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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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- Significant health care program changes in the 2017-18 California State Budget.(California News)
- MEET WITH YOUR MEMBER OF CONGRESS!(National News)
- TOMORROW is the deadline to submit an abstract for ASH's annual meeting (Affiliate News)
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California News
- Tuesday, August 8th, at 5p.m. (PT
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Noam Z. Drazin, MD, Cedars Sinai Medical Group, will share helpful tips to improve and enhance patients' communications
with their health care team and empower participants to advocate for themselves when discussing individual concerns including screening, fertility, fear of recurrence, new research, clinical trials, and immunotherapy. A peer supporter will share their personal story and a live question and answer session will follow the presentation. To register for the free webinar click here.
- The University of California at San Francisco's Institute for Computational Health Sciences will lead a program to aggregate all patient data from five UC medical centers into a single database, with a $10 million donation from Facebook CEO Mark Zuckerberg and his wife, Dr. Priscilla Chan, independent of their Chan Zuckerberg Initiative. The large dataset will then be available to researchers and clinicians.
- The 2017-18 California State Budget, enacted on June 27, includes a number of significant health care program changes. Following is a summary of some of the more significant changes:
Coordinated Care Initiative.
Under the CCI, people eligible for both Medicare and Medi-Cal receive medical, behavioral health, long term care services and support, and home and community-based services coordinated through a single health plan. The law creating the CCI pilot, specifically states that it will be discontinued in the next fiscal year if found to be ineffective from a cost perspective. Citing "lessons learned" from the pilot, the current budget act extends the CCI duals demonstration pilot through December 2019.
Proposition 56.
The Budget includes funding to support new growth in Medi-Cal for expenditures for supplemental provider payments for physician services, dental services, women's health, Intermediate Care Facilities for the Developmentally Disabled, and HIV/AIDS waiver providers. The funding for supplemental provider payments are subject to federal approval, and contingent on continued stability in federal Medicaid funding.
Major Risk Medical Insurance Fund Abolished.
According the budget summary, the Affordable Care Act reduced the need for the MRMI high-risk pool because of its ban on denied coverage for pre-existing conditions. The remaining fund balance will be transferred to the newly established Health Care Services Plan Fines and Penalties Fund to fund MRMIP and the Medi-Cal program.
Managed Care Organization Tax
- Chapter 2, Statutes of 2016, Second Extraordinary Session (SBx2 2), authorized a tax on the enrollment of Medi-Cal managed care plans and commercial health plans. This tax funds the nonfederal share of Medi-Cal managed care rates for health care services provided to children, adults, seniors and persons with disabilities, and persons eligible for both Medi-Cal and Medicare.
Managed Care - AB 72.
The Department of Managed Health Care budget includes funding for 16 new positions for implementing AB72 (2016), which prohibits "surprise" balance billing.
DSH.
Medi-Cal DSH calculation is revised.
21st Century Cures Act.
Authorizes DHCS to enter exclusive and non-exclusive contracts with organizations to implement and administer 21st Century Cures Act grants.
For more information, click
here for text of the main health care trailer bill, SB 97.
- Jump-Starting Hard Conversations As The End Nears is the conversation of an end-of life-planning website encouraging patients to tackle that difficult topic before they become too ill to communicate, according to a new study. But they may be more likely to make concrete plans with help from a doctor or social worker.
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- ASP Medicare Part B Drug Pricing Files and Revisions - October 2017 CR10187. Make sure your billing staffs are aware of these changes. Change Request (CR) 10187 instructs MACs to download and implement the October 2017 and, if released, the revised July 2017, April 2017, January 2017, and October 2016, ASP drug pricing files for Medicare Part B drugs via the Centers for Medicare & Medicaid Services (CMS) Data Center (CDC). Medicare will use these files to determine the payment limit for claims for separately payable Medicare Part B drugs processed or reprocessed on or after October 1, 2017, with dates of service October 1, 2017 through December 31, 2017.
* MLN Connects
Announcements--Quality Payment Program: Explanation of Special Status Calculation; Updated CMS Measures Inventory Posted
Claims, Pricers, & Codes
--Clinicians: Medicare Part B Crossover Claims Issue Tied to Error Code H31312
Publications--
Quality Payment Program 2017 MIPS: Improvement Activities Performance Category Web-Based Training Course-New
* Internet-based PECOS Help is Available
* Recovery Audit Program (RAC) Updates
- Forthcoming Noridian/JEMAC webinars include:
* Self Service Re-openings in NMP for Part B Providers (August 8)
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Medi-Cal Matters is a compilation of key facts and figures illustrating the breadth and scope of Medi-Cal coverage and how that coverage benefits its nearly 14 million enrollees in California.
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- Thank you to those who joined us for MOASC's "Spotlight On...Clinical Oncology" series presentation by the University of California Irvine last Saturday, July 29, 2017, at the Waterfront Beach Resort, Huntington Beach. MOASC awarded educational grants to 3 UCI Fellows who attended the ASCO Annual meeting in Chicago on June 2-6, 2017. They, and faculty from UCI, presented their discoveries through interactive discussions on, colorectal & gastro-esophageal cancer, breast cancer and lung cancer and abstract highlights. In case you were unable to attend, below is a synopsis of the event.
Jason Zell, DO, MPH Associate Professor, Depts. Of Medicine & Epidemiology School of Medicine University of California, Irvine, welcomed all and introduced the following speakers.
Sarmen Sarkissian, MD UC Irvine, Division of Hematology/Oncology, Fellow, spoke on ASCO Abstracts Highlights.
Daniela Bota, MD, PhD UC Irvine Department of Neurology, discussed Neuro-Oncology Updates
Farshid Dayyani, MD, UC Irvine, Division of Hematology/Oncology, presented Practice Changing Abstracts in Colorectal & Gastro-esophageal Carcinomas.
Rita Mehta, MD UC Irvine, Division of Hematology/Oncology, spoke on Breast Cancer Updates.
Viola Zhu, MD, PhD UC Irvine, Division of Hematology/Oncology discussed Lung Cancer Updates.
Attendees engaged in deeper discussion of challenging patient cases and various treatment questions. All took advantage of the opportunity to network with colleagues and faculty in addition to visiting the exhibits to learn about current and upcoming products. MOASC would like to recognize and thank for their support of this meeting: Agendia, Alexion, Amgen, Astrazeneca, Celgene, Daiichi Sankyo Pharmaceuticals, Inc., Eli Lilly, EMD Serono, Merck, Pfizer, Sun Pharma, Takeda, Teva, and University of California, Irvine.
We look forward to seeing you at our next "
Spotlight On...Hematology
" in January 2018.
- MOASC's Chairman of the Board Emeritus, Cary A. Presant, M.D., F.A.C.P., F.A.S.C.O., has provided his follow up to ASCO's Annual Conference. These abstracts were presented by COH physicians. COH- ASCO 2017.
- You are invited to attend the upcoming physician reception on August 9 for the Grand Opening of the University of California Irvine's new digestive disease center. UCI Invitation.
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- Congratulations to ANCO member David Oh, M.D., University of California, San Francisco, for receiving an ASCO Young Investigator Award at ASCO's 2017 Annual Meeting.
- The Conquer Cancer Foundation of the American Society of Clinical Oncology is now accepting applications for the 2018 Young Investigator Award (YIA). The Association of Northern California Oncologists (ANCO) is funding one 2018 YIA for a qualified northern California applicant, and urges all eligible northern California physicians to apply. The YIA is a one-year, $50,000 grant that provides research funding to promising physicians to support their transition from final years of training to faculty appointment and to encourage and promote quality research in clinical oncology. Applications in all areas of cancer research are accepted from U.S. and international applicants. For 2018, CCF has dedicated funding for the following areas: breast cancer, northern California researchers, global oncology, kidney cancer, lung cancer, pediatric cancer, sarcoma, and supportive care. Other areas of interest include cholangiocarcinoma, chronic lymphocytic leukemia, gynecological caners, and melanoma. YIA applications opened on July 1 and are due by 11:50PM ET on September 21. Eligibility criteria, award details, and the request for proposals are available on the CCF website (www.conquer.org/YIA). For questions about the YIA or assistance with your application, please e-mail grants@concquer.org.
- 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. Download the meeting announcement and registration form at www.anco-online.org/ProfEduc2017.pdf.
- ANCO's 3Q2017 Hematologic Malignancies Update will take place on September 9 at the Stanford Park Hotel in Menlo Park. Watch for a meeting announcement in late July. Bruno Medeiros, M.D., Stanford University, Charalambos Andreadis, M.D., University of California, San Francisco, and Brian Sworder, M.D., Ph.D., Stanford University, will review the latest research on novel treatment modalities for leukemias and lymphomas, along with case studies for these diagnoses. These Updates are supported by Janssen Biotech, Merck, Pfizer Oncology, and Pharmacyclics. Download the meeting announcement and registration form at www.anco-online.org/3Q2017HemeMalig.pdf.
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- Health and Human Services Secretary Tom Price, a former orthopedic surgeon, has taken a number of steps that are favored by his former physician colleagues, including quietly rolling back regulations that have been criticized by provider groups. Tom Price has been meeting with groups of physicians, the "victims" of Obamacare, who felt the law was hurting their patients and their own bottom lines. Stat News
- Your assistance is needed to get to a 3/5 majority in the House and Senate and force action on the Independent Payment Advisory Board (IPAB) repeal. In the House: H.R. 849 has 256 cosponsors & H.J.Res.51 has 202 cosponsors. In the Senate: S. 260 has 37 cosponsors & S.J.Res.17 has 23 cosponsors, and S. 251 has 13 cosponsors & S.J.Res.16 has 13 cosponsors.
Energy and Commerce Health Subcommittee held a hearing last week "Examining Bipartisan Legislation to Improve the Medicare Program." Community advocates spoke in support of H.R. 849, the Protecting Seniors Access to Medicare Act, bipartisan legislation to repeal the IPAB created under Obamacare. While the board has not been filled, the HHS Secretary still has the authority to carry out cuts to vital services. When asked by a congressional member about what the effects of IPAB would be, the advocate response was that the number one effect would be reduction of access to care for Medicare beneficiaries. If you support the IPAB repeal and would like to join these efforts, please go to this link to sign-on.
- In a statement submitted to a House Energy and Commerce Health Subcommittee hearing entitled Examining Bipartisan Legislation to Improve the Medicare Program, ASCO expressed strong support for two pieces of legislation--HR849, Protecting Seniors' Access to Medicare Act of 2017, and HR3120. HR849 would repeal the Independent Payment Advisory Board, a group created by the ACA to reduce Medicare spending growth. HR3120 would remove a requirement that EHR standards become more stringent over time. Read ASCO's statement at
www.asco.org/advocacy-policy/asco-in-action/asco-supports-bills-improve-medicare-comments-house-energy-and.
- This afternoon, Congress officially broke for August recess. For the next month members will travel around districts, giving face time to constituents. This is the perfect opportunity for practices to connect with them and talk about our issues. To take advantage of this break and strengthen our relationships with Congress, COA is reviving the Sit in My Chair program. First introduced in 2009, this is one of the best opportunities for your practice to engage with Congress, delivering a unique, lasting, hands-on experience. With the battles over 340B and PBMs heating up, this is also a great opportunity to discuss these issues with them directly. Go to these links to the resources COA has put together for more details on Sit in My Chair. COA is making participation for your practice EASY, including providing a planning guide that includes everything you need for Sit in My Chair, all in one easy to use packet. With a few emails and an hour of planning you can have a member of Congress sitting in your practice.
August recess schedules are still open but will fill up fast, so reach out ASAP! Now is an excellent time to encourage your member of Congress' office to make time for a visit. If you have any questions or would like contact information for Congressional staff/schedulers, please let COA know. While your member of Congress is visiting, you can introduce them to your oral's pharmacy within your clinic. This helps them to see and understand the convenience and importance of patients getting their oral and IV drugs at the point of care and how personalized this process is. You are encouraged to participate in this Sit in My Chair program.
- The August 2017 UnitedHealthcare Network Bulletin has been published. This monthly publication for participating care providers, features timely updates to procedures, programs and policies, and important administrative and clinical information. In this issue, you will find articles about the new care provider website, enhancements to Link, revamped prior authorization and notification app, and much more.
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- The legal team at Johnson & Johnson created "2018 MACRA QPP Proposed Rule Update" highlights and Q&A documents. These provide a concise summary of the 2018 MACRA QPP Proposed Rule. CMS is accepting comments until August 21, 2017. The following live links will take you directly to the CMS website.
CRA QPP CY2018
MACRA QPP
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Affiliate Association News
- TOMORROW, Wednesday, August 2, at 11:59 p.m. PT is the deadline to submit an abstract for
ASH's annual meeting in Atlanta, GA, December 9-12, where the best scientific research in all areas of hematology will be showcased. Submit an abstract of your latest findings as it may be the next breaking news in the field.
SUBMIT ABSTRACT
- The Agency for Healthcare Research & Quality (AHRQ) showcases research on strategies to address physician burnout. The new AHRQ Views blog looks at factors that can contribute to physician burnout, including a lack of control over work conditions, time pressures, chaotic workplaces and difficulties associated with electronic health records. Co-authored by Gopal Khanna, M.B.A., the agency's director, and Arlene Bierman, M.D., director of AHRQ's Center for Evidence and Practice Improvement, the blog also offers potential strategies to minimize burnout, such as expanding the ways nurses and medical assistants might interact with patients. In addition to the blog, AHRQ has profiled grantee Mark Linzer, M.D., of Hennepin County Medical Center in Minneapolis, who has studied working conditions in health care, especially as they contribute to burnout, for the past 15 years and has created a tool to measure burnout. For more information about AHRQ's work on physician burnout, access our online fact sheet.
- ASCO is launching its new Practice Engagement Program to help administrators, physicians, and other members of the care team navigate ASCO tools, programs, and resources available to help oncology practices respond to the changes occurring in the cancer care delivery system. Building on an array of resources developed to help practices remain viable and thrive during this turbulent period, the new Practice Engagement Team will help participating practices learn more about the specific ASCO services and programs that can best support their needs. Learn more at www.asco.org/advocacy-policy/asco-in-action/new-practice-engagement-program-connects-practices-specific-resources.
- Read four perspectives--from a physician, a patient advocate, a payer, and industry--on How Should We Intervene on the Financial Toxicity of Cancer Care?
- NCCN has published and/or updated their Chemotherapy Order Templates; Clinical Practice Guidelines in Oncology, Drugs & Biologics Compendium; Evidence Blocks; Guidelines for Patients; Imaging Appropriate Use Criteria; and/or, Radiation Therapy Compendium for acute lymphoblastic leukemia (V1.2017), chronic myeloid leukemia (V1.2018), gastric cancer (V2.2017), Hodgkin lymphoma (V1.2017), kidney cancer (Spanish; V1.2017), melanoma (chemotherapy order template). Go to www.nccn.org for more information.
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- Bristol-Myers Squibb Oncology informs ANCO and MOASC that the United States Food and Drug Administration has expanded the indication for Yervoy to now include the treatment of unresectable or metastatic melanoma in pediatric patients 12 years of age and older.
- Genentech informs MOASC and ANCO that on June 22, 2017, RITUXAN HYCELA™ (rituximab/hyaluronidase human) was approved by the US Food and Drug Administration (FDA). The full Prescribing Information can be found at https://www.gene.com/download/pdf/rituxan_hycela_prescribing.pdf. Genentech Access Solutions offers a full range of access and reimbursement support to help physicians and patients understand their coverage and get assistance with out-of-pocket (OOP) costs so treatment can begin as soon as possible.
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MOASC CALENDAR
Professional Educational Series
November 8-9
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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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