The Community Oncology Alliance (COA) has unveiled a comprehensive healthcare reform blueprint aimed at addressing mounting challenges in cancer care delivery and broader healthcare system issues. The "COA Prescription for Health Care Reform" outlines crucial legislative reforms needed to protect patient access to high-quality, affordable medical care while ensuring the sustainability of independent community practices.
Dr. Debra Patt, COA president and practicing breast cancer specialist at Texas Oncology, emphasizes the critical nature of the current healthcare landscape. "Our health care system has reached a critical tipping point as Americans pay more than ever for health care that is becoming increasingly out of reach," she states. "Consolidation, administrative burdens, and skyrocketing costs are hurting patients and providers alike."
Key Reform Priorities
The five-part reform plan addresses several interconnected challenges facing the healthcare system:
Hospital Consolidation Impact
The report highlights how hospital mergers have created local monopolies that drive up healthcare costs despite maintaining nonprofit status. COA advocates for site-neutral payment policies and a reevaluation of nonprofit status definitions, along with restrictions on aggressive debt collection practices.
PBM and Insurance Reform
Vertical integration has given Pharmacy Benefit Managers (PBMs) unprecedented control over healthcare decisions. The proposal calls for increased transparency, strict limits on prior authorization, and prevention of patient steering to PBM-affiliated pharmacies. Notably, COA recommends requiring PBMs to divest from pharmacy ownership entirely.
Medicare Reimbursement and Workforce Solutions
The plan addresses the declining value of Medicare Physician Fee Schedule payments, which particularly impacts independent and rural practices. Proposed solutions include aligning reimbursement with inflation, ending sequestration, and creating incentives for rural practice residencies to address staffing shortages.
Oncology Treatment Access
COA identifies multiple barriers to cancer care access, including rising costs for novel therapies and chronic shortages of sterile injectable drugs. The proposal suggests technical adjustments to the Inflation Reduction Act to protect independent practices during Medicare price negotiations and calls for measures to enhance access to cost-saving biosimilars.
Medicare Policy Modernization
The blueprint calls for a comprehensive overhaul of fragmented Medicare payment policies that currently favor consolidation and inefficiency. COA advocates for equitable payment approaches across all practice settings and increased oversight of value-based payment models.
Current Context and Implementation
The timing of this reform package coincides with concerning findings from an American Society of Clinical Oncology (ASCO) survey, which revealed significant burnout among medical oncology fellows, with 20% reporting burnout and 18% experiencing high levels of emotional exhaustion.
While some elements of the reform package, such as PBM reform, have gained significant legislative traction, others may face longer implementation timelines. Dr. Patt acknowledges that certain aspects, particularly 340B program reform, may require extended negotiations due to stakeholder dependencies.
Under the theme "Empower and Advocate," COA plans to strengthen its policy initiatives throughout the year, focusing on coordinated efforts to advance these reforms through Congress and regulatory agencies.
