cancer survivors. She has had several grants funded through this program announcement.

There is also a program announcement on the use of health claims data for health services research. This has been used primarily to fund research using the SEER-Medicare database, which is maintained by NCI, but it could also be used for analyses of other types of health claims


Presenter: Dr. Peter Bach

CMS conducts demonstration projects to identify and evaluate new approaches to health services delivery and/or reimbursement. There are many examples of demonstration projects turning into programmatic initiatives. One example is Medicare Advantage, which is a system in which private plans receive a capitated payment amount for each Medicare beneficiary who chooses to receive all their care from the plan. The Medicare Part D program, which pays for prescription drugs, also began as a demonstration program. CMS is actively experimenting with different strategies, for example, paying for quality metrics or paying for efficiency, in an effort to move toward a delivery system that enhances quality and is patient centered.

An oncology demonstration program began in 2005 to evaluate the use of billing codes to gather data on cancer patient symptoms. Oncologists submitted symptom G codes in association with codes used for infusion chemotherapy administration. Under Medicare’s fee-for-service system, a doctor submits a bill on a form (called the 1500 form) and codes are filled in at the bottom of that bill signifying the patient’s diagnosis and the services delivered. For this demonstration, CMS created additional codes to capture physician assessments of pain control, nausea and vomiting, and fatigue. Physicians were paid $130 for reporting on these three symptoms in association with a chemotherapy treatment visit. By the end of the year, more than 80 percent of oncologists were submitting data on chemotherapy patients’ symptoms using these billing codes. This demonstration provided the proof of principle that the billing system could work to capture data on important patient outcomes. Mathematica has a contract to evaluate these data and summarize lessons learned from this demonstration.

The 2005 demonstration was limited to patients undergoing intravenous chemotherapy, and there was interest in broadening the scope of measurement to extend to all cancer patients along the continuum of care. In addition, there was an interest in developing longitudinal measures of efficiency, that is, getting similar or better outcomes and well-coordinated

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement