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California Oncology Weekly
"Where California Oncologists Go For Answers!"
A collaborative publication of the
Medical Oncology Association of Southern California, Inc.
and the
Association of Northern California Oncologists, Inc.
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California News
- The deadline to introduce legislation for this year was Friday, February 17th at 5:00PM. MOASC is one of many organizations representing patients and providers in opposition to AB 265 (Wood), which would ban patients in California from receiving copayment assistance from a pharmaceutical manufacturer when a therapeutically equivalent or interchangeable brand or generic medication is available at a lower cost. Recent changes in insurance design and higher cost-sharing for prescription medicines have led to increased financial burden for many patients. In addition, it is becoming increasingly common that patients must meet a deductible, often quite high, before any prescription medication coverage applies. Copay assistance programs are a valuable resource for many commercially-insured patients, especially those who are struggling to afford the increasing out-of-pocket costs associated with insurance coverage for their medications. These copay assistance options reduce the out-of-pocket burden for these patients, improving access to prescription medicines, and help patients stay on the medicines they need. AB 265 will eliminate this critical resource for patients and is contrary to the goal of controlling health care costs.
- Legislation introduced in the state Senate, last Friday, would set California on a path toward the possible creation of a single-payer health care system a proposal that has failed to gain traction here in the past. The bill, which is a preliminary step, says that it is the "intent of the Legislature" to enact a law that would establish a comprehensive, single-payer health care program for the benefit of everyone in the state. The legislation, introduced by state Sen. Ricardo Lara (D-Bell Gardens), does not offer specifics of what the plan would look like, nor does it mention a timetable. A single-payer system would replace private insurance with a government plan that pays for coverage for everyone. Proponents argue that single-payer systems make health care more affordable and efficient, but opponents say they raise taxpayer costs and give government too much power. Medicare, the federally-funded health coverage for the elderly, is often held up as a model of what a single-payer system might look like.
- The California Dialogue on Cancer is pleased to announce the American Cancer Society's upcoming 80% by 2018 California Colorectal Cancer Roundtable events in Sunnyvale on March 21st and Los Angeles on March 22nd. The featured speaker for the Roundtables will be Richard Wender, MD, Chief Cancer Control Officer of the American Cancer Society. These events will be an opportunity to connect with different groups (community clinics, health plans, companies, hospitals, and community members) who are working toward our collective goal of 80% nationwide screening for adults aged 50+ by 2018. Participation is free. Please register by March 10th. For more information, click on the following links.
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* MLN Connects Provider News
Announcements--
Claims, Pricers, and Codes--
Events--
Publications--
* QMB Indicator in the Medicare Fee-for-Service Claims Processing System CR9911
* NCCI PTP Edits, Version 23.1, Effective April 1, 2017-Quarterly Update CR9970
* HCPCS Codes Subject to and Excluded from CLIA Edits CR9946
* Chronic Care Management (CCM) Webinar (February 22)
* Radiation Oncology (February 28)
* Duplicate Claims Webinar (March 1)
* Screening Services Webinar (March 9)
- Noridian Medicare Portal Functionality Webinar for Part B Providers - March 23, 2017
The Noridian Provider Outreach and Education (POE) staff is hosting a Noridian Medicare Portal Functionality for Part B Providers webinar on March 23, 2017 at Noon Pacific Time. Read the complete update.
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- DON'T MISS TOMORROW'S MOASC LunchTime Series presentation of, "Physician in Transition, Six Timely Considerations for You & Your Practice," Wednesday, February 22 at 12:00 pm Pacific Time, by Charles Denny, M.A., Charles Denny Consulting. Please RSVP to moasc@moasc.org or call 909-985-9061 x 1.
- On Saturday, March 11, 2017 join nationally known, and regionally based, key-opinion leaders to assess your tools for thriving in an era of Personalized Medicine! Join us for the 2017 MOASC Oncology Summit. There's an Oncology Revolution going on: Are your treatment choices still relevant in the era of Immuno-oncology and Molecularly-targeted therapies? We will discuss how to use the new tools of "Personalized Medicine" to guide treatment choices for Lung Cancer, Prostate Cancer and Multiple Myeloma. This will be a practically-oriented, clinically relevant discussion and you will leave with new insights into your own practice patterns and how to make sure you are embracing the future today! For complete information on this superb program, please contact the MOASC Office at 800-310-3553 x 1, moasc@moasc.org or www.moasc.org.
- The City of Hope conference, How the Experts Treat Hematologic Malignancies, will be March 16 to 18, 2017 at the Mandarin Oriental, Las Vegas. City of Hope experts will provide the conferee with the most recent advances in bone marrow transplant, multiple myeloma, lymphoma and leukemia. Updates on improved curative and palliative treatments and evolving molecular and immunologically-based system therapies, as well as important, completed or ongoing clinical trials, will be profiled and discussed. This activity has been approved for AMA PRA Category 1 Credit™. Please register at one of the following: 626-218-5622 or CityofHope.org/cme cme@coh.org
- The 2nd Annual UC Irvine Health Hematology Symposium, presented by the Department of Pathology and the Department of Medicine, Division of Hematology/Oncology, will take place on Saturday, March 25, 2017, at Disney's Paradise Pier Hotel, Anaheim, CA.
Topics will include: * Molecular diagnostics in selected disorders; * Myelodysplastic syndrome;
* Primer on flow cytometry for the general practitioner; * Venous thromboembolism;* Approach to the evaluation of anemia;* Selected vector-borne diseases;* Lupus anticoagulant and antiphospholipid antibody syndrome. For registration or more information please contact Dannielle Lampkin at dlampkin@uci.edu or 714-456-8621 or visit the Hematology Symposium registration website, http://pathology.uci.edu/hema-symposium/
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MOASC and UCI's
"Spotlight on ASH," held Saturday, February 11, 2017,at the Hyatt Regency in Huntington Beach was a resounding success! If you were unable to attend, you can view the entire program here: Spotlight on ASH 2017.
MOASC would like to thank Alexion
, Amgen, AstraZeneca, Celgene, Gilead, Incyte, Merck, Pfizer, Pharmacyclics and Takeda
,
for their support!
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ANCO is pleased to announce the 17th Multidisciplinary Management of Cancers: A Case-based Approach
on March 17-19, 2017 at The Silverado Resort and Spa in Napa. Registration and housing now open at
www.multicancers.org
.
REGISTRATION ENDS February 28 AND THIS MEETING SELLS OUT EVERY YEAR
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- The Internal Revenue Service has become the first agency to follow President Trump's directive to start undermining the Affordable Care Act. In a quiet rule change, but an important one, the IRS has told tax preparers and software firms that it won't automatically reject tax returns that fail to state whether the tax filer had health insurance during the year. That effectively loosens enforcement of the ACA's individual mandate. It appears to be a direct response to Trump's Jan. 20 executive order requiring federal agencies "minimize...the economic and regulatory burdens of the Act."
- Drug manufacturers are fighting back against a request by U.S. senators who want HHS Secretary Tom Price to make it easier to import drugs from Canada as a strategy to combat rising drug prices. Read More
- The U.S. Justice Department has joined a whistleblower lawsuit claiming that UnitedHealth Group and affiliated health plans have been gaming the Medicare program and fraudulently collecting millions of dollars by claiming patients were sicker than they really were. Read More
- Aetna is doubling the quarterly dividend it pays shareholders and buying back stock as it regroups from its failed attempt to acquire rival health insurer Humana. Aetna said Friday its board declared a quarterly cash dividend of 50 cents per share and also authorized the repurchase of up to an additional $4 billion worth of the company's stock. The Hartford, Conn., insurer had said Tuesday that it was calling off plans to buy Humana for roughly $34 billion. That deal had already been rejected by a judge after federal regulators had sued last summer to stop it and a similar combination of the insurers Anthem and Cigna.
- The February 2017 edition of the Anthem Network Update is now available online at
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- The Centers for Medicare & Medicaid Services (CMS) awarded approximately $20 million to 11 organizations, with clinicians in individual or small group practices of 15 clinicians or fewer, for the first year of a five-year program to provide on-the-ground training and education about the Quality Payment Program. CMS intends to invest up to an additional $80 million over the remaining four years. These local, experienced, community-based organizations will provide hands-on training to help thousands of small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas. The training and education resources will be available immediately, nationwide, and will be provided at no cost to eligible clinicians and practices. The selected organizations will provide customized technical assistance to clinicians and practices to help them be successful in the Quality Payment Program. For example, clinicians will receive help choosing and reporting on quality measures, as well as guidance with all aspects of the program, including supporting change management and strategic planning and assessing and optimizing health information technology.
This funding is one part of a multi-level outreach effort to help clinicians understand and provide feedback about the new Quality Payment Program. Through webinars and in-person presentations, thousands have received free training and education from CMS staff since the Quality Payment Program Final Rule was released last October.
As part of that outreach effort, CMS also launched a new telephone helpline for clinicians seeking assistance with the Quality Payment Program. Clinicians may contact the Quality Payment Program by calling 1-866-288-8292 from 8AM - 8PM EST or emailing qpp@cms.hhs.gov or visit: qpp.cms.gov.
- AVOID 2018 MEDICARE PAYMENT ADJUSTMENTS! CMS has extended the deadline from February 28, 2017 to March 13, 2017 for the 2016 Quality Reporting Document Architecture (QRDA) data submission for the EHR reporting mechanism. This affects Individual eligible professionals (EPs), PQRS group practices, qualified clinical data registries (QCDRs), and qualified EHR data submission vendors (DSVs). EPs who do not satisfactorily report 2016 quality measure data to meet the PQRS requirements will be subject to a downward PQRS payment adjustment on all Medicare Part B Physician Fee Schedule (PFS) services rendered in 2018. A complete list of 2016 data submission timeframes is below:
March 13, 2017 deadlines:
EHR Direct or Data Submission Vendor (QRDA I or III) - 1/3/17 - 3/13/17
Qualified Clinical Data Registries (QRDA III) - 1/3/17 - 3/13/17
March 17, 2017 deadline:
Web Interface - 1/16/17 - 3/17/17
March 31, 2017 deadlines:
Qualified Registries (Registry XML) - 1/3/17 - 3/31/17
QCDRs (QCDR XML) - 1/3/17 - 3/31/17
Submission ends at 8:00 p.m. Eastern Time (ET) on the end date listed. An Enterprise Identity Management (EIDM) account with the "Submitter Role" is required for these PQRS data submission methods.
Click Here
to go to the CMS web site for more information.
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Affiliate Association News
- Please join the Community Oncology Pharmacy Association (COPA) and Accreditation Commission for Health Care (ACHC) for a free webinar on February 23 from 9:00 - 10:00 pm Pacific. The webinar you will hear firsthand from national accreditation leaders from COPA and ACHC, as well as from oncology pharmacy providers that have gone through the accreditation process. The information will be invaluable to those considering accreditation or have specific questions about the process. Access to tools in helping pharmacies achieve this accreditation will also be discussed. RSVP: Please Click Here to Register. Note: You will receive an email confirmation once your registration is complete.
- The Leukemia & Lymphoma Society is pleased to announce their upcoming Blood Cancer Conference in Anaheim on March 4, 2017. These educational conference has been developed to meet the needs of patients, survivors, caregivers and healthcare professionals. Conference attendees will receive the most current information and access to local resources to help navigate and make informed decisions about treatment and survival. The conference is free, but registration is required.
For more information and conference registration, go to:
- Three Meetings in One! The 2017 Community Oncology Conference April 27-28, 2017 at the Gaylord National Hotel & Convention Center. The annual Community Oncology Conference is, and always has been, developed by community oncology providers, administrators, staff, and patients to address their needs in the real world. The Conference offers three distinct agenda tracks with content covering clinical, business, and patient advocacy topics. Each provides fantastic opportunities for education and networking built into the sessions.
- The clinical track will be presented in multiple learning formats, including panel discussions, interactive sessions, and case studies.
- The business track will be geared to both clinical and non-clinical attendees and will cover a variety of topics, including success in the Oncology Care Model (OCM), aligning payment to quality and value, and more.
- An abbreviated pharmacy track will feature sessions relating to oncology pharmacy accreditation, in-office dispensing challenges, dealing with PBMs, and other relevant pharmacy topics.
- The COA Patients Advocacy Network (CPAN) will host a special patient advocacy track focused on building strong patient and staff community oncology advocates.
The packed agenda covers the timeliest topics in today's community oncology landscape, including how to survive MIPS/MACRA, the Oncology Care Model (OCM), the 340B Program, immuno-oncology, the Oncology Medical Home, and the latest value tools.
- Applications are now being accepted for ASCO's Quality Training Program at
www.asco.org/training-education/professional-development/quality-training-program. This comprehensive 6-month program is oncology-focused and teaches clinicians how to improve quality using evidence-based decisions and how to reduce clinical and process variation for predictable and sustainable results. In 2017, there will be two regional locations, including Portland, OR (Session 1: April 20-21; Session 2: June 28-29; and Session 3: October 18).
- ASCO's Criteria for High-Quality Clinical Pathways in Oncology, a set of 15 inter-related criteria that provide an overarching framework for assessing pathway programs in the United States, are featured as a special article in the Journal of Oncology Practice at
http://ascopubs.org/doi/abs/10.1200/JOP.2016.019836.
- A new White Paper by the law firm of Frier Levitt, LLC and commissioned by the Community Oncology Alliance (COA) examines the ongoing practice by Pharmacy Benefit Managers (PBMs) to increase corporate profits through murky "direct and indirect remuneration" fees-commonly known as "DIR Fees" charged to community oncology practices, as well as retail and specialty pharmacies ("Pharmacy Providers"). DIR Fees, which have no basis in regulation or law, artificially inflate the costs paid by Medicare beneficiaries for prescription drugs, pushing them into the Medicare Part D "donut hole" faster, fueling rising drug prices, and ultimately adding to the burden on taxpayers. PBMs must report all discounts given after the drugs are sold to CMS. These are called "Direct and Indirect Remuneration" or "DIR." PBMs often receive additional discounts from manufacturers after the initial sale of drugs to patients. DIR Fact Sheet.
- COA would like for you to please read the article below from the National Community Pharmacists Association (NCPA). They have been fighting this battle on DIR fees for some time as COA had discussed last year. It is quite supportive of the COA position on DIR fees since they also share the same points brought out in the COA white paper. Ricky Newton rnewton@COAcancer.org is asking if you know any of the officers on the board of NCPA, or are any of your staff members of NCPA? He would like to reach out to them about collaborating with their organization on the DIR issues the same way COA is with NASP. Thank you for your assistance.
- COA is seeking your feedback regarding difficulty obtaining Cost Exceed overrides with Optum Rx Insurance. It appears the new year brought a change whereby all override requests can only be obtained through Briova Specialty Pharmacy. OptumRx would not authorize an override because the patient is not registered in their system, and only the patient can register themselves. OptumRx would not allow the physician practice to register on behalf of the patient. The time lapse of more than 24 hours to obtain an override requires repeated calls to OptumRx. OptumRx would question the physician's office for filling the medication, and continuously tries to take over the prescription to fill at OptumRx's location,even after being informed that the drug is being filled at the physician dispensary. If you are experiencing similar issues with any payer, please communicate with the MOASC Office your specific issue at moasc@moasc.org. Thanks!
- NCCN has published updated NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) with NCCN Evidence Blocks™ for bladder cancer (V2.2017), non-small cell lung cancer (V4.2017), and Waldenstrom's Macroglobulinemia (V1.2017). For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit
www.nccn.org.
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- Janssen Biotech is hosting an educational program entitled Darzalex-based Triplet Therapy for Multiple Myeloma Patients at First Relapse with Amy Marsala, N.P., UC San Francisco, on March 17 at Morimoto, 610 Main Street, Napa. RSVP at www.medforcereg.net/SOMP1085229.
- Innovatix
announces that effective February 20th, eligible members will have access to a 5% discount for Tygacil®
(Tigecycline for IV Solution 50 mg) under the PremierPro Rx label. Tygacil® is used to treat many different bacterial infections of the skin and digestive system, as well as of pneumonia. Click here for detailed product and pricing information.
For more information about contract number C16648-1, please contact your Innovatix Client Service Associate (toll free) at (888) 258-3273.
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| MOASC CALENDAR
Spotlight on ASH
February 11, 2017
LunchTime Series
February 22, 2017
Oncology Summit
March 11, 2017
NCCN Meeting in Florida
March 23-25, 2017
COA Annual Meeting
April 27-28, 2017
ASCO National Meeting in Chicago
June 2-6, 2017
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(NCCN, San Francisco, March 11)
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The
Medical Oncology Association of Southern California
(MOASC) is a leading oncology society that advances and protects the ability of cancer patients to obtain, and the ability of the oncology physicians to provide, optimal cancer care. The
Association of Northern California Oncologists
(ANCO) is an association of hematologists/oncologists dedicated to promoting high professional standards of cancer care by providing a forum for the exchange of ideas, data, and knowledge.
The material contained in the
California Oncology Weekly
is intended as general information for ANCO and MOASC members. Because diagnostic, treatment, contracting, coding, and billing decisions should be made on a case-by-case basis, any such information contained in the
California Oncology Weekly
may not apply in any given situation. Members are encouraged to contact their own consultants or advisors to obtain specific advice on matters relating to contracting, coding, and billing. The information contained in
California Oncology Weekly
should not be used as a substitute for such advice.
This publication provides a summary of regulations affecting oncology and its business practices. Reading this newsletter does not substitute for understanding regulations and verifying the validity of every claim. This information is time-sensitive and is subject to change. MOASC or ANCO accepts no liability for any statements or articles herein.
CPT codes are owned and trademarked by the American Medical Association. All Rights Reserved.
MOASC: P.O. Box 161, Upland, CA 91785 | P (909) 985-9061 | F (909) 804-5006| www.moasc.org
ANCO: P.O. Box 151109, San Rafael, CA 94915 | P (415) 472-3960 | F (415) 472-3961 | www.anco-online.org
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