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Nurses Call for Coverage of Patient Education

Washam, Cynthia

doi: 10.1097/

Three years after asking Congress to approve Medicare payment for cancer-patient education, leaders of the Oncology Nursing Society say they think they finally have the support needed to pass the bill. ONS President Carlton Brown, RN, PhD, AOCN, and Health-Policy Director Alec Stone, MPA, discussed HR 1927 during an informal meeting at the ONS's advanced-practice nursing conference in November in Orlando.

“We're very proud to say we have 34 organizations that endorse our bill,” Mr. Stone said. Among the organizations are ASCO, the Association of Community Cancer Centers, and the Susan G. Komen Breast Cancer Foundation.

The bill, dubbed the Assuring and Improving Cancer Treatment Education and Cancer Symptom Management Act of 2009 (HR 1927), also has 41 cosponsors in the House of Representatives, double what it had when it was introduced three years ago. That was before the 37,000-member ONS hired Mr. Stone to lobby for this bill and other health care legislation.

HR 1927 would require Medicare to pay $80 to $90 for nurses to spend an hour educating cancer patients about their upcoming treatment. Patient education is something oncology nurses say they already do, but without payment, they're often unable to give each patient enough time.

“Nurses have been doing it, but might not be a full hour,” Dr. Brown said. “It might be done with more patients in a room.”

He pointed out that Medicare has a precedent of covering patient education provided by nurses. The federal program already pays for education of patients with diabetes and end-stage renal disease.

“We think chemotherapy is much more technical [than diabetes treatment]. We're just a little behind.”

The coverage mandate would cost Medicare about $275 million over five years, Mr. Stone said. In the long run, though, it would save money: “We're confident it would more than pay for itself in reduced ER visits and inpatient hospitalizations.”

Donna Gerber, RN, PhD, AOCN, an advanced-practice nurse at MD Anderson Cancer Center, who sat in on the discussion, said she sees the cost savings in her patients.

“With good education, they don't end up in the emergency center. If you paid to allow nurses an hour of education, you'd see a dramatic drop in costs.”

Cost savings is a benefit that Rep. Patrick Tiberi, R-OH, hopes will persuade fellow congressmen to approve the bill, which he is cosponsoring along with Rep. Steve Israel, D-NY.

“It's expected to reduce costs of treatment,” said his press secretary, Breann Gonzalez. “Education improves outcomes.”

At the Orlando conference, Carlton Brown and Alec Stone collected some 250 signed petitions from ONS members supporting the bill and had then planned to distribute them to the members' congressional representatives later in November. Earlier this year, they handed out nearly 800 petitions collected at the ONS Annual Congress in May.

They said that although they doubt the bill will pass this late in the year, they do expect the momentum to continue into January, when Congress will consider the bill anew. “We're trying to get a companion bill in the Senate,” Mr. Stone said. “We're really going to make a major push on this bill next year.”

© 2010 Lippincott Williams & Wilkins, Inc.
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