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The American Society of Clinical Oncology (ASCO) selected Charles Balch, professor of surgery at the University of Southern California School of Medicine, to succeed John Durant as executive vice president of the 14,000-member society, ending a search process that took more than a year.
Balch, an ASCO member for 19 years and an authority in melanoma and breast cancer, will take over the top executive post of the society effective March 1, 2000. He also will continue his clinical work part-time in the surgery department at Johns Hopkins Medical Center in Baltimore. ASCO's offices are located in Alexandria, VA.
"As the world's leading organization of cancer physicians, it was of primary importance for us to find a clinical oncologist with the experience, knowledge, expertise, reputation, and vision to lead ASCO into the future," ASCO President Joseph Bailes said. "I've worked with Charlie in varying capacities for the better part of the last decade, and he embodies all of these qualities. He will be a tremendous asset to ASCO and we're very pleased to have found such a uniquely qualified individual to assume the office of EVP."
Balch has led a distinguished career in clinical and academic surgical oncology for 25 years. He served as president and chief executive officer of City of Hope Medical Center and Research Institute in Los Angeles prior to joining USC.
From 1985 to 1996, he held numerous positions at the University of Texas M.D. Anderson Cancer Center, including executive vice president for health affairs, vice president for hospital and clinics, head of the surgery and anesthesiology division, and chairman of the Department of Surgical Oncology.
Balch earned his medical degree from Columbia College of Physicians and Surgeons in New York and did his surgical and oncology training at Duke Medical Center and the University of Alabama at Birmingham. He also had an immunology fellowship at Scripps Clinic and Research Foundation and worked at the National Institutes of Health in the General Clinical Research Centers Branch.
During his residency at Alabama, Balch's mentor was Durant. Ironically, in 1994, Balch served as chairman of the nominating committee that selected Durant to serve as ASCO's first EVP.
"I can now retire secure in the knowledge that ASCO will be in the best of hands under Dr. Balch's stewardship," Durant said. "I've known Charlie for many years and I couldn't have hand-picked a better successor."
Balch has been a member of the ASCO Board of Directors, and served as chairman of both the Intellectual Properties Task Force and the Strategic Planning and Implementation Committee.
"This Society is the premier organization for promoting multidisciplinary cancer care and research as well as advocacy for the cancer patient," Balch said. "I am privileged to have the opportunity to carry on what John began here five years ago, and I look forward to being a part of the leadership of ASCO."
Balch is the editor of Cutaneous Melanoma, a textbook on malignant melanoma, and founded two medical journals, the Annals of Surgical Oncology, and Breast Diseases: A Year Book Quarterly. He also has conducted laboratory research in tumor immunology, as well as cancer clinical trials. He has more than 520 publications, including 13 textbooks, to his name.
Balch served in leadership positions in other organizations. He was president of the Society of Surgical Oncology, president of the Association for Academic Surgeons, on the Executive Committee of the American Joint Committee on Cancer, chairman of the Publications Committee of the American Radium Society, and chairman of the Executive Council of the Commission on Cancer.
Reimbursement Policy: Medicare Should Pay Routine Care For Patients In Trials: IOM
Medicare should pay for routine care of beneficiaries enrolled in clinical trials in the same way it pays for this care outside of clinical trials, according to a new report from the Institute of Medicine of the National Academy of Sciences.
The Medicare statute has been widely interpreted to exclude reimbursement for routine care necessary during a beneficiary's participation in a clinical trial. The Health Care Financing Administration (HCFA) has never offered explicit guidance on the subject, however, except for a policy it issued relating to trials of medical devices. In practice, it appears that health care providers often submit reimbursement claims for Medicare patients enrolled in these studies, and usually the claims are paid, the report said.
The report, "Extending Medicare Reimbursement In Clinical Trials," urged HCFA to issue unambiguous rules to end widespread uncertainties about reimbursement. The committee that wrote the report noted that since Medicare has a stake in ensuring that medical interventions it pays for are effective, it would be sound policy to remove any disincentives to the participation of Medicare recipients in clinical trials.
Medicare should not pay for unapproved drugs and devices, or radical new procedures, unless reimbursement is already allowed under a prior agreement with the federal government, the report said. All data-collection costs should remain the responsibility of the researchers or their sponsors.
The nearly 20 percent of Medicare beneficiaries enrolled in managed-care plans should have the same reimbursement eligibility for care in clinical trials as those who have traditional fee-for-service Medicare benefits, the committee added. But this coverage should not go beyond the limits of the managed-care contract.
Physicians treating Medicare patients in clinical trials should be able to submit reimbursement claims in the same way they submit claims for patients not in trials, the report recommended. If Medicare or trial sponsors fail to cover costs for care, patients should not be billed for costs above what they would pay if they were not in the trial.
The committee could not estimate the additional cost of an explicit policy for reimbursement of routine care in clinical trials, but said it is likely to be small. The limited available evidence suggests that most routine care costs in clinical trials are reimbursed already. Less than 1 percent of Medicare beneficiaries participate in clinical trials each year, and the few studies done to date suggest that costs are only slightly, if at all, higher for patients in trials compared to those treated outside of trials, the report said.
When research would be of particular importance to the Medicare population, HCFA should encourage studies by extending coverage beyond routine care, and collaborate with other organizations to initiate them, the committee recommended. Also, a national registry of clinical trials—perhaps built on a registry currently under development at NIH—should be created to analyze costs and track the experience of Medicare beneficiaries enrolled in clinical trials, the report said.
Preventive Services
In another report, an IOM committee examined coverage for skin-cancer screenings and medically necessary dental services, and elimination of time limits on coverage of immunosuppressive drugs for transplant recipients.
The committee found insufficient evidence to either support or reject coverage of routine skin-cancer screenings for Medicare beneficiaries. The program already covers physician examinations prompted by a patient's concern about changes in a mole or other skin feature.
The report, "Extending Medicare Coverage For Preventive And Other Services," said studies are lacking in the effectiveness of screenings for beneficiaries who have no symptoms. The committee noted that patients and physicians should continue to be alert to the common signs of skin cancer and to investigate suspicious signs further. Also, education programs should continue to encourage people to limit sun exposures and learn about the risk factors for skin cancer.
The committee also recommended that Congress consider updating the Medicare law to clearly allow coverage for dental care that is effective in reducing infections and other complications associated with serious medical conditions and their treatment. However, evidence of effectiveness for these interventions is limited, the report said.
Some evidence indicates that for patients with head and neck cancer, preventive dental care can reduce the potential for serious damage to the jaw by radiation therapy. Medicare, however, only covers extraction of teeth for these patients, and this procedure may lead to worse health outcomes, the committee said. For leukemia patients, treatment of acute dental infections before chemotherapy may reduce the risk of later life-threatening infections. Lack of evidence made it difficult for the committee to offer conclusions about dental care for lymphoma patients, organ transplant recipients, or individuals with repaired or replaced heart valves.
Medicare covers this immunosuppressive therapy for patients who receive organ transplants for up to 44 months. With significant advances in organ transplantation, 60 percent of recipients now survive longer than five years.
The committee found indirect evidence suggesting that the inability of some patients to sustain the financial burden of paying for immunosuppressive drugs after Medicare coverage ends leads to some transplant failures. It is reasonable for Congress to eliminate the time limit on this coverage, but granting special exceptions for one class of drugs for one group of beneficiaries raises questions about fairness, the report said.
Copies of the reports are available from the National Academy Press, phone 202-334-3313 or 800-624-6242.
Reimbursement: New Jersey Insurers To Cover Patient Care Costs In Trials
Health insurers in New Jersey have agreed to cover all costs of routine care for patients receiving treatment in all types of cancer clinical trials, Gov. Christine Todd Whitman announced recently.
Oxford Health Plans, Aetna/US Healthcare, Cigna HealthCare, and Prudential HealthCare agreed to cover the costs of patients participating in clinical trials for experimental cancer treatments that have been sanctioned by federal health agencies.
The agreement was crafted by the New Jersey Working Group to Improve Clinical Outcomes in Cancer Patients, a group formed by the Cancer Institute of New Jersey, the New Jersey Association of Health Plans, the New Jersey Commission on Cancer Research, and the American Cancer Society Eastern Division.
"If we continue to treat patients with the same standard therapies, we will get exactly the same results," Mary Todd, co-chairman of the working group and deputy director of the Cancer Institute of New Jersey, said at a press conference last month. "In the treatment of cancer it is not acceptable to follow the cookbook—we must write the new recipes. Clinical trials are the new recipes that we write for the treatment and eventual cures of cancer."
Under the agreement, routine patient care costs such as physician fees, laboratory expenses, the administration of treatment and continuing evaluation of the health of the patient during a clinical trial will be covered and reimbursed by insurers. A database and Internet website aimed at reducing paperwork for patients, physicians, and health insurers is planned.
"This is a model to address consumer health needs by cooperation and consensus-building instead of by legislation, regulation, or litigation," said Paul Langevin, president of the New Jersey Association of Health Plans.
National Cancer Institute Director Richard Klausner said the New Jersey agreement "highlights the importance of clinical trials in the appropriate care of patients with cancer. It is only through this form of carefully designed research that the toll from cancer on our population will be lessened."
ASCO urged insurance companies nationwide to follow the example of the New Jersey working group.
"It is high time that cancer patients nationwide benefited from promising new therapies offered in clinical trials," said Joseph Bailes, ASCO president. "These companies should be applauded for recognizing their role in encouraging cancer patients to participate in clinical trials."
ASCO also called on members of Congress to pass legislation to guarantee such coverage for Medicare beneficiaries. The legislation, sponsored by Sens. Connie Mack (R-FL) and Jay Rockefeller (D-WV), has been introduced in both houses of Congress for the past several years. About half of all people diagnosed with cancer are over age 65 and eligible for Medicare.
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