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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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- CMS issues proposed rule update to Medicare payment and policies for CY 2018 (Noridian News)
- Patients' Access to Treatment Act (H.R. 2999) introduced in the House of Representatives.(National News)
- The Medicare trust fund will be insolvent by 2029 (CMS News)
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California News
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Not much has changed since last week on SB 790.
The author has not yet submitted or released amendments to the bill. The California Cancer PAC (ANCO & MOASC) thinks that perhaps the author of the bill is finding it very difficult to write this bill in a way that does not interfere with critical physician education or clinical trials. Given the new rule to require all bills to be in print for 72 hours before a final vote can be taken, and the fact that the legislature will be gone on its summer recess in less than 72 hours, it is not expected that this bill will be voted on until after the summer recess. The Legislature will be on recess at the end of this week and will not reconvene until August 21
st
. However, whenever the CalCancer PAC gets the amendments, we will share them with interested members.
- In what may be the first-of-its-kind lawsuit related to California's End of Life Option Act, the family of a San Francisco terminally ill cancer patient is suing the UC San Francisco Medical Center alleging that her physician and the system misrepresented that they would help the dying woman use California's right-to-die law when her time came. Instead, according to the July 7 civil lawsuit filed in San Francisco Superior Court, Judy Dale's wish for a peaceful death was denied to her by the defendants' "conscious choice to suppress and conceal'' their decision that they would not participate in the law, despite Dale's repeated indications to doctors and social workers that she intended to use its provisions. gave her over and over.''
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On July 13, CMS issued a proposed rule that would update Medicare payment and policies for doctors and other clinicians who treat Medicare patients in CY 2018. The proposed rule is one of several Medicare payment rules for CY 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.
The Physician Fee Schedule is updated annually to include changes to payment policies, payment rates, and quality provisions for services furnished to Medicare beneficiaries. This proposed rule would provide greater potential for payment system modernization and seeks public comment on reducing administrative burdens for providing patient care, including visits, care management, and telehealth services. The rule takes steps to better align incentives and provide clinicians with a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program. The rule encourages fairer competition between hospitals and physician practices by promoting greater payment alignment, and it would improve the payment for office-based behavioral health services that are often the therapy and counseling services used to treat opioid addiction and other substance use disorders. In addition, the proposed rule makes additional proposals to implement the Center for Medicare and Medicaid Innovation's Medicare Diabetes Prevention Program expanded model starting in 2018.
For More Information:
Proposed Rule, Fact Sheet and the full text of this excerpted Press Release (issued July 13).
- Forthcoming Noridian/JEMAC webinars include:
* 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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- SAVE-THE-DATE, for MOASC's
"Spotlight on"
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 who attended the ASCO Annual meeting in Chicago on June 2-6, 2017. They and Faculty from UCI will and present their discoveries through interactive discussions on, abstract highlights, colorectal & gastro-esophageal cancer, breast cancer and lung cancer. Contact moasc@moasc.org to register.
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- 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.
- SAVE THE DATE ANCO's 3Q2017 Hematologic Malignancies Update will take place on September 9 at the Stanford Park Hotel. Watch for a meeting announcement in late July.
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- Representatives David McKinley (R-WV) and G. K. Butterfield (D-NC) recently introduced the Patients' Access to Treatment Act (H.R. 2999) in the House of Representatives. The legislation aims to remove the burden of excessive cost sharing for Americans who need high-cost, specialty-tier medications. Currently, many insurance companies divide prescription medications into cost-sharing tiers. Patients using drugs placed in the lower tiers, often tiers 1, 2, and 3, are usually charged a fixed co-pay. Increasingly, insurers are moving higher cost drugs, like biologics and oral chemotherapy, into "specialty tiers" (tiers 4 and 5). For medications in these tiers, patients are often responsible for a percentage of the cost (coinsurance) rather than a fixed rate. These treatments can cost in excess of $10,000 a month, and can have coinsurance payments as high as 25 to 50 percent. The Patients' Access to Treatment Act would require a fixed co-pay for specialty tier drugs that is in line with the highest non-preferred tier. The American Society of Hematology issued a statement applauding the bill's introduction on June 23 and urging congressional support for the legislation.
- The U.S. Food and Drug Administration (FDA) recently announced it will undertake a new Medical Innovation Development Plan designed to facilitate the development of innovative drugs by updating FDA's regulatory tools and policies to ensure that they are "modern, risk based, and efficient." According to the FDA Commissioner, the plan's purpose is to ultimately lower health care costs by "finding better treatments for a lot of costly diseases."
Although full details of the Medical Innovation Development Plan are still forthcoming, FDA intends to streamline the path to market for targeted therapies and other novel drugs to encourage innovative therapies. In particular, the plan will focus on facilitating the approval of tumor-agnostic therapies that target cancer-linked DNA. As part of the plan, FDA will develop guidance on strategies to improve efficiency of clinical trials, including adaptive trial designs. The plan will also address regulation of new digital health technology. The first element of the Medical Innovation Development Plan is the Orphan Drug Modernization Plan, which aims to eliminate the backlog of orphan designation requests within 90 days of receipt. Currently, about 200 orphan drug designation requests are pending with the FDA. Please check ASCO in Action for updates on cancer policy and regulations.
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- CMS
released its proposed FY 2018 Payment Rules, Proposing Significant Cuts to 340B Hospitals and New Outpatient Facilities. The Centers for Medicare & Medicaid Services (CMS) released the proposedCY 2018 Outpatient Prospective Payment System (OPPS) and Physician Fee Schedule (PFS)payment rules, which contain significant provisions that would reduce payments to hospitals participating in the 340B Drug Pricing Program and to new off-campus provider-based facilities billing under OPPS. CMS is proposing to cut reimbursement from ASP+6% to ASP minus 22.5% and establish a modifier for hospitals to report drugs that were not acquired under the 340B Program. The agency is also proposing to cut reimbursement in half - from 50% to 25% of OPPS rates - for off-campus provider-based departments that began billing under the OPPS on or after November 2, 2015. CMS does estimate that, except for the 340B provisions, hospital OPPS payments will increase by 2% next year. Physician payment rates will increase by 0.31% in 2018 compared to this year, including an estimated 1% increase for radiation oncology. While these are only proposed rules, the cancer community is very concerned about the impact these policies will have on cancer programs and practices treating a high number of Medicare patients without secondary insurance, particularly for small and rural cancer programs and in vulnerable communities without other sources of healthcare. You are encouraged to submit comments to CMS by September 11, 2017, at www.regulations.gov.
- CMS recently sent letters in the mail notifying clinicians of their MIPS participation status. A sample of the letter can be found on the Education page of
https://qpp.cms.gov/. This tool is another resource for clinicians to use to determine their status. Eligible Professionals (EP's) who demonstrated meaningful use successfully in a prior year for the Medicare EHR Incentive Program can determine their participation status in the Quality Payment Program for 2017 through a look up tool (click here to check your participation status) on the Quality Payment Program website. Information will then be provided on whether or not you should participate in the Merit-based Incentive Payment System (MIPS) this year and where to find resources.
New to the Quality Payment Program?
EPs participating in the Medicare EHR Incentive Program for the first time in 2017 must take one of the following actions by October 1, 2017 to avoid the 2018 payment adjustment:
1) Attest to the Modified Stage 2 2017 EHR Incentive Program requirements; OR
2) Submit a onetime hardship exception application if they are transitioning to the MIPS path of the Quality Payment Program and plan to report on measures specified for the Advancing Care Information performance category.
Click Here to access the onetime hardship exception application.
- The Medicare trust fund will be insolvent by 2029, the program's trustees reported last week. The prediction is a year later than the 2028 date the Obama administration outlined in last year's report. Based on the new findings, the Independent Payment Advisory Board, which was designated by the Affordable Care Act to rein in Medicare costs if they grew faster than a set rate, will not be activated. That's likely good news as the IPAB has never had to be formed. Trustees are worried doctors will exit the program anyway. The report contained new concerns about access to physicians in the coming years due to the Medicare Access and CHIP Reauthorization Act. MACRA replaced the physician payment updates under the sustainable growth rate formula, which clinicians were paid under for years. Under MACRA the annual physician payment update for 2017 through 2019 will be 0.5%. For 2020 through 2025, there will be no payment update, which alarmed the trustees. Medicare Part D expenditures per enrollee are estimated to increase by an average of 6.4% annually over the next five years; that's higher than the projected average annual rate of growth for the U.S. economy, which is 5.2 % during that period. The report found that these costs are trending higher than previously predicted, particularly for specialty drugs.
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Affiliate Association News
- Attention PHYSICIANS, NP's, PA's, ADMINISTRATORS, CARE MANAGERS and NURSE NAVIGATORS! You are invited to participate in the Oncology Patient Engagement Trend Report. You are being held accountable for costs of patient care.Yet there is a gap between your perception of care and your patients'. By participating in this report, you can close that gap. How do you: Improve the quality of the patient experience? Engage patients in a way that saves on total costs of care? Avoid downstream gaps? Leverage payer contracts with this information? This Report will inform your practice and stimulate the discussions that we all need. Your assistance, and the assistance of your care team, is greatly needed.
A completed survey from each of these perspectives, from your practice, will be of great value. This Report is part of the solution. You can be part of the solution. You are strongly encouraged to participate in the Oncology Patient Engagement Trend Report survey. Each respondent will receive an honorarium and the final report free. The Report will be an important resource and a catalyst for improvements across the country in patient engagement. Care providers, payers and employers across the country will use the report's results as a benchmark and platform for increased patient engagement activities and utilization of patient engagement resources in their own markets. Participating in the oncology trend survey at www.oncologytrendsurvey.com will help you,
other oncologists and oncology practice managers manage their practice more wisely. If you have any questions, please do not hesitate to call or email Dawn Holcombe at 860-305-4510 or
dawnho@aol.com
. Thank you.
- Learn how cutting-edge scientific data can be translated into new strategies for diagnosis and treatment, and find out what to do in cases where there are no data, at the ASH Meeting on Hematologic Malignancies, September 8 - 9, 2017, Chicago, IL. Participate in panel discussions on each of the core malignancies, including leukemia, lymphoma, myelodysplastic syndromes, myeloma, and myeloproliferative neoplasms. Engage in stimulating conversations on specific disease topics with the meeting's expert presenters during lunch on both Friday and Saturday. This is a unique opportunity to get additional treatment insights and answers to your most challenging patient care questions.
Schedule & Program
Register NOW
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NCCN has published the following
NEW
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) with NCCN Evidence Blocks™
for
Hodgkin Lymphoma, Version 1.2017;
and
Chemotherapy Order Templates (NCCN Templates®)
for Melanoma,
MEL20 - Pembrolizumab dosing. For the complete updated versions of the
NCCN Guidelines, et.al., please visit NCCN.org.
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- Seattle Genetics is hosting an educational program on July 19 entitled Adcetris: Overview of Indications and Clinical Data with Mehrdad Abedi, M.D., University of California, Davis. The program takes place at 6:30PM at Ruth's Chris in Walnut Creek. RSVP to Krista Saumure at (916) 402-6846 or
ksaumure@seagen.com
.
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MOASC CALENDAR
Spotlight on ASCO
July 29, 2017
Professional Educational Series
November 8-9
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(ANCO Member Discount Code IBW17ANCO, San Diego, July 14-15)
(ANCO Member Discount Code ILC17ANCO,
Huntington Beach, July 27-29)
3Q2017 Hematologic Malignancies Update
(Palo Alto, September 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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