NYSSMOH

Congress Passes Another Short Term Extention of the 2009 Medicare Physician Payment Rate to Restore 21 Percent Cut

2010-04-19T00:15:00.001-04:00

April 16, 2010 –
Last night President Obama signed the Continuing Extension Act of 2010 (H.R. 4851), into law, reinstating Medicare physician payments to where they were on March 31 and again postponing the 21.3 percent cut that was supposed to take effect in 2010. This most recent extension of 2009 payment rates will continue through the end of May, and will be applied retroactively to all physician services provided to Medicare patients in April. The legislation passed the Senate at about 5:45 pm by a bipartisan vote of 59-38, and subsequently passed the House of Representatives shortly after 8:00 pm by a bipartisan vote of 289-112.
The hold on processing April claims that the Centers for Medicare & Medicaid Services (CMS) had placed to avoid implementing the payment cut technically expired on April 15, but because Congressional action was so imminent, we do not believe many claims were actually processed at the lower payment rates. Any claims paid that reflected the 21.3 percent cut will be reprocessed automatically without any action required from physicians.
The Society thanks all members who took part in the recent Advocacy Campaign that successfully helped urge the Congress to restore physician payment rates.

Abraham Mittelman, MD
NYSSMOH, President

Petition to Stop Cancer Care Cuts

2010-01-15T09:34:00.002-05:00

Members are encourage to place copies of a petition aimed at asking our representatives in government to stop the continued cuts to Medicare at your front desk and in each physician’s exam room. More information can also be obtained by going to http://nyssmoh.us1.list-manage.com/track/click?u=c1baa62bcce8234f03f15b2e7&id=d6ff2b1ac2&e=38bb34b435

You can also complete the Petition on line at the following link:

http://nyssmoh.us1.list-manage.com/track/click?u=c1baa62bcce8234f03f15b2e7&id=14e8c8f4b9&e=38bb34b435

Please join us in signing a petition to ask our elected officials to stop the cancer care cuts. We have the best cancer care in the world, but it is now endangered by the continual government slashing of cancer care payments. Health care reform needs to address the cancer care crisis.

Joined others in signing a petition that will be sent to policymakers. Please follow the link below to read the Stop Cancer Care Cuts Petition at http://nyssmoh.us1.list-manage.com/track/click?u=c1baa62bcce8234f03f15b2e7&id=228fc9ebdd&e=38bb34b435 , and add your name to show your support for the future of cancer care in our country.

Thank You
Abraham Mittelman, MD
NYSSMOH, President

A Letter From Dr. Silver

2010-01-11T16:52:00.001-05:00

January 11, 2010

Dear Colleagues:

I'd like to tell you that the randomized, double blind placebo control study using a JAK2 inhibitor for the treatment primary myelofibrosis in myelofibrosis related to PV is now open at Cornell. We would be happy to evaluate your patients for this medication. Results were presented at ASH this year. The Incyte drug does represent a significant advance for the treatment of some patients with massive splenomegaly. Please contact any of our leukemia doctors at 212-746-2098.

Best regard for the New Year.
Sincerely,
Richard T. Silver, MD
Past President NYSSMOH

Erythropoiesis Stimulating Agents - Incorrect Denials

2009-12-08T21:26:00.001-05:00

Attention Members:
The NYSSMOH Board of Directors has contacted the Medical Director of National Government Services (Medicare) regarding the issue of incorrect denials for Erythropoiesis (see below) beginning November 2009. We have been advised that this issue will be corrected by Friday, December 11, 2009. We are also told that no action is needed by the provider and that Medicare will reprocess all claims that have denied incorrectly.

Please contact NYSSMOH Administrator Florence Madonia (845-986-3295 or fmbilling@yahoo.com ) if you continue to received denials after Friday, December 11th.

Thank you,
NYSSMOH Board of Directors

Attention Part B Medicare providers who bill Erythropoiesis Stimulating Agents to National Government Services:

National Government Services has identified an issue with edit 638A based on the Local Coverage Determination Erythropoiesis Stimulating Agents L25211. It has been identified that claims are denying inappropriately with reason codes 029 or 481, These are non-covered services because this is not deemed a 'medical necessity' by the payer.We are working to correct this issue, and expect it to be resolved by mid-December 2009. All claims that have been incorrectly denied will be adjusted by National Government Services. Providers do not need to take any action at this time.Thank you for visiting the National Government Services Web site!National Government Services encourages all Web site users to provide feedback regarding ways to improve our Web site. The ForeSee Results (pop-up) survey is an easy mechanism for providers to use to let us know how we can best serve you. Your comments play a large role in the enhancements that are made to the National Government Services Web site.National Government Services, Inc.Corporate Communications

Doctors On Healthcare Reform

2009-11-04T10:55:00.000-05:00

The following article was posted in the Wall Street Journal and includes quotes by NYSSMOH past president Seymour M. Cohen, MD

Doctors from across the country were invited to the White House on Oct. 5, but the president did most of the talking. Medical professionals are being ignored or vilified more often than consulted in the current health-care reform debate. To broaden the discussion, the Committee to Reduce Infection Deaths invited 16 highly regarded physicians to convene at the Grand Hyatt in New York City on Oct. 19 to reflect on the current legislative proposals. Here's what they had to say on four key issues.

OCTOBER 28, 2009, 7:34 P.M. EDoctors on Health-Care Reform 'Government is in the process of duplicating everything that managed care did for the last 15 years that was reviled by everybody.'By BETSY MCCAUGHEY

Government-Imposed Treatment GuidelinesDr. Jeffrey Borer, cardiologist, named to Castle Connolly's "America's Top Doctors": "What's the impact of guidelines on the doctor-patient relationship? Guidelines step in between the doctor and the patient. If it's necessary to respond to guidelines rather than what you see, feel and hear when you're evaluating a person, then perhaps you're going to do something that isn't really the right thing. There really isn't an average patient. Every person that you see with a medical problem has some unusual or unique characteristic and this often has to be considered in dealing with the problem."

Dr. David Fields, obstetrician and gynecologist, Lenox Hill Hospital, New York: "They tend to forbid better-than-average medical care; guidelines are always average medical care . . . they tend to cramp the physician who can do better than average."

Dr. Borer: "One of the more common problems that people have as they get older is a disease called aortic stenosis. . . . [W]e can relieve that aortic stenosis with an operation with really very acceptable safety, low mortality rates . . . if that 85-year-old cannot walk down the street because he or she is too breathless to do so . . . or feels light-headed or could faint and break a hip . . . then there is really a very good justification for offering the therapy."

Dr. Richard Amerling, nephrologist, Beth Israel Medical Center, New York: "The example that you give of valve surgery in an 85-year-old is just not going to happen under [White House health care adviser] Ezekiel Emanuel. He's going to just say that that's a nonstarter. That person has outlived their useful years, no matter how long they could live beyond that."

Dr. Borer: "What we're hearing from the president's medical advisers is that what we have is good enough and we really shouldn't be wanting or expecting any more."

Dr. Seymour Cohen, oncologist, named to "America's Top Doctors": "When we went to medical school, people used to die at 66, 67 and 68. Medicare paid for two or three years. Social Security paid for two or three years. We're the bad guys. We're responsible for keeping people alive to 85. So we're now going to try to change health care because people are living too long. It just doesn't make very good sense to me."

Shifting Resources From Specialty to Primary CareDr. Cohen: "Let's talk about specialization for a moment. . . . We don't go to our general attorney when we have a patent problem, but they're telling us to do this now in medicine. We have different types of engineers, even journalists. There's a financial writer, there's a sportswriter . . . . Now in health care we're telling everybody, 'you just go to the guy who's your general doc. He's going to know everything and maybe we'll find a specialist for you if the panel decides maybe you're sick enough to need a specialist.' It really doesn't make sense at all."

Dr. Jeffrey Moses, interventional cardiologist, named to "America's Top Doctors": "If you have heart failure or heart attack or coronaries in general in the hospital you need to be treated by a cardiologist. Study after study shows that . . . when you have an illness and you want to have an accurate diagnosis and the most up-to-date and accurate treatment, you want a specialist."
Patient PrivacyDr. Samuel Guillory, ophthalmologist, refractive and orbital surgery, named to Castle Connolly's "New York's Top Doctors": "We're being asked by the executive branch . . . to break the code with patients and deliver all their records into electronic medical records . . . ."
Cost-Cutting MethodsDr. Fields: "Government is in the process of duplicating everything that managed care did for the last 15 years that was reviled by everybody and which we fought very hard to overcome, The courts finally said 'You can't have withholds, you can't pay people to deny care. You can't have gag rules.' The government is in the process of doing all that. Massachusetts is about to establish capitation [a fixed payment remitted at regular intervals to a medical provider] as the rule of the state. Capitation was the wort thing that ever happened to medical care."

Dr. Joel Kassimir, dermatologist, Mt. Sinai Hospital, New York: "We're now being told by physicians advising the president that we take the Hippocratic Oath too seriously."
Dr. Tracy Pfeifer, plastic surgeon, president, New York Regional Society of Plastic Surgeons: "When physicians graduate from medical school we take an oath, the Hippocratic Oath, to do no harm to our patients. It's a very important philosophy to us and we uphold it and hold it very dear to our hearts. Plato, another philosopher, used to say things like 'Those with a poor physical constitution should be allowed to die. The weak and the ill-constituted shall perish.' These government programs that are being proposed I think are very scary in the sense that physicians could be induced to violate the Hippocratic Oath.

"There's a limit to how much of a financial penalty each individual practitioner is going to be able to bear. . . . If the patient is sitting in the examination room with us and they're wondering, 'Is the doctor not ordering a test for me because he's going to get penalized if he does it?' This is a major, major problem for patients and physicians alike."

Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former Lt. Governor of New York State. For a complete transcript of the physicians' meetings, visit www.defendyourhealthcare.us.

New Incyte Drug for Treatment

2009-10-30T08:26:00.000-04:00

I thought you would be interested to learn that we have the new Incyte drug for the treatment of patients with large spleens in primary myelofibrosis. This is a randomized trial between the drug and a placebo. You can refer patients to any of us including Gail Roboz, Eric Feldman, Ellen Ritchie, Usuma Georgis, or me. The contact number is (212) 746-2098.

Best regards,
Richard T. Silver, M.D.
Professor of MedicineWeill Cornell Medical College
Past President, NYSSMOH

"The War on Specialists" -Wall Street Journal

2009-10-09T18:40:00.002-04:00

In President Obama's Washington, medical specialists are slightly more popular than the H1N1 virus. Compared to bread-and-butter primary care doctors, specialists cost more to train and make more use of expensive procedures and technology—and therefore cost the government more money. Even so, the quiet war Democrats are waging on specialists is astonishing.
From Senate Finance Chairman Max Baucus's health-care bill to changes the Administration is pushing in Medicare, Democrats are systematically attacking specific medical fields like cardiology and oncology. With almost no scrutiny, they're trying to engineer a "cheaper" system so that government can afford to buy health care for all—even if the price is fewer and less innovative ways of extending and improving lives.

FOR THE FULL ARTICLE LINK BELOW
http://online.wsj.com/article_email/SB10001424052748704471504574443472658898710-lMyQjAxMDA5MDAwOTEwNDkyWj.html

Phase II study Evaluating Tamibarotene

2009-07-16T21:00:00.001-04:00

July 16, 2009

Dear Colleagues:

NorthShore University Hospital is participating in a Phase II study for adult patients with relapsed or refractory acute promyelocytic leukemia (APL) who have been previously treated with ATRA & Arsenic Trioxide. The trial is evaluating Tamibarotene, an orally administered synthetic retinoid. In vitro studies show that Tamibarotene does not substantially bind to CRABP, suggesting possible therapeutic efficacy in patients with ATRA-resistant APL.

If you have any patients that might benefit from this study or would like further information, please call my office at 516-734-8959.

Sincerely,

Steven L. Allen
Associate Chief, Division of Hematology
NorthShoreUniversityHospital
MonterCancerCenter

URGENT Immediate Action Needed!

2009-07-09T23:23:00.003-04:00

Urgent! Immediate Action Needed!

NYSSMOH strongly urges all members to complete the Community Oncology Alliance (COA) Components of Care Study.

CMS has released the 2010 Medicare Physician Fee Schedule. It contains the 21.5% cut to all physician-related payments. It eliminates consultation codes. And the real surprise is a 6% additional cut to medical oncology.
That’s correct — an additional cut of 6% to medical oncology.

The oncologists own (AMA) data was used by CMS to arrive at these cuts. Every practice should complete and return the Components of Care Survey so we have data to refute this. We need to send out the results of the Components of Care Survey to the Congress, Administration, and the press.

Additionally, this is not a final rule — we have a comment period. In short, we need accurate, realistic data or your practice is facing large cuts next year effective 1/1/10.
The link below will direct you to the COA website.

Components of Care Study

Again, NYSSMOH strongly urges all members to complete the Components of Care Survey and forward this email on to your colleagues.

Intravenous Vs Oral Drug Questions & Answers

2009-06-30T22:01:00.002-04:00

Disclaimer: The answers to these questions were prepared by National Government Services, to assist the provider community in understanding the coverage and reimbursement for oral and parenteral drugs. These responses reflect NGS’s understanding and implementation of CMS’ instructions, and may or may not reflect the interpretations of other contractors or agencies reviewing claims.

We have received many questions regarding CMS’ policy on the medical necessity and payment for intravenous (IV) preparations of drugs when an oral preparation of the same drug is available and in common use. The following Q&As may provide guidance for correct billing in situations when both preparations of a drug are available.

Q:If an oral anti-emetic drug fails to prevent intra- or post-treatment chemotherapy induced nausea and vomiting (CINV), would an intravenous anti-emetic drug administered at the time of the next treatment session be considered medically necessary?

A:If the oral anti-emetic drug was chosen appropriately and administered in an adequate dosage and failed, we would allow the intravenous form during subsequent treatments. Such claims may be subject to medical review.

Q:Would reimbursement be contingent upon the response to the intravenous anti-emetic medication as compared to the response to the previous oral anti-emetic therapy?

A:No, the reimbursement is not dependent on the result. However, future use of the intravenous medication would require at least a better response to the intravenous anti-emetic than was achieved with the oral formulation.

Q:Would subsequent intravenous treatments be covered based upon a poor initial response to the oral formulation and an improved subsequent response to the intravenous formulation? That is, does the provider need to re-establish that the oral anti-emetic is still ineffective after the initial failure and before each start of the intravenous drug?

A:The patient does not need to fail the oral form with each course of therapy. Subsequent IV courses would be covered.

Q:If a patient has a positive response to intravenous treatment after failure of the oral preparation, does that support medical necessity of the intravenous formulation for that patient only, or for all similar patients?

A:Medical necessity is supported only for the individual patient. Because the intravenous form was necessary in one patient, that does not provide clinical evidence that the IV form will be necessary in all such patients.

Q:If a patient has taken oral anti-emetics prior to presenting for treatment and still experiences pre-treatment nausea, would the provider be reimbursed for intravenous administration of additional anti-emetics at that time?

A:Yes, if the nausea prevented the administration of the additional dose in the oral form. The inability to take oral medication at the time of treatment is considered a medically necessary reason to administer intravenous preparations.

Q:If the IV form of an anti-emetic is medically necessary, would concomitant prophylactic Benadryl and Decadron also be covered if administered intravenously?

A:No, not necessarily. The parenteral administration of any particular drug in place of its oral formulation would not be covered unless it was medically necessary. If the patient were on intravenous anti-emetics without concomitant nausea and/or vomiting, and there was no other medically necessary indication for the use of parenteral Benadryl or Decadron, then the parenteral form of Benadryl and Decadron would not be covered.

Q:Can IV Benadryl be covered in the absence of nausea/vomiting?

A:The IV form can be covered only if the oral form was unable to be ingested or was medically contraindicated for some other reason, or if needed to treat an acute allergic reaction, or recommended in the FDA labeling for the chemotherapy drug, or the scientific medical literature for the administered chemotherapy drug documents that intravenous administration is preferred or required.

Q:Can IV Decadron be covered in the absence of nausea/vomiting?

A:The IV form can be covered only if the oral form was unable to be ingested or was medically contraindicated for some other reason, or if needed to treat an acute allergic reaction, or recommended in the FDA labeling for the chemotherapy drug, or the scientific medical literature for the administered chemotherapy drug documents that intravenous administration is preferred or required.

Q:Under which specific circumstances, other than inability to ingest or swallow oral medications (e.g., physical obstruction of the esophagus or active nausea or vomiting) at the time of, or prior to, chemotherapy treatment can anti-emetics, antihistamines, steroids, or other medications be covered when administered intravenously? Please identify the specific conditions that would be considered “medically necessary.”

A:It is impractical to list every possible medical reason that IV medication would be necessary. It is expected that the attending clinician would be able to determine whether the reason for IV administration is medically necessary rather than for convenience, patient preference, or for financial considerations.

Q: If a patient fails on an oral anti-emetic drug, can the provider be reimbursed if a patient is administered intravenous drugs or must another, different oral drug be tried?

A:The provider may be reimbursed for using the intravenous formulation of the same drug. However, if the provider wishes to use the intravenous formulation of a different drug, then the oral formulation of that different drug must be shown to be ineffective or contraindicated before the IV form is covered.

Q: Will scientific studies of chemotherapy regimens utilizing only intravenous formulations be sufficient to document the medical necessity for IV forms of chemotherapy drugs that exist in both oral and intravenous forms?

A:If studies of chemotherapy treatment regimens were performed using only IV forms of the chemotherapy drug, then the IV form would be covered, since the oral form had not been proven to be effective. However, if studies show that both oral and IV forms are effective, then the IV vs. oral rules would apply.

Q: If the patient develops CINV after administration of an oral anti-emetic (other than Emend), can they receive IV Emend at the next treatment without having first tried oral Emend?

A:No, oral Emend may be more effective in a particular instance than other oral anti-emetics, so the oral formulation of the Emend must be tried before using the intravenous formulation.

June 17th, 2009 Message from former President

2009-06-17T21:49:00.002-04:00

June 17, 2009Message from former President Richard T. Silver, MD

Dear Colleagues:
I wish to tell you of a very interesting opportunity for your patients that we are conducting at Cornell. Wyeth is sponsoring a drug trial comparing imatinib to their new drug bosutinib in untreated patients with chronic myeloid leukemia. Both drugs will be provided free. This may be of some importance for those patients who have a 10% or 20% deduction or a donor. Bosutinib has been thought to be equally or more effective than imatinib with less toxicity. It has already been used in imatinib-resistant patients with success. If you have such patients, please call 212-746-2098 for anyone in our group in the Leukemia/Myeloproliferative Disease section who are all well-qualified to see such patients.I send my best regards.

Sincerely,
Richard T. Silver, M.D.
Attending PhysicianProfessor of MedicineDirector, Leukemia and Myeloproliferative Center

Providers Beware - Recent Identity Theft Schemes

2009-06-17T20:15:00.004-04:00

Protect Your Identity!
If you have recently received a phone call or fax from an alleged contractor employee asking for a “CMS File Update,” please contact the provider enrollment department immediately for verification. If you have responded to an employment opportunity which, in retrospect seems suspicious, again contact the provider enrollment department so the information may be forwarded to the Program Safeguard contractor(PSC). Remember, it takes all of us working together to protect the Medicare Trust Fund.

Common Sense Tips!
1. Perform rigorous research regarding opportunities presented toyou when making application for joint venture opportunities of companies unknown to you.
2. Remove any unnecessary personal identifying information from outgoing correspondence.
3. Do not post your resume on line, especially if it contains any confidential personal identifying information.
4. Remember, no one from Medicare will contact you to verify your Medicare numbers. They already have this information.
5. Don’t leave laptops or other gateways into your personal information unattended.
6. Cancel computer access immediately when anyone leaves your employment.
7. Perform rigorous research regarding the company you intend to work for when applying for employment prior to sharing any personalinformation.
8. Check with your carrier to see what practice locations theyhave listed for you.
9. Contact the OIG Hotline if you suspect you are the victim ofprovider identity theft:

Phone:1-800-HHS-TIPS (1-800-447-8477)
Fax:1-800-223-8164TTY:1-800-377-4950
E-Mail:HHSTips@oig.hhs.gov
Mail:
Office of Inspector GeneralDepartment of Health and Human Services
Attn: HOTLINE
P.O. Box 23489
Washington, DC 20026

"Out Reach" Program 2008-09 We Want To Hear From You!

2009-04-19T21:47:00.022-04:00

We want to hear from the practicing Oncologist!

ASCO created the State Affiliate Grant Program in 2005 to provide financial support to its State/Regional Affiliates as they seek to enhance the scope of their activities.
NYSSMOH is a 2008-2009 Grant Recipient . Our project goal is to restructure NYSSMOH to meet the individual needs of our members, their patients, and address the impact of the current economic crisis relative to their geographic area. By evaluating data from your completed questionnaires and discussion at our focus group meetings NYSSMOH can develop, implement and promote a restructuring plan that will focus on providing members with meaningful support.

Our purpose for this grant will be to meet the needs of the practicing Oncologist in 2009. An "Out-Reach" project is being developed and will be promoted to focus on current and ongoing issues related to members specific geographical areas.

Our "Out-Reach program will begin by dividing our localities into three sections.

These sections will be
1. Bronx , Brooklyn, Manhattan
2. Queens, Long Island, Staten Island
3. Rockland County, & Westchester County

The "Out Reach" meetings will be held in September!..

....

Please make sure to check your emails & participate!!

Letter to CMS on March 1st Anti-Emetic Policy

2009-02-22T23:25:00.004-05:00

On February 22nd NYSSMOH along with UNYSMOH, HOMny and Connecticut Oncology Association sent a letter to CMS on behalf of all members to address the March 1st Anti-Emetic Policy

22 February 2009

Barry M. Straube, MD
Director and Chief Clinical Officer
Office of Clinical Standards and Quality
Centers for Medicare & Medicaid Services
Mail Stop S3-02-01
7500 Security Boulevard
Baltimore, MD 21244

Dear Doctor Straube:
We are writing on behalf of the Connecticut Oncology Association (CtOA), the Hematology Oncology Managers of New York (HOMny), the New York State Society Medical Oncologists & Hematologists (NYSSMOH) and the Upstate New York Society of Medical Oncology Hematology (UNYSMOH) to request that the Centers for Medicare & Medicaid Services and National Government Services (NGS), an A/B Medicare Administrative Contractor, reconsider and rescind the application of limitations on use of injectable medications when an oral equivalent is available in the oncology setting.
While we understand the intent of this policy, the complexity and logistics of cancer care make a blanket application of this policy both contrary to the interests of Medicare patients and to national Medicare policy. It also takes the treatment decision for the individual patient out of the hands of the attending Oncologist.

Background: On January 13, 2009, NGS posted the following announcement on its web site:

Use of Injectable Medications When an Oral Equivalent is Available National Government Services would like to remind providers that the use of injectable medications when an oral form of the same medication is available must meet medical necessity requirements for use of the drug, and for the route of administration. Documentation should indicate that the patient was unable to tolerate the oral preparation prior to initiation of the intravenous form of the medication. An example is a failed course of the oral anti-emetic before starting an intravenous form of the same anti-emetic. Instruction regarding this topic is from the Centers for Medicare & Medicaid Services (CMS) and is a national not a local determination.

References Noted by NGS and CMS: The Medicare Benefit Policy Manual, CMS Publication 100-2, Chapter 15, Section 50.2 & 50.5.4 National Government Services Local Coverage Determination Supplemental Instruction Article for Drugs and Biologicals, Coverage of, for Label and Off-Label Uses - Supplemental Instructions Article (A44930) As noted in the announcement, NGS takes the position that this policy – under which intravenous drugs, including anti-emetics will ordinarily not be covered by Medicare – is mandated by provisions of the Medicare Benefit Policy Manual that were issued in 2005. NGS cites section 50.5.4 of the Manual, but this section does not support its position. This provision relates to Part B coverage of oral antiemetics when they are a “full replacement” for intravenous antiemetics. It provides that, notwithstanding the “full replacement” requirement, Medicare will cover supplemental intravenous antiemetics if the oral antiemetics were ineffective. Section 50.2.A, K of the Manual, also cited by NGS, provides that the route of administration must be medically reasonable and necessary. It states further that “if a drug is available in both oral and injectable forms, the injectable form of the drug must be reasonable and necessary as to using the oral form.” We do not believe that this language was intended to deny coverage to injectable drugs whenever an oral version exists. Instead, we believe that his language is intended to reflect the policy stated in section 50.4.3: Medication given by injection (parenterally) is not covered if standard medical practice indicates that the administration of the medication by mouth (orally) is effective and is an accepted or preferred method of administration for that particular patient. In the case of antiemetics administered in conjunction with anticancer chemotherapy, the standard practice is to use IV antiemetics for moderately and highly emetogenic chemotherapy combinations, although oral antiemetics may sometimes be used instead. In fact, in Section 50.3 of Chapter 15 of the Claims Processing Manual states that the weight of whether or not any drug should be denied by Part B as self-administered is whether ≥ 50% of Medicare beneficiaries are receiving that Medication in a self-administered form. This is not the case with almost all antiemetics and cancer drugs where two forms are available.

Early and effective management of nausea and vomiting is critical to a successful course of treatment. Successful management of these side effects and symptoms caused by the toxic nature of individual and combination therapies has helped patients to tolerate more dose dense treatments and contributed to the decline of cancer death rates. Indeed, the cancer death rate has been steadily declining since the early 1990s. The American Cancer Society reported in February 2008 that death rates from all cancers combined peaked in 1990 for men and 1991 for women. Between1990/1991 and 2004, death rates from cancer decreased 18.4 percent for men and 10.5 percent for women. Coincidentally, during this same time, the treatment and management of cancer has evolved from the hospital setting (predominant before DRGs in 1984) into the physician office setting. By 2001, over 80% of all cancer was being treated in the community physician office setting; in addition the use of IV antiemetics allowed better compliance with the completion of chemotherapy prescribed.

Clarification Needed: The physician’s standard for care in these offices for management of nausea and vomiting is determined not only by whether IV or oral forms of the medications exist, but also is based upon the individual patient’s tolerance for the treatment and management of the side effects, as well as the interactions and composition of all the drugs involved in the treatment. Frequently, failure in management of nausea and vomiting can affect the patient’s health status and state of mind, especially when embarking upon a treatment regimen involving multiple cycles. Clarification is needed by CMS as to whether their intention is to insist upon use of oral when the physician’s judgment and patient history suggest that use of the infusion version of a given drug,. This may mean that therapy will be interrupted due to lack of tolerance by patients, who become dehydrated or have intractable vomiting. This may lead to higher costs to the Medicare program due to the stopping and starting of therapies. The following are just some of the examples where an absolute application of the assumption that a clinically equivalent oral can be readily substituted for an IV version is likely to cause disruption in the care and treatment of Medicare patients, and therefore should justify use of appropriate physician judgment at the time of care delivery. We request clarification of the intent and application of this policy in the following settings:

• Multiple cycles of therapy – if a patient has failed use of an oral on the first line of therapy, they will have already experienced the impact that nausea and vomiting can have on their lives. Common medical practice is to not risk further disruption of care with additional failures, or even the onset of anticipatory nausea and vomiting – a common occurrence for cancer patients, and thus to use IV treatments in subsequent cycles.

• Anticipatory nausea - Shall anticipatory nausea be identified as an appropriate “medically necessary” justification for use of IV antiemetics?

• Complex combination regimens – many chemotherapy regimens constitute multiple complex and highly emetogenic drugs and the preparation for these regimens can also involve multiple supportive care drugs, some of which may have both IV and oral versions. In a vacuum, it is easy to consider the effect and uptake for a single isolated drug. However, chemotherapy is not delivered in a vacuum and many regimens have been built with a standard of care that involves multiple IV versions of a variety of different drugs. The timing and anticipated uptake of the effect of these drugs has been carefully developed and balanced for the most medically effective impact of that regimen.

CMS overstepping authorization – We are concerned that the application of this policy in the cancer disease state may represent a situation where our local MAC is entering both into medical decision-making and attempting to circumvent Medicare law set by Congress by limiting payment for appropriately indicated Part B drugs administered in a physicians office to the least costly alternative. No other MAC has a similar policy, nor have any been drafted that are as sweeping as this one.

A federal court ruling on October 16 has already found that Medicare law does not authorize CMS or the contractors to redefine payment rates or policy that have already been set statutorily. There are several compendia approved by Congress to indicate medically appropriate treatment. Those compendia do not limit use of drugs to one route of administration over another for drugs with both IV and oral forms for very valid reasons, linked to the medical judgment of the physician and each individual patient situation. Even the national oncology guidelines set forth by the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) do not limit use of drugs to one route of administration over another for cancer patients.

Recommendation and request: It is our recommendation that this policy be exempted for drugs involved in the treatment and management of cancer. Our local MAC, NGS, has attempted to create this limitation without regard for the medical complications of such a policy, and without regard for their authority to create limitations for covered items and services as determined by Congress.

Because the appropriate use of drugs is clearly defined through FDA indication as well as the authorized compendia for Medicare coverage, CMS has created a limitation that is inappropriate, particularly in the treatment of cancer. As U.S. District Judge Henry H. Kennedy Jr. wrote in the ruling set forth October 16 from the U.S. District Court for the District of Columbia, “It does not make sense to conclude that Congress, having minutely detailed the reimbursement rates for covered items and services, intended that the secretary could ignore these formulas whenever [he or she] determined that the expense of an item or service was not reasonably necessary…There is no indication that Congress intended to confer such broad authority.”

Respectfully yours,
For the Connecticut Oncology Association:
Steven C. Lattanzi, MD President,
Dawn Holcombe, Executive Director
Tel: 860-305-4510
Email: dawnho@aol.com

For the Hematology Oncology Managers of New York:
Abe Moshel,President
Patricia A. Kaden, Vice President
Tel: 516-921-5533
Email: PatMedOnc@aol.com

For the New York State Society Medical Oncologists & Hematologists
Abe Mittelman,MD, President ,
Tel: 914-681-0025
Email: mittens4@aol.com
Florence Madonia,
Executive Director

For the Upstate New York Society of Medical Oncology Hematology
John Poggi, MD,President
Tel: 315-788-7990
Email: johnpoggi@hotmail.com
Nancy Izzo, Executive Director

Cc: American Society of Clinical Oncology
Community Oncology Alliance
Dr. Paul Deutsch, National Government Services
Nancy Davenport-Ennis, Patient Advocate Foundation

NYSSMOH RECIEVES ASCO'S STATE AFFILIATE GRANT

2009-02-02T15:01:00.000-05:00

Dr. Mittelman and Ms. Madonia-

Congratulations! The New York State Society of Medical Oncologists & Hematologists’ application has been accepted for funding through ASCO’s State Affiliate Grant Program. I am very interested in the progress of your society’s needs assessment and hope that your findings can be shared with other Affiliates. Please carefully review and return the attached acceptance letter so funds may be released to your organization.

Once again, congratulations on your projects approval for funding. If you should have any questions or concerns throughout the grant cycle, do not hesitate to contact me.

Best,
TerryTerry A. Hamlin Senior Manager
State Affiliate ProgramCancer Policy & Clinical Affairs Department
American Society of Clinical Oncology
www.asco.org/stateaffiliates

February 2, 2009

Abraham Mittelman, MD
New York State Society ofMedical Oncologists & Hematologists
311 North Street, Suite 304
White Plains, NY 10605

Dear Dr. Mittelman:
On behalf of ASCO’s Clinical Practice Committee, it is with great pleasure that we informyou of your society’s selection to receive a State Affiliate grant in the amount of $10,000 for your project, “Outreach Program – Meeting the Needs of the Practicing Oncologist in 2009.”
The grant period commences on April 1, 2009, with disbursement of funds, and concludesApril 1, 2010. A six-month progress report is due October 1, 2009, and a final report is dueMay 3, 2010. You will receive a reminder along with a form to complete approximately 60days prior to each deadline.

In an effort to increase the visibility of your state society and bring attention to the work that your organization conducts on a local level, your society will be asked to create a poster for display at the State Societies Booth during ASCO’s 2010 Annual Meeting. Your society may also be asked to participate in a grant focused breakout session at the State Affiliate Leadership Conference. Additionally, your project may be highlighted in an article in the Journal of Oncology Practice or fax to Terry Hamlin’s attention at 571-366-9568 by Monday, February 23, 2009. If you have any questions, please contact Terry at 571-483-1638 or terry.hamlin@asco.org.
Congratulations – we look forward to seeing you in Orlando!

Sincerely,
W. Charles Penley, MD
Michael Neuss, MD
Chair Clinical Practice Committee
Chair-Elect Clinical Practice Committee

cc: Florence Madonia

NGS Medical Policy Revision

2009-01-29T01:42:00.006-05:00

National Government Services Medical Policy Revision for: Drugs and Biologicals, Coverage of, for Label and Off Label Uses
LCD and Coverage Articles Part A & B Effective January 1, 2009
Posted on NGS January 26, 2009

LCD for Drugs and Biologicals, Coverage of, for Label and Off-Label Uses (L25820)R5* (effective 01/01/2009); Internal; the LCD has been revised to include compendia recognized by CMS based on Change Request 6191 (Compendia as Authoritative Sources for Use in the Determination of a Medically Accepted Indication of Drugs and Biologicals Used Off-Label in an Anti-Cancer Chemotherapeutic Regimen. Added Internet Only Manual (IOM) language to the “Limitations” section. The following articles have been added: A48208 - Filgrastim, Pegfilgrastim (e.g., Neupogen®, Neulasta TM), A48339 – Floxuridine, A48211 - Thyrotropin Alfa (Thyrogen®) and A48213 - Vitamin B-12 Injections. The following article has been retired: A46093 – Rituximab (Rituxan®). Minor changes were made to reflect current template language. Although revision R5 is effective 01/01/2009, the addition of the compendia based on Change Request 6191 is effective 11/25/2008. No notice period required and none given.

Link to Article

Medicare Widens Drugs It Accepts for Cancer

2009-01-27T12:13:00.004-05:00

By REED ABELSON and ANDREW POLLACK
Published: January 26, 2009 New York Times

Medicare, with little public debate, has expanded its coverage of drugs for cancer treatments not approved by the Food and Drug Administration.

Cancer doctors had clamored for the changes, saying that some of these treatments, known as off-label uses, were essential if patients were to receive the most up-to-date care. But for many such uses there is scant clinical evidence that the drugs are effective, despite costing as much as $10,000 a month. Because the drugs may represent a patient’s last hope, though, doctors are often willing to try them.

The new Medicare rules are the latest twist in a protracted debate over federal spending on off-label drugs — drugs prescribed for uses other than those for which they have been specifically approved.

Proponents of the changes say such spending not only helps patients, but can also enhance medical understanding of which treatments work against various forms of cancer.

But opponents argue that the new approach may waste money and needlessly expose patients to the side effects of drugs that may not help them. They also raise the possibility of conflicts of interest, because the rules rely on reference guides that in some cases are linked to drug makers.

The new policy, which took effect in November, makes it much easier to get even questionable treatments paid for, critics of the changes say. Medicare is providing “carte blanche in treatment for cancers,” said Steven Findlay, a health policy analyst for Consumers Union. He said overly expansive coverage encourages doctors to use patients as guinea pigs for unproved therapies.

Because Medicare officials canceled a cost analysis of the changes, it is hard to predict how much spending will increase beyond the $2.4 billion Medicare paid in 2007 for cancer drugs. But cancer doctors and other experts say the new policies, adopted in the final months of the Bush administration, seem almost certain to raise the federal drug bill, while making it more difficult for the new administration to rein in spending on unproven medical treatments.

Although President Obama has made a goal of controlling health care costs, a spokesman for the Obama administration declined to comment on the Medicare changes.

One of the many drugs whose use is likely to expand is the Eli Lilly product Gemzar, which costs $2,500 to $5,000 a month. The F.D.A. has approved it to treat only four types of cancer. But the new rules will virtually guarantee that Medicare will pay for its use for about a dozen other cancers, including advanced cervical cancer — even though the evidence supporting Gemzar for that use is “inconclusive,” according to one of the reference guides Medicare will now be consulting.

In the case of Genentech’s Avastin, one of the world’s most expensive and widely used cancer drugs, Medicare rejected in 2007 nearly all of the estimated $16 million in requests from doctors’ offices to cover its off-label use for ovarian cancer, according to claims specialists who work with Medicare data but declined to be identified because of the controversy over the topic. Under the new rules, Avastin will be routinely covered for ovarian cancer — as will at least some other off-label uses, including for brain and kidney cancer.

It is unclear how much precedent Medicare’s new rules might have on private insurers, which often follow the agency’s lead on paying for drugs.

Medicare officials defend the new policies, saying they respond to cancer doctors’ concerns that the agency has been too slow to recognize promising new off-label treatments. Dr. Steve Phurrough, who has overseen coverage for the agency since 2003, noted that a 1993 federal law gave Medicare specific authorization to cover some unapproved uses of cancer drugs.

“Congress wanted a lesser level of evidence,” Dr. Phurrough said. The question of what is adequate evidence is “not a line in the sand,” he said. “It’s a broad stripe in the sand.”

The American Society of Clinical Oncology, which represents cancer doctors, has hailed the new rules, saying they will ensure that the appropriate off-label uses are covered.

But some specialists say that being able to offer off-label drugs can also let physicians avoid hard discussions with patients about a grim prognosis.

“It makes it easier to give drug after drug,” said Dr. Andrew Berchuck, director of gynecologic oncology at Duke University, “and keep the fantasy alive.”

The new rules expand the number of reference guides — or compendiums — that Medicare relies on for determining which off-label uses of cancer drugs to cover. The writers and editors of these compendiums, who work completely outside the federal government, scan the medical literature and evaluate the evidence in making their recommendations.

In 1993, Congress had authorized three compendiums for Medicare, all published by not-for-profit organizations. But by 2007 two had stopped publishing, leaving Medicare with a single compendium. Having selected three additional guides last year, the agency plans to review its choice of guides every year.

Under the old rules, Medicare representatives were supposed to consult the compendiums but also use their own discretion in interpreting the guides’ recommendations. The new rules essentially delegate the decision to guides Medicare has selected, even when there is little clinical evidence behind a particular recommendation. As long as at least one of them recommends a cancer treatment, Medicare is essentially obliged to pay for it — unless one of the other guides specifically advises against it.

And some of these new compendiums have close financial ties to the drug industry, according to the draft of a report Medicare commissioned last year after Congress raised questions about possible conflicts of interest. The draft was completed in October, with a final version to be released soon.

The draft criticizes the new rules for essentially taking most decisions about off-label cancer drugs out of Medicare’s hands, even when the agency is aware of potential conflicts. The guide’s recommendation, the report says, “becomes the final word.”

For some experts, the bigger concern about using some cancer drugs off-label without adequate evidence is that they may not only be useless — they may cause dangerous side effects.

“We have very little faith that those indications that make it into the compendia are safe, let alone effective,” said Dr. Allan M. Korn, the chief medical officer for the Blue Cross and Blue Shield Association, who added that Medicare should cover off-label drugs only if the results of their use are carefully tracked afterward. There is no such requirement in the new Medicare guidelines.

There have been three different top Medicare administrators since the off-label rule changes were set in motion a few years ago. The second of them, Leslie V. Norwalk, chose to select the compendiums through a streamlined and internal administrative process, instead of the more elaborate and public process that Medicare often uses for broad coverage decisions.

“I did not see it as a significant step in coverage,” said Ms. Norwalk, who left Medicare in 2007.

Drug makers say they welcome the Medicare changes. A spokesman for the Pharmaceutical Research and Manufacturers of America, the industry’s main trade group, said the new rules ensured “that cancer patients have access to the treatments they need.”

Many oncologists say they needed greater flexibility in using cancer drugs because it can take months or years for a new use to be approved by the F.D.A. They cite the example of Celgene’s drug thalidomide, now a mainstay treatment for multiple myeloma, which was prescribed only off-label for years before the F.D.A. formally approved it for that use.

And in the case of rare types of cancer, there may be so few potential patients that companies have little financial incentive to undergo the formal F.D.A. process for approving a drug for expanded use. Only two drugs have been approved by the F.D.A. for brain cancer, for example, and cancer doctors say they need the ability to try other drugs or other combinations of treatments.

“To arbitrarily stop after two drugs to me is ludicrous,” especially for younger patients, said Dr. Virginia Stark-Vance, a solo practitioner in Dallas and Fort Worth. She said one of her brain cancer patients had been kept alive for 10 years by off-label use of irinotecan, a colon cancer drug that was the ninth drug the patient tried.

Medicare seems to have ignored some concerns raised by a group of outside researchers whom the agency had asked to survey a half-dozen compendiums, including the four that Medicare has now adopted. That report, completed in 2007, found that the six guides “cited very little of the available evidence,” said Dr. Amy P. Abernethy, a Duke oncologist who led the study.

The study also found great variability among the guides, in terms of what uses were recommended — or discussed at all.

Despite her study’s findings, Dr. Abernethy says she does not oppose Medicare’s new rules.

“I think the addition of the new compendia this year is an important increase in the bandwidth,” she said.

Critics say the agency also seems to have played down the potential financial conflicts of interests between the drug industry and the producers of the compendiums. The draft study that was completed in October notes that one of the new guides is published by the National Comprehensive Cancer Network, a group of 21 leading cancer centers that routinely employs experts who have financial ties to the drug industry.

William T. McGivney, the network’s chief executive, said each committee of reviewers had 20 to 30 members, which “diminishes the opportunity for dominance of one person’s opinion,” regardless of any ties to drug makers.

Then there is the American Hospital Formulary compendium, the one that Medicare was using before the November changes and will continue to consult. It has long been published by the nonprofit American Society of Health-System Pharmacists. But last year the society forged a financial relationship with a foundation linked to drug companies and some cancer doctors’ private practices.

A drug company can apply to that foundation, the Foundation for Evidence-Based Medicine, and pay a $50,000 fee to have new uses of its drug reviewed by the compendium within 90 days. The foundation was started in 2007 by the Association of Community Cancer Centers, which represents oncology practices, and says it received about $200,000 in initial funding from drug makers.

Gerald K. McEvoy, the guide’s editor in chief, said the application fee was meant to raise money to pay for additional researchers, to address previous criticism that the publication was too slow to vet new evidence. The foundation insulates the guide’s staff from industry pressure, he said, and fewer than one-third of the reviews under the new arrangement have resulted in a positive recommendation in the compendium.

Medicare officials acknowledge that some of the potential conflicts need to be addressed. But they say they have confidence in the guides they have chosen. “We had significant conversations with all the companies,” Dr. Phurrough said.

NGS News Modifier -25 and -57

2008-12-11T16:16:00.003-05:00

NEWS FROM NGS

Clinical Education
December 2008
Modifier 25 vs. 57
Modifier 25 indicates a “Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.” Modifier 25 should be used only when an E/M service performed on the same day as a minor procedure can be demonstrated through documentation to be “significant and separately identifiable.” Modifier 57 indicates the E/M service resulted in the decision to perform major surgery. Modifier 57 is then appended to the appropriate E/M code. Carriers pay for an evaluation and management service on the day of, or the day before a procedure with a 90-day global period, if the service resulted in the decision to perform the procedure. It would not be appropriate to bill evaluation and management services with, modifier 57 if the services were provided on the day before, or the day of a procedure with a 0 or 10-day global surgical period. Also modifier 57 would not be appropriate for pre-op visits. With pre-op visits, the decision for surgery has already been made. Scheduled pre-op visits the day before or day of surgery are included in the global package and should not be billed with a modifier 57. This also applies to minor procedures, those with 0 – 10 global days, and modifier 25. Preoperative care is part of the global package for major and minor procedures. Modifier 25 is used for E/M services the same day as minor procedures. Modifier 25 is a little different than Modifier 57. As mentioned earlier, Modifier 57 is used on E/M services the day before or day of major surgery when the initial decision to perform the surgery is identified. To illustrate the difference, an orthopedic surgeon visits Ms. Jones Tuesday night. It is determined that she has a hip fracture, and the surgeon decides, at that time, that an open reduction is required. The surgery is scheduled for the next morning. The E/M service is related, and not significant and separately identifiable from the major procedure performed, but since the decision for surgery was based on that E/M, it is payable with modifier 57. In the case of a clinic visit, the use of Modifier 25 would require documentation that the evaluation and management service performed was above and beyond the reason for the visit. An example: An orthopedist sees a patient with complaints of right shoulder pain and limited range of motion. The diagnosis is right frozen shoulder. The physician injects a steroid for pain relief, orders outpatient physical therapy, and prescribes an anti-inflammatory. An outpatient MRI of the right shoulder is scheduled for the next day and the physician will consider possible manual manipulation under general anesthesia. Documentation of the patient’s history, exam and decision making for the visit is completed. The physician is addressing the pain today by giving the injection. An anti-inflammatory has been prescribed and a diagnostic test to rule out other conditions ordered. This supports the management of separate issues and the use of Modifier 25.
Page last modified: 12/10/2008

HHS Health care reform News Link

2008-12-05T15:05:00.000-05:00

December 5th, 2008

NEWS LINK

HHS Will Be Shepherding Health-Care Reform

Study for Private Mdicare News Link

2008-11-23T15:04:00.000-05:00

November 23, 2008

NEWS LINK

Studies Say Private Medicare Plans Have Added Costs, for Little Gain

Transcript Now Available – ICD-10-CM/PCS National Provider Conference Call for Other Part A and Part B Providers

2008-11-21T22:22:00.000-05:00

The transcript of the Centers for Medicare & Medicaid Services’ ICD-10-CM/PCS National Provider Conference Call for Other Part A and Part B Providers that was held on November 12, 2008 is now available at

http://www.cms.hhs.gov/ContractorLearningResources/Downloads/November12calltranscript.pdf

Additional information can be found on CMS web site:

http://www.cms.hhs.gov/ICD10/01_Overview.asp#TopOfPage

Capitol Hill Project

2008-10-25T11:14:00.000-04:00

October 25, 2008

Dear Program Director:

I am writing on behalf of the New York State Society of Medical Oncologists and Hematologists (NYSSMOH), the regional organization representing Heme/Onc specialists in downstate New York. As you may be aware, NYSSMOH extends complementary membership to all Program Directors in our area. A number of Program Directors serve or have served on NYSSMOH's Board of Directors. Complementary associate membership is also extended to second and third year Heme/Onc Fellows in the NYSSMOH area.

The Board of Directors believes that all hematologists/oncologists and their professional societies have an important responsibility to act as advocates for their patients, and to support government funding for Heme/Onc research. We are also exploring strategies to involve younger Heme/Onc physicians in the advocacy and political process. Ideally, such involvement should start during the Fellowship years.

Every March, the American Society of Hematology (ASH) sponsors a Capitol Hill Day. Hematologists/Oncologists come from around the country to meet together in Washington, DC and also to meet with their Senators and Representatives. Their purpose is to lobby for increased Federal funding for Heme/Onc research. They also aim to publicize ASH's commitment to patient care.

NYSSMOH has voted to support and fund a pilot program offering a travel grant to Heme/Onc Fellows in their second or third year to attend ASH's annual Capitol Hill Day as an observer and participant. Travel, lodging and meal expenses would be defrayed for the overnight trip. For 2009, travel grants for 2 Fellows would be provided. NYSSMOH members would also attend and seek appointments with appropriate Senators and Representatives from New York. If the pilot program is successful, NYSSMOH would probably establish it as an annual program for Heme/Onc Fellows. The program might also catch the attention of other state Heme/Onc societies, leading to involvement of their Fellows and members.

The pilot program has been approved by the ASH Committee on Government Affairs. NYSSMOH proposes to offer the opportunity to attend Capitol Hill Day in March, 2009 to all second and third year Fellows in our area by simultaneous email. As per the criteria of ASH's Government Affairs Committee, preference will be given to Fellows who plan to attend the 2008 ASH meeting in San Francisco. There, they will attend the meeting of the Government Affairs Committee and learn about the ASH advocacy goals for 2009. Associate membership in ASH is also expected of the 2 chosen Fellows.

We hope that all Program Directors will support this NYSSMOH project for their Fellows. As soon as possible, PLEASE EMAIL ME louis.reed@nbhn.net the names and email addresses of your second and third year Fellows, so that NYSSMOH may circulate this opportunity to them. Many thanks for your time, interest and support.

Sincerely,

Louis Juden Reed, MDClinical Associate Professor of MedicineAlbert Einstein College of Medicinelouis.reed@nbhn.net

Sumbit your NYSSMOH Capitol Hill Project information on line

Senate Acts to Avert Medicare Physician Payment Cuts

2008-08-09T14:35:00.000-04:00

July 9, 2008

This afternoon, the Senate passed H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008, which would avert the 10.6% cut to Medicare physician payments, by a veto-proof majority. The House of Representatives passed H.R. 6331 before the July fourth recess, also by a veto-proof majority. The President has threatened to veto the bill and still might in order to force the House and Senate to override the veto.

The legislation would maintain the current 0.5% increase to physician payments from 2007for the remainder of 2008 (retroactive to July 1). The legislation also provides a 1.1% increase for 2009. This bill had failed by one vote in the Senate on June 26, but Sen. Ted Kennedy (D-MA), while under active treatment for cancer, returned today to Washington D.C. to make this important vote to ensure that this bill passed.

Thank you to all of you who were in contact with your Representative and Senators during this difficult series of votes. Your outreach made a difference. ASCO will keep you updated as this legislation advances to the President.

Congress Overrides President's Veto of medicare Legislation

2008-07-16T12:11:00.000-04:00

July 16, 2008

Yesterday, the President vetoed H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008, the bill that would avert the 10.6% cut to Medicare physician payments the Medicare legislation that would avert the 10.6 percent cut. The House and Senate both voted to override the veto yesterday evening.

The law will provide a 0.5% increase for the remainder of 2008 (retroactive to July 1) and a 1.1% increase for 2009. ASCO will update you on the plans for implementation once the Center for Medicare and Medicaid Services (CMS) releases information.

Senate Acts to Avert Medicare payment Cuts

2008-07-09T15:00:00.000-04:00

Congress Fails to Pass Madicare Fix

2008-06-27T13:40:00.000-04:00

Congress Fails to Pass Medicare Fix -
10.6% cut Will Go Into Effect on Tuesday -
Your Continued Action is Necessary

June 27, 2008

Late last night, after a political back-and-forth, the Senate failed to move H.R. 6331, the legislation that would have averted the 10.6% cut to final passage. Earlier this week, the House of Representatives passed H.R. 6331, The Medicare Improvements for Patients and Providers Act of 2008, by an overwhelming vote of 355-59. Since both the House and Senate have adjourned for the July 4th recess, this means that the 10.6% cut to physician payments will go into effect on July 1st . It is possible, but not guaranteed, that the Congress will pass a bill in July to adjust physician payments retroactively.

Thank you to all who contacted their Members of Congress in the lead up to these votes. Please continue to call and visit your Senators, Representatives, and their staff in their district offices while they are home for the week of June 30 - July 4. Thank those who supported H.R. 6331 and urge all Senators and Representatives to pass an SGR patch as soon as they return to Washington, DC, after the July 4 district work period. Your calls, letters, e-mails, and in-person visits make a huge impact and are critical to keeping this issue at the top of the priority list.
ASCO will continue to advocate for immediate legislative action when Congress returns from recess. For more information, contact ASCO's Cancer Policy & Clinical Affairs Department at 703-299-1050 or publicpolicy@asco.org.

Medicare Improvements For Patients and Providers ACT, 2008

2008-04-16T13:57:00.002-04:00

Today, the Centers for Medicare & Medicaid Services (CMS) announced steps it is taking to implement certain Medicare provisions in the Medicare Improvements for Patients and Providers Act of 2008. On Tuesday, July 15 , Congress voted to override the President's veto of the Medicare Improvements for Patients and Providers Act (H.R. 6331). The House vote was 383-41, while the Senate voted 70-26 in favor of enacting H.R. 6331 into law.

As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with a 0.5 percent update, retroactive to July 1, 2008.

Physicians, non-physician practitioners and other providers of services paid under the MPFS should begin to receive payment at the 0.5 % update rates in approximately 10 business days, or less. Medicare contractors are currently working to update their payment system with the new rates.

In the meantime, to avoid a disruption to the payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, Medicare contractors will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6% update level. After your local contractor begins to pay claims at the new 0.5% rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates.

Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1 – June 30, 2008, fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced nonparticipation amount also will need to request an adjustment.
To read the CMS Fact Sheet at: http://www.cms.hhs.gov/apps/media/fact_sheets.asp

More information on physician pay issues is available at:

http://www.cms.hhs.gov/PhysicianFeeSched/

More information on therapy caps is available at http://www.cms.hhs.gov/TherapyServices/

More information on DME is available at http://www.cms.hhs.gov/DMEPOSCompetitiveBid/