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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
- California Assembly member, Jim Wood, D-Healdsburg, has introduced a bill that would ban drugmakers from issuing coupons that lower patients' prescription copayments for certain drugs. The bill would prohibit distribution of discount coupons for prescription drugs where a cheaper, FDA-approved equivalent exists. Wood, who is chairman of the Assembly Health Committee, said drug coupons are used as a "marketing tool to drive patients to higher-priced drugs," and that their use ultimately drives up the cost of health insurance premiums. Patients with coupons tend to buy higher-cost drugs even when cheaper brand-name or generic drugs are available, according to a 2016 study.
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Noridian News
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* MLN Connects Provider News
Announcements--Clinical Laboratories: Prepare Now to Report Lab Data through March 31; Updated Clinical Laboratory Fee Schedule Website
Claims, Pricers, and Codes--
Events--Understanding and Promoting the Value of Chronic Care Management Services Call-February 21
Publications--Telehealth Services Fact Sheet-Revised
* Self-Service Reopenings Available Through Noridian Medicare Portal
* New Waived Tests CR9956
* Radiopharmaceutical Fee Schedule 2016 Updates-Revised
* The Process of Prior Authorization CR9940
* Medicare B News JE January 2017 Bulletin-Now Available
* Enrollment Tutorials for Rural Providers
* Medicare Participating Physician Directory Information for 2017
* Pegfilgrastim (Neulasta) J2505-R1
* MolDX: NRAS Genetic Testing LCD-R1 and R2
* Intravenous Immune Globulin (IVIg) NCD-R1
* Proper Billing of Modifier AS.
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DHCS/Medi-Cal News
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- California Assembly member, Jim Wood, D-Healdsburg
has introduced AB 205, Medi-Cal: state fair hearing. This bill would authorize a person to request a hearing involving a Medi-Cal managed care plan within 120 calendar days after the order or action complained of, and would exclude a request from the 120-calendar day filing time if there is good cause, as defined, for filing the request beyond the 120-calendar day period. Existing law establishes hearing procedures for an applicant for, or beneficiary of, Medi-Cal who is dissatisfied with certain actions regarding health care services and medical assistance, to request a hearing from the State Department of Health Care Services under specified circumstances, and requires a request for a hearing to be filed within 90 days after the order or action complained of.
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- THIS Saturday, February 11, 2017, MOASC and the University of California Irvine (UCI) invite you to attend their 2nd Annual Spotlight on ASH. UCI faculty, who attended the 2016 Annual ASH Conference, will bring the premier topics and discussions to clinicians at the Hyatt Regency in Huntington Beach.
Register Now
, or contact the MOASC office at 800-310-3553x1
- MOASC has been working with Walgreens Specialty Pharmacy to insure access to oral drugs for the cancer patient.
There will be a Grand Opening this Thursday, February 9th from 11:00am - 2:00pm, at 4130 La Jolla Village Drive, La Jolla, CA. It is a small community pharmacy specializing in Oral Oncology. If you are in the area, MOASC & Walgreens invite you to stop by to see the new store, meet the pharmacist and learn more about services for oncology.
- 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 x1,
moasc@moasc.org
or
www.moasc.org
.
- 50% off registration before February 10th for the City of Hope conference ,How the Experts Treat Hematologic Malignancies , 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: CityofHope.org/cme; 626-218-5622 or 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.
- 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!
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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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- Here is the latest article by Cary A. Presant, M.D., FACP, FASCO, MOASC Chairman of the Board Emeritus, on cancer care in America, in light of the ACA and Moonshot
Dr. Presant was invited by the White House to represent MOASC in discussions on
Making Health Care Better - Community Oncology, the Moonshot, followed by discussions with the Senate on Innovation and Access in Quality Cancer Care on January 11, 2017. He is author of "Surviving American Medicine." Please contact the MOASC Office if you would like a signed copy at moasc@moasc.org
- The Healthcare Leadership Council (HLC), a coalition of leaders from all sectors of American healthcare, last week, endorsed legislation that would repeal the Independent Payment Advisory Board (IPAB), a panel of political appointees that will have power to initiate arbitrary cuts to the Medicare program and undermine healthcare access and quality for millions of seniors and Americans with disabilities. There is bipartisan opposition in Congress and the country to eliminate IPAB because it is a harmful and counterproductive approach to improving Medicare. It is vital that Congress act urgently to enact the Protecting Seniors' Access to Medicare Act, introduced by Senator John Cornyn (R-TX) in the U.S. Senate and Representatives Phil Roe (R-TN) and Raul Ruiz (D-CA) in the U.S. House. If triggered this year, as expected, the HHS Secretary would announce specific Medicare spending reductions in 2018 that will go into effect in 2019, unless quickly overridden by a supermajority of Congress. Medicare has low reimbursement rates for healthcare services and treatments than, to cut these payments more may result in beneficiaries having more difficulty finding physicians who can afford to treat them. It is essential to urge Democratic and Republican Senators to cosponsor the Wyden and Cornyn repeal bills. More information about this effort can be found at
www.protectmydoctorandme.com. Subscribe to the Protect My Doctor and Me twitter feed at @MyDrAndMe. The more followers on the Twitter feed, the more effective in communicating with members of Congress through social media.
- The UnitedHealthcare Network Bulletin (February 2017) is now available onlineat features articles entitled: UnitedHealthcare eligibilityLink App Replacing Other Online Options; The latest information on HEDIS; and, Coverage Determinations for Health Care Services. Go to
www.unitedhealthcareonline.com > Tools and Resources > News and Network Bulletin for more information.
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- 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 de
adlines:
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
- The Abstract Submission Deadline is TONIGHT, Tuesday, February 7, at 8:59 PM (PST)! Why should you submit an abstract to the 2017 ASCO Annual Meeting? Achieve global impact: ASCO provides a highly visible forum for presenting the most significant and timely scientific discoveries to a global audience of oncology professionals.
Revolutionize the future of cancer care
: With over 5,000 abstracts submitted annually, the ASCO Annual Meeting represents the latest cutting-edge research and best practices in cancer prevention, diagnosis, and treatment.
Ensure that high-quality, high-value cancer care is delivered to all patients
: ASCO brings together all oncology disciplines and roles, strengthening our shared knowledge to make personalized care possible for our patients.
Receive exposure to audiences outside of the Meeting
: Abstracts are peer reviewed and published in the Annual Meeting Proceedings, a supplement of the Journal of Clinical Oncology.
Visit
am.asco.org/abstracts
for detailed information on ASCO's abstract policies, submission guidelines, and frequently asked questions. Abstracts that have been presented at ASCO-cosponsored symposia are eligible for submission and presentation at the Annual Meeting with updated data, results, and/or analysis.
Submit your abstract today.
This live activity has been approved for
AMA PRA Category 1 Credit
TM
.
- A team from ASCO's Leadership Development Program is conducting a survey to understand how ASCO can better engage practices without losing sight of individual members. They are interested in determining who within the practice is making decisions regarding the potential update and use of ASCO's educational services. Take the survey at
https://www.surveymonkey.com/r/QT5TC9V by February 12.
- ASCO invites interested stakeholders to submit comments on its draft clinical practice guideline update on Antiemetics by February 13. To participate, visit
www.asco.org/open-comment-guidelines.
- 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:
- The 2017 Community Oncology Conference will take place April 27 - 28 at the Gaylord National Hotel & Convention Center in National Harbor, MD, just outside of Washington, DC. Join more than 1,000 oncologists, allied health professionals, payers, and industry partners for two days of jam-packed learning and networking.
Register today at COAConference.org
Attendees will gain the insight and knowledge they need to fuel innovation and success in community oncology. For more information and to register click
here
.
- 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).
- 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.
Rule of thumb: When a DC group has to resort to calling names by calling COA a "splinter group," they have no data. And when they respond in the first place to a "splinter group," they know they have no data. COA intends to work this issue and related PBM issues as hard as we worked the Part B Experiment.
- 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!
- ASCO is pleased to remind members that you can use the QOPI platform to meet the MIPS reporting requirement of one measure through manual reporting. While one is the minimum requirement to avoid the 2019 penalty, ASCO encourages practices to report on at least four measures to become fully acquainted with the system and ensure that the CMS requirements are met. In addition, ASCO is using 2017 as a transition year to modify the QOPI Quality Clinical Data Registry (QCDR) to allow practices to meet 2018 MIPS reporting requirements. In the meantime, ASCO encourages all oncology practices to use 2017 to ensure they are positioned to report at the significantly higher volume (60% of their eligible charges for ALL measures) requirement in 2018.
- Download ASH's MACRA 101 for Hematologists at
- NCCN has published updated NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) with NCCN Evidence Blocks™ for esophageal and esophagogastric junction cancers (V2.2016), Waldenstrom's Macroglobulinemia/Lymphoplasmacytic Lymphoma (WM/LPL; 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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- AstraZeneca is hosting a dinner meeting entitled Multidisciplinary Approach to Diagnostic Testing in Metastatic Non-Small Cell Lung Cancer with Jeffrey Gregg, M.D., UC Davis, on February 13 at Prima Ristorante in Walnut Creek. RSVP to Jason Yonehiro at (415) 205-3699 by February 10.
- Bristol-Myers Squibb Oncology informs ANCO and MOASC that the United States Food and Drug Administration has approved Opdivo for treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or have disease progression within 12 months of neoadjuvant or adjuvant treatment with a platinum-containing chemotherapy.
- Genomic Health informs ANCO and MOASC that Oncotype DX is now included in the 8th edition of the American Joint Committee on Cancer (AJCC) Criteria for Breast Cancer Staging. For the first time, AJCC adds molecular market to the staging criteria, including Oncotype DX along with Estrogen Receptor (ER), Progesterone Receptor (PR), and HER2 status. More information is available at
- 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
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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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