a cancer RLHS, Etheredge outlined a series of steps CMS could take to influence and support a learning agenda for cancer care, including the following:

  • Cover new cancer therapies subject to evidence development reporting requirements to learn as rapidly as possible about their best use for personalized care.

  • Require expanded reporting of cancer clinical data and quality measures to national cancer registries, and withhold payment to providers until after such information is submitted and passes review.

  • Fund and set standards for EHRs, with Medicare cancer care modules for Medicare patients.

  • Shift Medicare cancer payments from paying for anything and everything that is done to “pay for performance” in “preferred provider” contracts, thereby paying more for effective, high-quality care, as measured by guidelines. This would incentivize participation in learning healthcare networks.

  • Inform Medicare patients and physicians about cancer CER, best practices, and quality performance. By posting information on the Web, patients can choose the best cancer providers and treatments.

  • Use innovation funds to support new models and incentives for patient-centered, high-quality care.

As Etheredge noted, much of the national funding for EHR subsidies will be from Medicare so it makes sense that this agency should set the standards for those systems. “It would be a huge travesty to have Medicare paying for EHRs and not be able to have the meaningful use requirements include reporting the data that we need to advance the quality and the information base of Medicare cancer care,” Etheredge said. He emphasized the need for an organized, coherent national cancer strategy in which “HHS is going to put all of the pieces together rapidly” to advance to a new era of evidence-based health care. Yet it can be challenging to carry out some of these Medicare objectives, noted Dr. Bach, who detailed the difficulties Medicare had with its coverage with evidence development (CED) program in which additional data are gathered in the course of care. This program may withhold payment for a specific treatment or diagnostic unless the intervention is accompanied with data physicians submit for their patients that receive the intervention. Within this program, Medicare may also agree to pay for an intervention, but it will pay providers more if

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