▪ Bill Introduced to Ensure Coverage for Terminal Illness
Senator Chris Dodd (D-CT) has introduced S. 3839 to amend the Social Security Act, which requires that an individual must have 20 quarters of Social Security coverage in the 40 quarters preceding a disability in order to be eligible for disability insurance benefits. The new bill would waive this requirement when a disabled person is facing a terminal illness.
The bill is named after Claire Collier, a mother of three who was diagnosed with amyotrophic lateral sclerosis in 2003. The bill ensures that people who have not been in the workforce for sufficient time would still be entitled to disability benefits.
“This bill is really about ensuring fairness. We should reward people who contribute to the Social Security system, not punish them,” Senator Dodd said. “Under the current system, hard-working Americans are being denied benefits at a time when they need them most.”
He added that the system discriminates against people who have earned the required number of credits outside the time period prescribed.
▪ Study: Nursing Shortage Eased in Some Areas, but Long-Term Worries Persist
While hospitals in 12 communities across the country report that short-term measures, such as higher pay and temporary staff, have helped ease nursing shortages, serious doubts remain about their ability to meet future nursing needs. That was a conclusion of a study from the Center for Studying Health System Change in Washington, DC, in an article published in Health Affairs (2006;25:316–323).
Although hospitals are pursuing longer-term strategies to address the nursing shortage, including investing in nursing education and improving working conditions, a lack of nursing school capacity remains a major barrier to solving the problem, wrote the authors, Jessica H. May, Gloria Bazzoli, and Anneliese M. Gerland.
Many hospital executives are concerned that heavy reliance on temporary or inexperienced nurses could affect patient care, the researchers said.
The study is based on site visits to hospitals in Boston; Cleveland; Greenville, SC; Indianapolis; Lansing, MI; Little Rock; Miami; northern New Jersey; Orange County, CA; Phoenix; Seattle; and Syracuse, NY. Along with other measures, some hospitals are trying to improve working conditions by hiring more staff and using more support staff.
Half of the 32 hospitals are planning to apply for “nurse magnet status,” which recognizes hospitals' performance on standards of practice that contribute to nurse retention and quality of care.
According to the report, government predictions of a nursing shortage of one million by the year 2012 mean that hospitals will again have to use expensive short-term strategies.
“There is an important role for public financial support to expand the nursing education system and address the shortage of nursing faculty,” the report concluded.
▪ ASCO Testifies Before House Committee on Physician Payment & Quality Care
ASCO testified before the House Energy and Commerce Subcommittee on Health about issues related to quality cancer care and pay-for-performance programs.
ASCO is developing a cancer treatment summary: an effort to capture in a succinct format patients' treatment and plan for follow-up care. “The summary is intended to improve communication and coordination among oncologists, patients, and other health care providers,” said Deborah Schrag, MD, MPH, a medical oncologist and researcher at Memorial Sloan-Kettering Cancer Center, who testified on ASCO's behalf.
The Society also urged the subcommittee to support extension of the Centers for Medicare & Medicaid (CMS) 2006 oncology demonstration project that is designed to gather information on patients' disease stage, the treatment rationale, and data on whether treatment followed evidence-based guidelines developed by ASCO and NCCN.
“ASCO has worked closely with CMS on this demonstration, and the model has worked,” Dr. Schrag said. “Physicians have been able to report information with minimal burden, and the information gained helps us understand patterns of care. Data from the demonstration project will be most valuable, however, if collected over a number of years, so we urge CMS to continue the project.”
Dr. Schrag also highlighted ASCO's quality care initiatives:
- The National Initiative on Cancer Care Quality (NICCQ) study of 1,800 patients to measure the degree to which breast and colorectal cancer patients receive care consistent with clinical practice guidelines. Results so far have revealed high adherence.
- The Quality Oncology Practice Initiative (QOPI) nationwide initiative to promote excellence in cancer care by helping practices create a culture of self-examination and improvement.
- ASCO/NCCN Quality Measures is a collaboration between ASCO and the National Comprehensive Cancer Network to select a subset of NICCQ measures that can be used to assess quality for breast and colorectal cancer.
- The Cancer Quality Alliance was formed by ASCO and the National Coalition for Cancer Survivorship and is a forum for a variety of public- and private-sector entities concerned about cancer care quality improvement.
▪ NCCS Applauds McClellan's Testimony Promoting Quality Care
Former Centers for Medicare & Medicaid (CMS) Administrator Mark McClellan, MD, testified before the House Energy and Commerce Subcommittee on Health about measuring the quality of physicians' services. Dr. McClellan said that in moving toward the vision of aligning Medicare's physician payment system with quality and efficiency, CMS has worked with physicians, patient advocates, members of Congress, and others to develop and expand measures that evaluate quality of care, as well as understand the methods and infrastructure needed to collect data used to assess quality.
In his testimony, Dr. McClellan discussed the Physician Voluntary Reporting Program, which CMS launched in January to develop ways of collecting data on physicians and provide confidential feedback.
He said that the program is CMS's first step toward alignment of payment with use of quality measures. Dr. McClellan also mentioned a number of demonstration projects that focus on quality care, including the 2006 oncology demonstration project.
The National Coalition for Cancer Survivorship worked with ASCO and the National Comprehensive Cancer Network to develop the oncology project, which is intended to assess oncologists' adherence to evidence-based standards as part of routine care for Medicare beneficiaries living with cancer.
▪ Annual Cancer Statistics Report: Cancer Death Rates Continue to Drop
The nation's leading cancer organizations report that the risk of dying from cancer continues to diminish, continuing a trend begun in the early 1990s. The rate of new cancers, however, remains stable.
“The Annual Report to the Nation on the Status of Cancer, 1975–2003,” published in the October 15th issue of Cancer and posted online ahead of print on September 6, includes comprehensive data on trends over the past several decades for all major cancers, showing that the long-term decline in overall death rates continues for all races and both sexes. The declines were greater among men (1.6% per year) than women (0.8% per year).
Death rates decreased for 11 of the 15 most common cancers in men and for 10 of the 15 most common cancers in women, in part because of successful efforts to reduce exposure to tobacco, earlier detection through screening, and more effective treatment. The report says that continued success will depend on maintaining and enhancing these efforts.
Overall cancer incidence rates for both sexes and all races have been stable from 1992 through 2003. Overall rates for men were stable from 1995 through 2003, whereas rates for women increased from 1979 through 2003.
The incidence of female breast cancer stabilized from 2001 through 2003, ending increases that began in the 1980s. Whether this first indication of a changing trend is real or a random fluctuation cannot be determined until data have been reported for the next few years, the authors said. There also has been a small increase in female lung cancer from 1991 through 2003, a much slower rate of increase than in prior years.
“The findings of the Annual Report this year highlight the importance of our nation's investment in carefully tracking cancer incidence trends,” John R. Seffrin, PhD, CEO of the American Cancer Society, said in a statement.
“When there are changes in trends like those reported for breast cancer and thyroid cancer this year [a significant increase for the latter], researchers are alerted to look for the causes that often lead to advances in cancer prevention and early detection.”
The report includes a special section on cancer in the Latino/Hispanic population, showing that between 1999 and 2003, Latinos had lower incidence rates than non-Hispanic whites for most cancers but were less likely to be diagnosed with localized disease for several cancers (OT, 10/10/06 issue).
The report is a collaboration between the ACS, NCI, CDC, and the North American Association of Central Cancer Registries and was coauthored by Holly L. Howe, PhD; Xiaocheng Wu, MD, MPH; Lynn A. G. Ries, MS; Vilma Cokkinides, PhD; Faruque Ahmed, PhD; Ahmedin Jemal, DVM, PhD; Barry Miller, PhD; Melanie Williams, PhD; Elizabeth Ward, PhD; Phyllis A. Wingo, PhD; Amelie Ramirez, DrPH; and Brenda K. Edwards, PhD.