Oct 24, 2014
By Faith Hayden, Senior Writer
Since its founding in 1964, ASCO hasfocused on its mission to conquercancer through research, education,prevention, and delivery of high-qualitypatient care. Although ASCO membersreadily see the Society achieving thismission through tangible efforts suchas meetings, journals, and guidelines,one critical component may fly underthe radar: ASCO’s policy and advocacyefforts.
“The way we pay for cancer care, theincentives we put into those payments,and how we encourage enrollment inclinical trials are all part of ASCO’s mission,”said Blase N. Polite, MD, MPH, ofthe University of Chicago and Chair ofASCO’s Government Relations Committee.“Oncologists can go out there anddo the best job they possibly can, butif we aren’t involved in the paymentmodels, regulations, and incentives, weare not going to achieve our mission ofdelivering high-quality cancer care toall patients. Federal and state policy,regulated insurance, the way insuranceis provided, and genetic testingall come into the public and legislativesphere. If we didn’t have a strong voicein that, then we would never achieveour goal.”
ASCO advocacy takes off
ASCO officially entered the policyarena in 1979, when the Board of Directorsvoted to begin advocating to Congresson key issues such as researchfunding and Medicare reimbursement.But it wasn’t until 1990, when ASCOestablished its first Washington, DC–based office, that its policy work reallyheated up, for a number of reasons.During this period, many cancer therapiesshifted from a hospital settingto the clinic. Furthermore, the 1990ssaw a boom in cancer drugs beingapproved by the U.S. Food and DrugAdministration (FDA). These changes,among others, provided ASCO with awealth of advocacy opportunities and apressing need to be involved.
“ASCO wanted to ensure access ofthese drugs for individuals with cancer,”explained ASCO Past PresidentJoseph S. Bailes, MD, FASCO. “Half ofthe individuals that oncologists carefor are Medicare beneficiaries. TheMedicare program has a great deal ofinfluence over how care is delivered,which things are covered, and howoncologists are reimbursed.”
Over the last 25 years, ASCO and itspolicy team have worked tirelesslyto advocate for issues vital tomaintaining high-quality patient care,leading ASCO to become one of themost well-respected oncology policyvoices in Washington. For example,between 1998 and 2003, ASCOassisted in doubling the NationalInstitutes of Health (NIH) budget from$13.7 billion to $27.1 billion and alsoimproved funding for the NationalCancer Institute (NCI) from $2.5billion to $4.6 billion. In 2006, ASCOissued a groundbreaking study oncancer quality and improvement, the“National Initiative on Cancer CareQuality,” which Dr. Bailes called the“springboard” for ASCO’s ensuingquality efforts, from the developmentof the Quality Oncology PracticeInitiative (QOPI®) to the creationof CancerLinQ™. In fact, Dr. Polite believes that ASCO’s work withinthe quality-improvement realm isresponsible for the Society’s stellarreputation on Capitol Hill.
“ASCO comes to the table with boldproposals for how to reform the system,”Dr. Polite said. “As ASCO hasdeveloped QOPI, it’s given the Societya higher degree of credibility. Our commitmentto quality is not lip service—we’ve put something on the table that’sreal. We approach the policy realm thesame way we approach the treatmentof cancer, which is to seek to achievethe optimal system and to examine thecurrent ways of doing things and lookfor new and different ways when somethingisn’t working.”
As the Cancer Policy Timeline in thesidebar illustrates, ASCO has beeninstrumental in spurring change inWashington and protecting the bestinterests of oncologists and patientswith cancer. Consult the timeline fora snapshot of some of ASCO’s mostimportant policy accomplishmentssince 1979, with commentary from Drs.Polite and Bailes on their impact.
Future policy priorities
ASCO has a number of policy initiativesin the pipeline, such as addressingthe implementation issues of theAffordable Care Act (ACA) and ongoingissues like working to repeal the SustainableGrowth Rate (SGR). ASCO willbe working with Congress as it revisitsrepealing the SGR after the electionsin the fall. As for the ACA, ASCO wantsto hear from members how implementationis happening in the states andaffecting their practices and patients.
“Are health plans abiding by the ACAor not? And if not, why? Are peoplefinding areas in the law that are overlycomplicated, causing disruption inpatient care, or need clarification?”Dr. Polite asked. “The ACA is selfimplementing,which means youwon’t be told any more than what’sin the law. ASCO’s belief is that thisis not acceptable because there istoo much room for interpretation inmany of these provisions. ASCO is inthe process of collecting data fromASCO members so we can go back tothe U.S. Department of Health andHuman Services and say ‘this is theimpact in the real world’ and makerecommendations for refinement.”