Planning Actively for Cancer Treatment (PACT) Act of 2013 (HR 2477)
Questions and Answers


What is the goal of the PACT Act?


The PACT Act aims to improve patients’ skills and knowledge to support informed treatment decision-making, enhance the coordination of active treatment and symptom management, and facilitate collaboration among the many cancer care specialists involved in patient care.  These goals will be accomplished by encouraging cancer care providers to develop and communicate treatment plans and survivorship care plans to their patients.


What cancer care problem or issue does the PACT Act address?


There are two problems that the PACT Act addresses:

  1. Gaps in cancer care for the individual.  The first issue addressed by the PACT Act is the failure to provide Medicare beneficiaries with cancer treatment plans and survivorship care plans that will facilitate the coordination of their active treatment and symptom management as well as collaboration among the multi-disciplinary teams who care for them.
  2. Lack of coordination and efficient use of resources across the entire cancer care system.  The PACT Act, by setting out individual plans for active treatment and survivorship care, will facilitate better coordination of care across the system and protect against duplicative and unnecessary utilization of resources.


Aren’t physicians routinely providing their patients treatment plans?


Cancer care providers are already communicating with their patients about their diagnosis and treatment.  However, it appears that cancer care professionals are often NOT providing written treatment and survivorship care plans, discussing those plans in a face-to-face visit, or ensuring that the plans discuss active treatment and symptom management and set out strategies for coordination among all cancer care providers.


The PACT Act sets a high standard for the kind of treatment plan or survivorship care plan that should be supplied to the patient.


Aren’t physicians routinely providing their patients survivorship plans?


Survivorship care plans are often NOT provided to cancer patients, in part because the process of preparing them and communicating them to patients is quite complex and time-consuming.  Cancer care providers do communicate with their patients about the need to monitor their health and care after active treatment, but they may not supply detailed survivorship care plans.  To be useful, those plans need to summarize all elements of active treatment, including dosages of treatments; detail the potential side effects of those treatments; and identify monitoring and follow-up care strategies and schedules.  The development of these plans is not an easy task, as it requires reference to the individual’s medical record and medical literature about side effects of treatments and monitoring and follow-up needs.


Why is it necessary to provide reimbursement for cancer care planning services?


The process of developing treatment plans and survivorship care plans will require medical decision-making of high complexity as well as significant time, and the communication of the plan to the patient will also require significant time and sophisticated communication skills.  In other words, the resources for development and communication of treatment plans and survivorship care plans will be significant.   The care planning process is more resource-intensive than a typical evaluation and management visit.


Are cancer care professional societies undertaking efforts to encourage and facilitate cancer care planning?


Professional societies are engaged in a wide range of activities to encourage treatment and survivorship planning.  For example, the American Society of Clinical Oncology (ASCO) has developed care planning templates that may be utilized by their members for the development of care plans.  ASCO has also made the provision of a cancer care plan one of the performance standards in its Quality Oncology Practice Initiative (QOPI) self-assessment program.


A collaborative effort among patient advocates, third-party payers, and pharmaceutical companies is developing and distributing tools for patients and physicians to develop survivorship care plan.


Why is 2013 the time to consider a new Medicare cancer care planning service?


The PACT Act is consistent with ongoing efforts to improve the coordination of care provided to Medicare beneficiaries.  Coordination of care contributes to quality improvement efforts as well as to more efficient utilization of health care resources.  The legislation responds to individual health care needs as well as to the needs of the entire system.


In the calendar year 2013 update to the physician fee schedule, the Centers for Medicare & Medicaid Services (CMS) established codes for Transitional Care Management for Medicare individuals discharged from acute care facilities.  These services, intended to facilitate the transition of the patient from the hospital to the community, demand the same level of medical decision-making and time as cancer care planning services and are consistent in their aims for improving individual and system health.