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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.
June 27, 2017
In honor of our country's independence, the California Oncology Weekly is taking
a holiday to celebrate 241 years of the best form of democracy in the world.
There will be no edition published next week.
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- Send your letter of support for AB315, TODAY! (California News)
- MOASC seeks your feedback. (MOASC News)
- CMS MU hardship exceptions deadline is THIS Saturday, July 1 (CMS News)
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California News
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ANCO & MOASC want to thank the Community Oncology Alliance (COA) for their letter of support for California Senate bill AB 315 (
Wood, Dahle): Pharmacy benefit management.
ANCO and MOASC are pleased to support AB 315, which would require pharmacy benefit managers (PBMs) to
be licensed and regulated by the Department of Managed Health Care (DMHC). It also requires a PBM to periodically disclose to a purchaser key information such as drug acquisition cost, rebates received from pharmaceutical manufacturers, and rates negotiated with pharmacies. AB 315 is a critical first step in bringing to light the role PBMs play in the drug supply chain and how those entities contribute to the cost of health care. In recent years, the PBM marketplace has transformed considerably. PBMs have grown to become large corporations, consolidating into only five national PBMs that control prescription drugs for 266 million Americans, or 80% of the market. Their role in the health care delivery system is also evolving and growing: PBMs often determine what drugs will be included on plan formularies and how those drugs are dispense, bordering on practicing medicine without a license.
The bill will be heard tomorrow, Wednesday, June 28
in Senate Committee on Health
Send you letter of support for AB315, TODAY
, to The Honorable Ed Hernandez
- Last November, California voters overwhelmingly approved Proposition 56, which added a $2 tax on tobacco products and stipulated that funds should increase access by improving provider payments. In January, Governor Brown redirected all tobacco tax revenues to support the state's General Fund obligations. In May, he doubled down on his proposal, offering no additional funding to improve provider payments. Restoring Prop. 56 funds to its original intent, both houses rejected the Governor's proposal and laid out a different framework for appropriating tobacco tax revenues into the final budget. The Senate and Assembly have approved the state budget, which includes a Prop. 56 appropriation bill that provides over $1 billion ($546 million in state funds plus a federal match) for the 2017-2018 fiscal year to improve provider payments.
- On July 1, 2017, a new law (AB 72) will take effect that will change the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law, signed in 2016, was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor. While patients with out-of-network benefits can consent to treatment from out-of-network providers, absent a valid consent form, health plans and insurers are required to reimburse out-of-network physicians at an interim payment rate, which is the greater of 125 percent of Medicare or the plan/insurer's average contracted rate (ACR). Under the new law, payors must submit their ACR data to insurance regulators by July 1, 2017. Both the California Department of Insurance (CDI) and the Department of Managed Health Care (DMHC) recently released implementation instructions for ACR filings under the new law.
- State Assembly Speaker, Anthony Rendon, announced last Friday, that he does not plan to take up SB 562, the single-payer bill, this year, calling the bill "woefully incomplete."
The bill, which
passed the Senate, lays out a plan for a government-run health system in California, but it doesn't include a way to pay for it. Rendon said the bill also doesn't adequately address delivery of care and cost. With an estimated cost of $400 billion per year, paying for it would require new taxes and cooperation from the Trump administration to redirect existing federal money. It would guarantee healthcare for all California residents and eliminate out-of-pocket costs for consumers, such as copays and deductibles.
The legislation was championed by the state's nurses' union and the Democratic Party's more liberal wing. Rendon looks to the Senate to draft a new version of the bill addressing how to finance the plan and more clearly detail how it would work. The plan could be taken to voters in the form of a ballot measure. In the meantime, he will not advance the bill through the Assembly committee process.
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CMA's webinar entitled
Transitioning your Practice: Retiring, Selling or Buying a Practice
takes place on June 28. Register online at
www.cmanet.org/events.
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Announcements--
MIPS Group Reporting: Registration Period Ends June 30; MIPS Performance Categories: Accepting Future Measures and Activities until June 30;
CMS Proposes Quality Payment Program Updates to Increase Flexibility and Reduce Burdens; Coming in April 2018: New Medicare Card-New Number; Quality Payment Program: New Resources Available; Quality Payment Program: View Recordings of Recent Webinars
Claims, Pricers, and Codes--
Events--
Publications--
* New Process for Providers and Suppliers Submitting Redeterminations and Reopenings via NMP-Effective June 16, 2017
* Medicare After Hours-Evening Webinars Available for Your Professional Growth
* Provider Enrollment Revalidation-Cycle 2-Second Revision SE1605
* Self-Administered Drug Exclusion List-R12
* Laboratory NCD Edit Software-Changes for October 2017 CR10156
- Forthcoming Noridian/JEMAC webinars include:
* Supplemental Medical Review Contractor (June 28)
* Medicare Secondary Payer (MSP; June 28)
* Medicare Secondary Payer Calculations (June 29)
* E&M Modifiers (July 6)
* Telehealth Services (July 11)
* Duplicate Claims (July 12)
* Noridian Medicare Portal Registration and Functionality (July 19)
* CMS 1500 Form Submission (July 19)
* Reopenings (July 20)
* Medical Oncology (July 25)
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MOASC seeks your feedback.
The MOASC Office is in receipt of a letter (see below) from one of our southern California members.
Though a specific organization is mentioned, MOASC would like to know if you have received a similar notice from Blue Shield in your area, with, perhaps the name of your local organization? We believe this may affect other markets, as well.
MOASC contacted our state medical association, the CMA.
Kristine Marck,Associate Director, Center for Economic Service, California Medical Association received the following back from Blue Shield.
1st - This is a "pilot" program where we are testing out an oncology value based program. Our hope is to demonstrate higher quality outcomes for our patients and customers as well as show our ability to collaborate with providers in innovative ways. This is a completely voluntary program and PCPs can still refer to any oncologist.
2nd - Regarding the mailing list - I'm guessing any oncologist who received the letter may be dual-listed with an internal medicine specialty type (we've seen many instances with both specialties listed) and this is likely how they made it on to the mailing list.
3rd - As to oncology member education, we haven't specifically marketed this pilot program to members. Our general talking points about this program are geared towards our intent to provide the highest quality to our members.
As you see, the information to the CMA from Blue Shield was pretty much a reiteration of the letter our member received.
Does Blue Shield's "whole body approach" refer to forcing their beneficiaries into a capitated model and force every patient to be referred to the local managed care plan?
This is not a collaborative approach, but Blue Shield strictly working with specific managed care plans at the exclusion of equally qualified physicians and providers. Blue Shield already has contracting capabilities with such organizations. Obviously physicians have had the choice to participate or not. This is blatant diverting and narrowing access to care to the lowest bidder, at the expense of the patient.
MOASC would like more details about the program and Blue Shield's future intents.
The impact on the oncology community is huge. Thank you for your feedback. Blue Shield Letter
- MOASC'S LunchTime Series webinar presentation is TOMORROW, Wednesday, June 28, 2017 at 12:30pm Pacific time. In preparing your practice for MACRA, OCM and the push for patient satisfaction and efficiencies through automation, Alison Twite, Senior Patient Engagement Specialist, Outcome Health, will share a few free technologies available to MOASC member practices that they can employ to assist in this arena. Such as:
The Digital Waiting Room, The Infusion Room Tablet, The Exam Room Tablet, The Digital Anatomy Board. Outcome Health is a patient engagement company, striving to improve the patient experience at the point of care through their free patient-facing technologies.
- SAVE-THE-DATE, for MOASC's 3rd Annual Spotlight on ASCO presentation by the University of California Irvine, Saturday, July 29 at the Waterfront Beach Resort, Huntington Beach. MOASC awarded educational grants to 3 UCI Fellows to attend ASCO and present their discoveries. Faculty from UCI will round out the discussions on: ASCO Abstract Highlights, Colorectal & Gastro-Esophageal cancer, Breast cancer and Lung cancer. Contact
moasc@moasc.org to register.
- The time of year has come to continue your investment in your association. We are looking forward to an exciting year ahead with benefits you won't want to miss - to both enhance your career and strengthen your practice! If you don't renew before June 30, 2017, this may be your last issue of the California Oncology Weekly newsletter.
There are two ways to renew your membership
NOW!
1. Print the application
HERE. Mail application with your check to: Medical Oncology Association of Southern California, P.O. Box 161, Upland, CA 91785
- In celebration of Independence Day, the MOASC Office will be closed on Monday, July 3 and Tuesday, July 4, and return to regular business hours on Wednesday, July 5.
We wish you a safe and relaxing holiday.
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- ANCO hosted an event on June 15 entitled The State of Cancer Care with Wes Kidder, M.D., and Margaret Tempero, M.D., University of California, San Francisco, at the San Francisco Marriott Marquis. Download their presentation at meeting announcement/registration form at www.anco-online.org/TemperoKidder2017.pdf.
- SAVE THE DATE--ANCO's 2017 Professional Education Meeting will take place on September 6 at the San Jose Fairmont and feature talks on QPP/MACRA, ASCO's COME HOME Project, USP 797/800, and California Legislative/Regulatory Updates. Watch for a meeting announcement in early July.
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On June 22, 2017, the U.S. Senate released draft legislation, the Better Care Reconciliation Act (BCRA),
to repeal large provisions of the Affordable Care Act (ACA). This legislation comes two months after the American Health Care Act (AHCA), the U.S. House of Representative's version of a repeal bill, which passed the House on May 4, 2017. the Senate bill does not differ significantly from the House legislation.
- MOASC encourages you to write to urge your Congressperson to support the joint resolution to repeal the Independent Payment Advisory Board. The IPAB is fast approaching activation, which means cuts to Medicare could be imminent. Seniors deserve to have their Medicare protected. IPAB cuts to Medicare are mandatory and largely unchecked, and would allow widespread changes to Medicare without Congressional approval. Congress must act now to preserve its authority over Medicare, and keep decisions that will impact the health of 55 million beneficiaries out of the hands of unelected bureaucrats. Oppose the IPAB and request that your Congressperson support the joint resolution to repeal IPAB.
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The hardship exceptions deadline is THIS Saturday, July 1. CMS has been accepting hardship exceptions from the meaningful use requirements of the EHR incentive payment program for the 2016 reporting year. Physicians who can show that demonstrating meaningful use would result in a significant hardship can apply for a one-year exception and avoid a negative payment adjustment in 2018. To be considered for an exemption and avoid a payment adjustment click here.
- The Centers for Medicare and Medicaid Services (CMS) will publish the 2016 Open Payments payment data, along with updates to the 2013 and 2014 data, on June 30, 2017. Drug and medical device manufacturers completed their submission of data to the Open Payments system on payments or transfers of value made to physicians during 2016 back in April. Physicians had 45 days to review and dispute records attributed to them. The review and dispute period closed May 15, 2017. The review and dispute process is voluntary, but encouraged. Disputes that were initiated before the May 15 deadline will be flagged in the public release on June 30.
Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians - including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other "transfers of value" are reported to CMS for publication in the online database.
Physicians who have already registered but who have not accessed their account in the past 60 days will need to unlock their account by going to the CMS Enterprise Portal, which will prompt you to enter your user ID and correctly answer all challenge questions. You will then be prompted to enter a new password. Users who registered last year, but who have been inactive for more than 180 days, will need to reactivate their account by contacting the Open Payments Help Desk at openpayments@cms.hhs.gov or (855) 326-8366.
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Affiliate Association News
- What's Next for Medicare? Millions of seniors and patients rely on Medicare for access to needed treatments. Proposed changes to Medicare could affect coverage for all beneficiaries. Join Medicare Rx Access Network (MRAN) CA/NV Partners, this Thursday, June 29th 10:00am - 10:30am Pacific time. Learn about how potential changes to Medicare could impact you. This free educational partner call will address: Current threats to Medicare (Part B, Part D, IPAB and CMMI); Risks to patients and caregivers; Ways to become an active MRAN partner and Actions you can take TODAY to protect patients. Please RSVP to Katelyn Downey at
katelyn@perrycom.com. Attendees will receive a free MRAN partner toolkit.
- ANCO and MOASC encourage all members to participate in ASCO's Practice Census, the only annual survey of the entire oncology community that aims to capture and describe changes in cancer care and oncology practice over time. Be counted by going to https://apps.asco.org/oncology-practice-central/survey.
- ASCO's next QPP webinars entitled Quality Payment Program: Optimizing Your MIPS Score takes place on July 10. Go to
www.asco.org/macra to learn more and register. Listen to recordings and view slides from past webinars at www.asco.org/macra > MACRA Webinar Series.
- NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN GuidelinesĀ®), et.al., for: distress management (V1.2017); esophageal and esophagogastric junction cancers (V2.2016); head and neck cancers-cancer of the lip and oral cavity (V2.2017); non-small cell lung cancer (V7.2017). For the complete updated versions of the NCCN Guidelines, et.al., please visit
NCCN.org.
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- Genentech BioOncology informs ANCO and MOASC that the United States Food and Drug Administration has approved Rituxan Hycela for adult patients with follicular lymphoma, diffuse large B-cell lymphoma, and chronic lymphocytic leukemia.
- Sanofi Genzyme is hosting an educational dinner meeting entitled What's Behind Your Patient's Hematological Abnormalities with Seymour Pack, MD, University of California, San Francisco, on July 13 at A16 Rockridge in Oakland. RSVP to Sandra Brink at (866)700-9297.
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MOASC CALENDAR
ASCO National Meeting in Chicago
June 2-6, 2017
LunchTime Series
June 28, 2017
Spotlight on ASCO
July 29, 2017
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(Stanford Cancer Institute and OncLive, San Jose, July 8)
(ANCO Member Discount Code IBW17ANCO, San Diego, July 14-15)
(ANCO Member Discount Code ILC17ANCO,
Huntington Beach, July 27-29)
ANCO 2017 Professional Education Meeting
(San Jose, September 6)
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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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