Recently, NCCS joined colleagues in the Cancer Leadership Council (CLC) in submitting comments to the Centers for Medicare and Medicaid Services (CMS) on the 2015 Physician Fee Schedule, which governs payments to physicians for services provided to Medicare patients. NCCS and the CLC have applauded efforts by CMS to strengthen care planning and coordination through the fee-for-service system, including the establishment of a transitional care management code, which pays for care management when a Medicare beneficiary is released from the hospital, and a chronic care management code that was defined last year and will be implemented in 2015.
We believe that these codes are a step in the right direction to support better coordinated care for cancer patients. However, many more cancer survivors will not meet the definitions to receive services under these codes, and thus the codes do not assure planning and coordination of survivorship care. Cancer survivors have complex post-treatment health care needs that cannot be fully addressed through the transitional care management and chronic care management services, and the CLC’s patient advocacy groups recommended that CMS define a cancer survivorship coordination service.
In the 2005 report, “From Cancer Patient to Cancer Survivor: Lost in Transition,” the Institute of Medicine identified four critical components of survivorship care:
• Prevention and detection of new cancers and recurrent cancer;
• Surveillance for cancer spread, recurrence, or second cancers;
• Interventions for consequences of cancer and its treatment (medical problems such as lymphedema and sexual dysfunction; symptoms, including pain and fatigue; and psychological distress of survivors and their families); and
• Coordination between specialists and primary care providers to guarantee that the survivor’s health needs are addressed.
The quality of survivorship care could be improved by access to a service, recognized through a specific fee-for-service code, for the planning and coordination of care. Enhancing survivorship care by providing access to these components of survivorship care will likely benefit the Medicare program by preventing hospital admissions and contributing to appropriate utilization of cancer care resources.