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
.
August 28,
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This Weekly's Hot Topics
- Send letter to Gov. Brown to protect patients on oral chemotherapy(California News)
- ICER report on non-mets castration-resistant prostate cancer(National News)
- Submit your comments on ASCO's Clinical Practice Guidelines(Affiliate Association News)
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California News
- As AB 1860 (Limon): Health care coverage: cancer treatment bill sits on Governor Brown's desk, you are encouraged to make multiple copies and share this letter with your patients who are on oral chemotherapy and ask that they send the letter to Governor Brown for his signature. This bill ensures that patients continue to have access to affordable anti-cancer oral medications.
- The link below is a Floor Alert for AB315 (Wood), a bill related to increased transparency for pharmacy benefit managers. This is a bill that the California Cancer PAC supported last year, but got pulled by the author at the end of session. Dr. Wood has amended the bill and is now moving it forward. It will be heard on the Floor of the Assembly any time this week. While it is not full transparency for PMBs, it does begin the process of bringing more information to light, by requiring PMBs to register with the state and disclose some information to health plans. The bill also requires PBMs and Health Plans to ensure pharmacies charge patients the lesser of the actual cost of the medication and the health plan cost-sharing amount. (If the medication is actually $5 dollars and the stated co-payment is $50, the pharmacy can only collect $5 from the patient.) The bill also requires DMHC to create a task force to look more into PBMS and report to the legislature on what kind of data they should be forced to disclose. The California Cancer PAC continues to support this bill. AB315 PBM's Support Floor Alert
- On October 2nd, the California Department of Justice (CDoJ) will begin enforcing mandatory use of the Controlled Substance Utilization and Review System (CURES) Database. In general, mandatory use will require prescribers to consult with CURES the first time that a patient is prescribed a controlled substance. For more information on mandatory use, see
this publication
from the California Medical Board.
- Overall, Californians are beating cancer for longer due to earlier detection and better treatment of the disease, a new study reveals.
Better detection and treatment are helping
Californians live longer
with cancer - highlighting the importance of cancer-screening procedures such as colonoscopies and mammograms. Survival rates are on the rise for nearly two dozen different types of cancer, according to a new report by the
University of California-Davis
. The cancers with the most gains in survival include kidney, liver and some forms of leukemia. There wasn't improvement, however, in cancers of the cervix, bladder or uterus.
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- Noridian/JEMAC has the following updates on their website
- MLN Connects Provider eNews:
Announcements
: New Medicare Card Mailing Update-Wave 5 Begins, Wave 3 Ends; New Medicare Card: 0 not O; 2016 PQRS and 2018 Value Modifier Experience Reports; 2019 MIPS Performance Year Virtual Groups Toolkit
Publications
: ICD-10 and Other Coding Revisions to NCDs MLN Matters Article-New
* EDI Dial-Up Model Support Ending October 1, 2018: Check out Available Connectivity Vendors
* CERT Late/Additional Documentation Deadline-August 30, 2018
* CERT Contractor New Provider Mailing Address Process-Effective August 14, 2018
* In Vitro Chemo-sensitivity & Chemo-resistance Assays Final LCD-Effective October 1, 2018
- Upcoming Noridian/JEMAC webinars include:
* Appeals II-Appealing a Decision Webinar (August 29)
* Appeals III-Appeal Decisions Webinar (August 30)
* Recovery Audit (RAC) Program Webinar (September 19)
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- SAVE THE DATE! Don't miss MOASC's Educational Series Program Thursday, September 20, 8:00am to 12:30pm at the Waterfront Beach Resort, Huntington Beach. For practice administrators & managers, topics include: utility and value of COA Analyzer Tool, Pharmacy Standards Update and Value Based Care and bundled payment negotiation. Billers' topics will address: Navigating Denials; Billing Updates; Telemedicine in Oncology, Care Management reimbursement opportunities; proposed changes for 2019 Medicare physician fee schedule and much more. Contact
moasc@moasc.org
for meeting information.
- The MOASC Office receives questions from members that we believe are worth sharing: 1) Take-backs from Medi-Cal Managed Care plans on Medi/Medi patients:
- Licensed Knox-Keene plans and insurers are precluded from pursuing overpayments more than 365 days after the original payment, unless the overpayment was caused in whole or in part by provider fraud or misrepresentation. (28 C.C.R. §1300.71(b)(5); Insurance Code §10133.66(b).) See the CMA ON-CALL document, below, for statute of limitations starting at page 6. There are a number of exclusions based on the specific contract held by the practice with the healthplan. On-Call 7512 Plan Request for Refund
2)
Differentiating between coverage under Anthem's AIM Pathway versus Anthem Formulary. If there is a product that is on the AIM pathway and not on the Anthem formulary, will the product be denied or approved by Anthem?
Anthem's response:
Anthem's Cancer Care Quality Program, which includes Oncology treatment pathways, is a voluntary program. The pathways focus
on the triple goals:
Quality - promoting evidence based patient-centric care
Delivery - appropriately aligning financial reimbursements to enhance care coordination
Affordability - safeguarding the affordability of healthcare
Pathways are not linked or related to drug formularies.
They are not related to Anthem's drug formulary. Claims will adjudicate according to the member's benefits.
- MOASC's "Spotlight On Oncology," presented by UCI, was held on Saturday, August 11, 2018, at the Waterfront Beach Resort in Huntington Beach. If you were unable to attend, you can view the entire program here: Spotlight On Oncology 2018. Topics presented were from 2018 ASCO Annual Conference covering: Breast Cancer, Genitourinary Cancer Updates,
Melanoma Updates, GI Colorectal Malignancies, GI Non-Colorectal Malignancies, Targeted Agents in Non-Small Cell Lung Cancer and Precision Medicine in Oncology.
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Return your completed survey no later than September 30!
MOASC and ANCO are jointly conducting a 2018 Staff Salary Survey. The survey was USPS mailed, e-mailed/FAXed to all MOASC members in mid-May and is available online at
www.anco-online.org/salsrvy.html
. A $50 Visa gift card for respondents is included in this year's survey. Results will be analyzed and reported in 4Q2018.
- MOASC has submitted their comments to CMS on Medicare Program: Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements Rulemaking. Once CMS has reviewed it. You may view MOASC's comment at www.Regulations.gov, document ID: CMS-2018-0076-0621, this process is dependent on CMS public submission policies/procedures and processing times. Use MOASC tracking number: 1k2-9517-uk59 to find out the status of MOASC'S comment.
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- The Conquer Cancer Foundation is now accepting applications for the 2019 Young Investigator Award (YIA), including the YIA dedicated to a northern California Fellow. Learn more about the YIA at https://www.conquer.org/young-investigator-award and submit your application no later than September 25. In addition, ASCO is accepting applications for Career Development Awards (CDAs) that provide research funding to clinical investigators who have received their initial faculty appointment as they work to establish an independent clinical cancer research program. Applications for CDAs are also due by September 25 at www.conquer.org/career-development-award.
- ANCO and MOASC are jointly conducting a 2018 staff salary survey. The survey will be USPS mailed, e-mailed/FAXed to all ANCO members in mid-May and is available online at www.anco-online.org/salsrvy.html. A $50 Visa gift card for respondents is included in this year's survey. Return your completed survey no later than September 30; results will be analyzed and reported in 4Q2018.
- ANCO is organizing a series of Hematologic Malignancies Updates in 2018. These updates are supported by AMGEN, Janssen Oncology, Jazz Pharmaceuticals, Novartis Oncology, and Seattle Genetics. Download the presentations www.anco-online.org/education.html. The next
Update
takes place on September 15 in Palo Alto; download the meeting announcement/registration form at www.anco-online.org/3Q2018HemeMaligUpdate.pdf
- ANCO'S 2018 Professional Education Meeting will take place on September 19 at The Claremont Resort in Oakland. The agenda will focus on the oncology care model. Download the meeting announcement/registration form at www.anco-online.org/2018ProfEducMeeting.pdf.
- ANCO members may take advantage of complimentary registration at the Best of World Conference on Lung Cancer organized by the International Association for the Study of Lung Cancer and taking place in San Francisco on November 17. Register for an "Early Bird ANCO Member" ticket at https://bestofwclc2018.eventbrite.com.
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National News
- The Institute for Clinical and Economic Review (ICER) has released an evidence report assessing the comparative clinical effectiveness and value of anti-androgen therapies for the treatment of non-metastatic castration-resistant prostate cancer. The report focuses on three anti androgen therapies--Zytiga (Janssen Oncology), Xtandi (Astellas Oncology), and Erleada (Janssen Oncology). Read the report at https://icer-review.org/material/prostate-cancer-evidence-report/
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CMS News
- Johnson & Johnson has put together the following for your review:
Of note:
QPP & Non-QPP
comments are due by September 10, 2018
Hospital Outpatient (OPPS)
comments are due by September 24, 2018
CMS Targeted Review
Requests are due by October 1, 2018
- The Centers for Medicare & Medicaid Services (CMS) released an evaluation report for the first performance year of the Innovation Center's Next Generation Accountable Care Organization (ACO) Model showing promising early results. Results demonstrated the positive outcomes in terms of quality and costs when providers are responsible for managing to a budget. For the 2016 performance year, the Next Generation ACO Model generated net savings to Medicare of approximately $62 million while maintaining quality of care for beneficiaries. As part of CMS's recent "Pathways to Success" proposal, CMS proposed taking many principles from the Next Generation ACO Model and adopting them more broadly for ACOs in the Medicare Shared Savings Program. To view the Next Generation ACO Model's first evaluation report, please visit: https://innovation.cms.gov/Files/reports/nextgenaco-firstannrpt.pdf
- CMS developed and published the 2019 performance period electronic clinical quality measure (eCQM) flows for eligible clinicians and eligible professionals (EPs) to the eCQI Resource Center. The eCQM flows are designed to assist in interpretation of the eCQM logic and calculation methodology for performance rates. eCQM flows provide an overview of each of the population criteria components and associated data elements that lead to the inclusion or exclusions into the eCQM's quality action (numerator). Some of the eCQM flows supplement, eCQM specifications for eligible clinicians and EPs are for:
Quality Payment Program
: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs)
; and
The Promoting Interoperability Program
These flows are intended to be used as an additional resource when implementing eCQMs and should not be used in place of the eCQM specification or for reporting purposes.
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Affiliate Association News
- THIS
FRIDAY! August 31 is the last day to participate in the 2018 ASCO Practice Census. This annual survey of the U.S. oncology practice community captures key information on today's practice environment and is chronicled in ASCO's State of Cancer Care in America initiative. Complete the survey at
https://redcap.asco.org/surveys/?s=7HFF8TYKYC
- NCCN has published the following updates at www.nccn.org: acute lymphoblastic leukemia (V1.2018), cervical cancer (V1.2019), chronic lymphocytic leukemia/small lymphocytic lymphoma (V1.2019), gestational trophoblastic neoplasia (V1.2019), occult primary (V1.2019), prostate cancer (V4.2018).
NCCN Radiation Therapy Compendium™ to reflect recommendations within the following NCCN Guidelines:
Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma version 1.2019
Multiple Myeloma version 1.2019
Occult Primary version 1.2019
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- Merck informs ANCO and MOASC that the United States Food and Drug Administration has approved Keytruda in combination with pemetrexed and platinum as first-line treatment of patients with metastatic, non-squamous non-small cell lung cancer (NSqNSCLC), with no EGFR or ALK genome aberrations.
- In response to California's wildfires, Pfizer Oncology informs ANCO and MOASC that it has implemented emergency relief protocols to ensure that patients have continued access to their Pfizer medicines. If a medicine provided through a Pfizer patient assistance program has been destroyed or lost, or patients who are enrolled are unable to reach their doctors' offices and need their medicine shipped to an alternate location, Pfizer can arrange for early refills and/or new shipping addresses. If new patients urgently need a Pfizer medicine but have been displaced and are unable to access income documentation and other paperwork needed for enrollment into the program, Pfizer is able to waive these requirements so that patients can receive their medication as quickly as possible. Facilities that participate in Pfizer's Institutional Patient Assistance Program can request early replenishment of the Pfizer medicines covered or request additional inventory to meet increased demand. For help with Pfizer's oncology medicines, call Pfizer Oncology Together directly at (877) 744-5675, Monday through Friday, 5am-5pm Pacific. For help with other Pfizer medicines, call Pfizer RxPathways at (844) 989-PATH (7284), Monday through Friday, 6am-3pm Pacific.
CORRECTION:
- Stemline Therapeutics announces that the FDA has accepted ELZONRISTM, for the treatment of patients with blastic plasmacytoid dendritic cell neoplasm (BPDCN), a biologics license application (BLA), grants Priority Review for the BLA and has set a target action date of February 21, 2019, under the Prescription Drug User Fee Act. For more information please contact Mark Perdue Mperdue@stemline.com.
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MOASC CALENDAR
LunchTime Series
August 22, 2018
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SAVE THE DATE
19th Multidisciplinary Management of Cancers: A Case-based Approach
(Napa, March 15-17)
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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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