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.
April 3, 2018
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- Monday, April 9, deadline for nominations for CMA delegates (California News)
- ICER releases Final Evidence Report on CAR-T therapies (National News)
- Thursday, April 5, CMS call for New Medicare Card Project (CMS News)
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California News
- Nominations for CMA member physicians interested in serving as delegates or alternates must be submitted via email no later than Monday, April 9, 2018 11:59 p.m. PDT. The California Medical Association (CMA) is seeking applications and nominations for physicians interested in serving as delegates or alternates for their mode-of-practice-forum-delegation to the CMA House of Delegates. CMA's mode of practice forums include the Solo and Small-Group Practice Forum, the Medium Group Practice Forum, the Large Group Practice Forum, the Very Large Group Practice Forum, the Academic Practice Forum, the Administrative Medicine Forum, the Government-Employed Physicians Forum and the Hospital-Based Physicians Forum. Membership in these forums is determined by each member's self-selected mode of practice. Delegates and alternates will be responsible for representing their modes of practice and overall constituency, not just their own personal views on issues, by attending and actively participating in delegation caucus meetings and in annual House of Delegates. Please submit nominations to nominations@cmanet.org. See the Nominations Solicitation Memo for nomination forms and other requirements.
The CMA Committee of Nominations will meet in early May to review applications and create a slate of nominees. A ballot will be distributed no later than May 7, 2018, to all eligible members of a given mode of practice forum. Election results will be announced no later than June 15, 2018. Contact: Navdeep Dhaliwal, (916) 551-2073 or ndhaliwal@cmanet.org, for more information.
- The Leukemia & Lymphoma Society is expanding assistance to Southern California patients to twice per year. This is an update to their Susan Lang Pay-It-Forward Travel Assistance Program. This program is available to blood cancer patients with financial need who may qualify to receive financial assistance for approved expenses which include: ground transportation (gas, tolls, car rental, taxi, bus, train, ambulance services, etc.), air travel, and lodging related expenses. Effective March 1, 2018, the award coverage period for the Central and Southern California Travel Fund will change from 12 months to 6 months, allowing patients to potentially receive assistance twice in a 12 month period. Patients who applied before March 1, 2018 must meet the following requirements before they may reapply on or after March 1, 2018 for additional assistance (assistance is dependent on funding availability).
Patients must have received assistance for more than 6 months since their approval date AND used their entire award. To reapply or to check on the status of your award coverage period and card balance please call 1-844-565-2269. The Central and Southern California travel fund is supported by Stater Bros. Charities for use limited to the Central and Southern California chapters. Click herefor a list of zip codes in Central and Southern California.
- Despite a California law passed in 2000 to address widespread payment abuses by health care service plans, many payors continue to flout the law. A recent survey by the California Medical Association (CMA) confirms that health plans regularly engage in unfair payment practices, with two-thirds of physician practices reporting routine payment abuses in violation of state law. Read More
- Yesterday, UC Berkeley researchers released a report showing that inpatient hospital procedures cost 70 percent more in Northern California than in Southern California, in part because of consolidation in the region's health industry.
- Scientists haven't rendered a verdict on whether coffee is good or bad for you but a California judge has. He says coffee sellers in the Golden State should have to post cancer warnings. The culprit is a chemical produced in the bean roasting process that is a known carcinogen and has been at the heart of an eight-year legal struggle between a tiny nonprofit group and Big Coffee.(Associated Press) The science doesn't really back up the ruling on California's law to require a cancer label on coffee. While rodents fed massive amounts of acrylamide do develop cancer, the ones in the study were dosed at rates 1,000 to 10,000 times higher than what humans consume in food.
- City of Hope is planning to build a $200 million cancer center, which would anchor a future medical campus south of the Orange County Great Park in Irvine. The new outpatient center, equipped with "leading-edge technologies and dedicated oncology specialists," would open on land donated by FivePoint, which is overseeing the development of about 10,000 homes around the Great Park, according to a press release announcing
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- Noridian/JEMAC has posted more updates to its website:
* MLN Connects Provider eNews--
Announcements--MIPS Data Submission Deadline: March 31; Open Payments Review and Dispute Period: April 1 through May 15; MACRA Patient Relationship Categories and Codes;
Publications--
Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget At of 2018 MLN Matters Article-New; Low Volume Appeals Settlement Call: Audio Recording and Transcript-New; E/M Services Listening Session: Audio Recording and Transcript-New
* NMP Advantages Over the IVR
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Webinar Event Materials Downloadable-Effective April 1, 2018
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There is Still Time to Evaluate Our Services!
* JW Modifier Billing Guidelines-R1
* MolDX: HBB Gene Tests Billing and Coding Guidelines-R2
* MolDX: SLCO1B1 Genotype Billing and Coding Guidelines-R2
* Chemotherapy Administration-R12 and R13
* Patients Supplied Donated or Free-of-Charge Drug-R1
* MolDX: Approved Gene Testing Article Retirement-November 7, 2017
* Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 CR10531
- Upcoming Noridian/JEMAC webinars include:
* Modifier 59, NCCI and MUE Webinar (April 4)
* Preventive Services and Screenings (April 18)
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- MOASC Member, UC Irvine, presents their 3rd Annual UCI Hematology Symposium on Saturday, April 21, 2018. The program will feature regional and national experts bringing you state-of-the-art updates on sickle cell disease, modern anticoagulants, CAR-T Cell therapy, and others. New this year, we will feature a Case Conference segment with individual case presentations and interactive discussions. We hope to see you at the 3rd Annual UCI Health Hematology Symposium.
  
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- ANCO is organizing a series of Hematologic Malignancies Updates in 2018. The first Update takes place on April 14 at the Sacramento Hyatt Regency with Joseph Tuscano, M.D., University of California, Davis, Jeffrey Wolf, M.D., University of California, San Francisco, and Naseem Esteghamat, M.D., University of California, Davis. The latest research on novel treatment modalities for hematologic malignancies--lymphomas and myeloma--along with case studies for these diagnoses will be presented. These updates are supported by AMGEN, Janssen Oncology, Jazz Pharmaceuticals, Novartis Oncology, and Seattle Genetics. Download the meeting announcement and registration form at www.anco-online.org/2Q2018HemeMaligUpdate.pdf.
- The 18th Multidisciplinary Management of Cancers: A Case-based Approach returned to the Silverado Resort and Spa in Napa on March 16-18, 2018. The meeting was sponsored by the Association of Northern California Oncologists, Stanford Cancer Institute, UC Davis Comprehensive Cancer Center, and UCSF Helen Diller Family Comprehensive Cancer Center. Go to www.multicancers.org to download the tumor board cases and presentations.
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- The Institute for Clinical and Economic Review (ICER) has released a Final Evidence Report on CAR-T therapies for treatment of B-cell cancers. ICER's policy recommendations highlight that even though the pricing of current CAR-T therapies align with patient benefit there will be changes needed in future pricing, payment, and delivery mechanisms to ensure patient access without threatening health system affordability. Read ICER's report at https://icer-review.org/material/car-t-final-report/.
- A timeline for revisions to USP797 will be released on July 27 for public comment through November 30. USP intends to align the timing and content of USP797 and USP800 to provide a unified approach to quality compounding. ASCO will review and comment on the new draft of USP797 when it is released.
- Unum Therapeutics is the latest biotechnology company to take the plunge into the public markets, raising $69.2 million that it plans to use to fund more clinical tests of its experimental cancer treatments.
The Cambridge, Mass., company priced its initial public stock offering of 5.77 million shares at $12 each, which was on the low end of the $12 to $14 per share range it had previously set. (Xconomy).
- There is another delay, by the Administration, of a regulation that would penalize drugmakers for overcharging for drugs in the 340B drug discount program. HHS's Health Resources and Services Administration has sought to change the definition of "knowingly and intentionally" violating the 340B
ceiling price, but a formal request to delay the regulation appeared on the website of the White House's regulatory review office. The 340B program forces drug companies to offer steep discounts on outpatient drugs to hospitals and clinics that serve low-income communities. The drug industry has criticized the use of those discounts, prompting inquires by Congress. CMS cut what it pays for certain 340B drugs starting this year, putting payment more in line with acquisition costs.
- Together with Integrated Oncology Network Holdings LLC (ION), which acquired SightLine in 2011, SightLine has agreed to pay the government up to $11.5 million. The settlement announced March 29, 2018 resolves allegations that SightLine violated the Anti-Kickback Statute and the False Claims Act by targeting physicians that were able to refer patients to its cancer treatment centers, and paid those physicians a share of its profits from referrals. It is alleged that SightLine formed a series of leasing companies in which referring physicians were permitted to invest, and through which SightLine allegedly distributed the profits that its physician-investors generated by referring cancer patients for radiation therapy.
Click Here for more information about this case.
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CMS News
- Current Medicare beneficiaries will get their new Medicare Cards on a rolling basis over the coming months. CMS will continue to accept the Health Insurance Claim Number (HICN)
through the transition period. CMS' Special Open Door Forum: New Medicare Card Project, is Thursday, April 5, 2018. 9:30 a.m. to 10:30 a.m. PST. This call is to provide information on the New Medicare Card Project prior to the mailing of the new cards starting April 2018. For more information about the New Medicare Project, please visit: www.cms.gov/newcard. Feedback and questions on the New Medicare Card Project can be sent to: Partnership@cms.hhs.gov.
Special Open Door Participation Instructions:
Participant Dial-In Number: 1-800-837-1935.
Please dial in at least 15 minutes prior to the start of the call.
Conference ID #: 7065199
ENCORE Presentation:
1-855-859-2056; Conference ID: 7065199
Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID beginning 2 hours after the call has ended. The recording expires on 04/09/2018 at 20:59 Pacific Time.
- Today, the Centers for Medicare & Medicaid Services (CMS) finalized polices for Medicare health and drug plans for 2019 that will lower out-of-pocket drug prices, save Medicare beneficiaries money on prescription drugs while offering additional plan choices. CMS is finalizing a reduction in the maximum amount that low-income beneficiaries pay for certain innovative medicines known as "biosimilars." Other actions that CMS is finalizing to lower the cost of prescription drugs include:
*Allowing for certain low-cost generic drugs to be substituted onto plan formularies at any point during the year, so beneficiaries immediately benefit and have lower cost sharing.
*Increasing competition among plans by removing the requirement that certain Part D plans have to "meaningfully differ" from each other, making more plan options available.
*Increasing competition among pharmacies by clarifying the "any willing provider" requirement, to increase the number of pharmacy options that beneficiaries have
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In Medicare, a rule implemented for 2018 will help beneficiaries save on coinsurance on Part B drugs administered at hospitals that participate in the 340B program by reducing the amount Medicare pays for those drugs. Due to CMS's policy change last year, Medicare beneficiaries are currently benefiting from the discounts that 340B hospitals receive. CMS is also providing new information to help hospitals implement this change, including how this change applies for Medicare Advantage plans.
As part of the announcement and guidance, the agency is reinterpreting the standards for health-related supplemental benefits in the Medicare Advantage program to include additional services that increase health and improve quality of life, including coverage of non-skilled in-home supports and other assistive devices. CMS is expanding the definition of "primarily health related." Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.
The final policies also advance the "Patients Over Paperwork" initiative - an effort aimed at removing regulatory obstacles and empowering patients to make informed healthcare decisions; developing innovative approaches to improving quality, accessibility, and affordability; and improving beneficiaries' customer experience. Specifically, the final policies will:
Authorize CMS to permit plans to use notice of electronic posting (and provision of copies upon request) to satisfy disclosure requirements for certain bulky documents to Medicare beneficiaries.
Improve transparency of the Star Ratings that give beneficiaries information about each Medicare Advantage and Part D plan's quality rating. The changes put patients first by increasing the weight given to patient experience and access measures.
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Affiliate Association News
- The last day to order NCSD merchandise is TOMORROW, Wednesday, April 4. Get yours before time runs out!
National Cancer Survivors Day®, the day set aside to recognize all those who are living with a history of cancer, is Sunday, June 3. And we know you're already planning an incredible Celebration of Life for the cancer survivors in your community. Don't you want to give them something to remember it by? NCSD Merchandise Catalog
- The 2018 Community Oncology Conference-Keeping Patients at the Center, is scheduled for April 12 -13, 2018 at the Gaylord National Harbor Hotel. The four tracks of the 2018 Community Oncology Conference really make this four meetings in one. They cover the breadth and depth of what we do every day in community oncology: Clinical; Business, Advocacy and Pharmacy. Check out the full Conference schedule to see all the great speakers and sessions: conference.communityoncology.org/2018-conference-agenda/. The discounted Community Oncology Conference room block is selling out fast. Be sure to register and reserve your room today. Join more than 1,300 oncologists/hematologists, pharmacists, practice administrators, nurses, advocates, payers, and industry partners for two days of learning and networking. Visit www.COAConference.org for details.
- ASH and ASCO staff are currently working on developing a case study on an issue that might be brewing in YOUR PRACTICE or locale. MOASC & ANCO want to reach out to see if YOU have any suggestions or issues in your area that might make a good case study for the national organizations to work on. Some suggestions are to look at last year's policy change on infusion pumps and value-based care. Please send your suggestions to moasc@moasc.org .
- ASCO invites all members to submit comments on draft standards for Safe Handling of Hazardous Drugs between March 30 and April 13. The open comment process provides greater transparency in the standard development process and the opportunity for key stakeholders to provide feedback before the documents finalization and publication. To participate, visit www.asco.org/open-comment-guidelines.
-COA is currently working to help community oncology practices manage takeback demands affecting practices that treat veterans unable to receive timely cancer care within the United States Department of Veterans Affairs (VA) health care system. Beginning earlier this year, a number of practices reached out to COA regarding recoupment letters they received from a contractor hired to conduct an overpayment audit on both in-network and out-of-network VA providers.
Learn more about the issue on COA's website.
- ASCO Practice Consulting Services & Support offers personalized services to help your practice achieve operational goals. Their team of nationally recognized consultants in oncology practice management is dedicated to assisting practices succeed in today's constantly evolving practice environment. Services include readiness assessment (prepare practices for value-based care, new payment models, and success with satisfying new reporting requirements in the Quality Payment Program), practice operational assessment (a comprehensive practice review focused on process and staffing efficiency, and financial management), practice transformation implementation support (consulting services tailored to support the practice's specific needs and goals in the transformation from volume- to value-based care), analytical services (practical data analysis--financial, clinical, operational) to support business operations), triage pathways (prepare for effective implementation of trial pathways, a decision support tool to help patients with cancer get the right care at the right time in the right place). For more information and to contact them, visit ASCO Practice Central at http://practice.asco.org.
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The Presidential theme for the
2018 ASCO Annual Meeting,
June 1-5
in Chicago,
developed by Dr. Bruce Johnson, is Delivering Discoveries: Expanding the Reach of Precision Medicine.
Precision medicine is transforming cancer care in profound ways by driving the most exciting and powerful advances to improve how providers care for their patients. Register today to make lasting professional connections and participate in a unique global exchange of information about how to drive progress and expand the reach of precision medicine to all patients.
Join colleagues from around the world to share oncology research.Come early, May 31 & June 1, and expand your educational opportunities. ASCO has two types of educational programs that offer innovative learning opportunities prior to the official start of the Annual Meeting. Space for these sessions is limited, register today!
- NCCN has published updates to the below. For the complete updated versions, please visit NCCN.org. Recent updates include: acute lymphoblastic leukemia (V1.2018), NCCN Guidelines for Bone Cancer. These NCCN Guidelines are currently available as Version 2.2018.cancer-associated venous thromboembolic disease (V1.2018) chronic lymphocytic leukemia/small lymphocytic lymphoma (V5.2018), colorectal cancer screening (V1.2018), esophageal and esophagogastric junction cancers (V1.2018), gastric cancer (V1.2018), head and neck cancers (V1.2018), penile cancer (V2.2018), rectal cancer (V1.2018), Soft Tissue Sarcoma. These NCCN Guidelines are currently available as Version 2.2018uveal melanoma (V1.2018).
NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Central Nervous System Cancers (
Infiltrative Supratentorial Astrocytoma/Oligodendroglioma). These NCCN Guidelines® are currently available as Version 1.2018.
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- Foundation Medicine
informs ANCO and MOASC that FoundationOne Cdx (F1CDx) is now available and is the next evolution of Foundation One, with FDA approval, Medicare coverage, and comprehensive results to help inform treatment decisions.
Specifically, F1CDx:
* is the first FDA-approved companion diagnostic for solid tumors
* has national coverage for qualifying Medicare and Medicare Advantage patients across all solid tumors
* is clinically validated with proven concordance with multiple companion diagnostic tests based on analytical and clinical validation of over 6,300 samples
* provides a simplified report with all guideline-recommended genes and genomic signatures such as Microsatellite Instability (MSI) & Total Mutational Burden (TMB).
As of January 1, 2018, CMS established exceptions to the HOPPS Final Rule, also known as the "14 day rule" which establishes a new exception to CMS date of service (DOS) policy. The new DOS policy eliminates the 14 da rule for molecular pathology tests when the specimen is collected during a hospital outpatient visit. In these circumstances, the order date will no longer affect Foundation Medicine broad-based molecular profiling by the 14 day rule. Please note PD-L1 (immunohistochemistry/IHC) is not excluded from these changes, and Foundation Medicine is required to bill back the facility for cases ordered within 14 days from the outpatient or inpatient discharge. For more information on how to order, please contact your local representative or Trey Regalo at tregalo@foundationmedicine.com or visit www.foundationmedicine.com/f1cdx.
- Foundation Medicine will host an educational dinner meeting entitled Comprehensive Genomic Profiling: What is new and exciting in the world of genomics with Jeffrey Gregg, M.D., University of California, Davis, on April 25 at Long Meadow Ranch, St. Helena. RSVP to Krista Gallucci at kgallucci@foundationmedicine.com or (415) 830-0365.
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MOASC CALENDAR
LunchTime Series
April 25, 2018
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(San Francisco,
April 27-28)
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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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