The CMS 2006 Quality in Oncology Demonstration Project and NCCN Guidelines

Author: William T. McGivney PhD
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On November 3, 2005, the Centers for Medicare and Medicaid Services (CMS) announced the Medicare Quality in Cancer Care Demonstration Project for 2006. Expanding on the chemotherapy demonstration project of 2005, the demo project is guided by the objective of encouraging high-quality care in all facets of management for patients with cancer. In the project, physicians are asked to 1) identify the primary focus of the evaluation and management (E & M) service from one of several categories defined by specific CMS-provided G codes, 2) report the status of the patient's cancer (e.g., characterize the extent of cancer spread), and 3) report whether the treatment adheres to guidelines developed by either the National Comprehensive Cancer Network (NCCN) or the American Society of Clinical Oncology. The demonstration project focuses on the application of guidelines recommendations for 13 cancer diagnoses. Practices reporting on all 3 categories listed above will qualify for an additional payment of $23 per visit. Clearly, the NCCN Clinical Practice Guidelines in Oncology pertain directly to this project. NCCN guidelines are recognized and applied nationally as the standard for clinical policy in oncology in both community and academic practice settings and are available for all 13 disease states included in the CMS demonstration project. The most up-to-date set of guidelines in medicine today, the NCCN guidelines are continually updated. They are also comprehensive, addressing the full continuum of multi-disciplinary cancer care. The NCCN has made these guidelines widely available free of charge, online at and in othe formats,...

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William T. McGivney, PhD, is the Chief Executive Officer of the National Comprehensive Cancer Network and a recognized expert in coverage policy and drug and device regulatory policy. Before joining the NCCN in 1997, Dr. McGivney directed the Division of Health Care Technology at the American Medical Association and worked for Aetna Health Plans as Vice President for Clinical and Coverage Policy. Awarded the FDA Commissioner's Medal of Appreciation in 1989, Dr. McGivney has served on numerous national boards and committees. He earned his PhD at the University of North Carolina at Chapel Hill and completed a postdoctoral fellowship in the Department of Psychiatry at the Harvard Medical School.

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