking cross border sales to avoid jeopardizing their own pricing and access.

Patel speculated that drug purchases will be incorporated into care models and this may improve the affordability of access. Separately, she said the pressure on physicians to make better value choices in medicine is increasingly out of physicians’ hands because payers are dictating so much of what they do by making the approvals process more and more difficult.

Patel and Todd also discussed the future of the Center for Medicare & Medicaid Innovation (CMMI), which suffered a setback with the demise last year of the Medicare Part B Drug Payment Model, a plan to implement different forms of drug pricing and payment that the oncology community contended involved them in an involuntary national experiment with no say in how it was conducted. Patel said that episode in CMMI’s history was so filled with “political toxicity” that it’s unclear what role CMMI will play going forward as an innovation arm of CMS.

The Oncology Care Model, another offspring of CMMI, has been far more successful, and is undergoing its inaugural year currently. The question was posed by audience member and conference participant Cary Presant, MD, of the City of Hope care network, California, whether CMMI would continue to receive funding. Todd expressed doubts that would happen.

“I think it’s really hard to imagine a reauthorization,” he said. With new leadership at the Department of Health and Human Services and CMS, CMMI’s value will be scrutinized and the outcome of that inspection may not be a vigorous thumbs-up. Certain programs should be cut based on honest assessments that they haven’t worked out, but the tendency, Todd said, is a “hands on the scale” approach to make sure that the programs do work. “But that’s not really the point. It’s also to kill things quickly.”

The Republican-led Affordable Care Act repeal and replace effort has the potential to be revived, but majority leaders may not want to risk further political capital in a battle that could go against them, speakers said at this year's Association of Community Cancer Centers' CANCERSCAPE annual conference.

ACCC Annual Meeting, CANCERSCAPE | Conference