February 2005 Practice Update

Average Sales Price (ASP) Implementation

As required by law, the HHS Inspector General’s (IG) Office is now conducting a study on the impact of the implementation of the new Medicare ASP pricing.  The IG’s office has asked ASH to help provide it with examples of any drug that physician offices are paying more than Medicare is reimbursing.  For example, ASH has heard from some physicians that they have encountered reimbursement problems with two drugs – Procrit and Aranesp – where the physicians are paying more up front than Medicare is allowing.  If you are experiencing similar ASP reimbursement problems with these or other drugs, please contact Mila Becker as soon as possible, but no later than February 24.  We need to have the name of the drug and the amount your office is paying the wholesaler.  ASH will compile a list and respond to the IG’s request.

ASH Efforts at PERC & RUC

• ASH presented at the February Practice Expense Review Committee (PERC) to protect reimbursement for code 38320 bone marrow harvesting.  ASH Reimbursement Subcommittee member Jim Gajewski successfully defended and preserved all of the time ASH asked for.  The only thing that ASH had to relinquish was an RN/OCN for the pre-service activities because the Committee wouldn’t accept that it takes an oncology nurse to schedule space and equipment, coordinate pre-surgery services, etc.  The Committee was only willing to accept a RN for the pre-service activities.  The RN rate is $0.51/min compared to the RN/OCN rate of $0.79 minutes.  Without ASH’s presentation, however, the code would have been zeroed out.
  
• At the February RUC meeting, ASH requested that a new permanent seat be added for hematology/oncology.  A copy of the ASH/ASCO request letter can be viewed online.  Not unexpectedly, however, the RUC voted 13-13 to preserve its current composition.  ASH will work with the other cognitive specialty societies interested in expanding the RUC composition to develop other strategies to achieve our goal.  Drs. Weinstein and Silver will continue to be involved in this effort.

Quality Subcommittee Pilot Projects

During its January meeting, the ASH Executive Committee reviewed the action plan submitted by the Quality Subcommittee.  The Executive Committee approved the Subcommittee’s proposal to sponsor a Special Symposium at the ASH annual meeting next December on the topic of anemia and the elderly.  The Executive Committee also requested that the Quality Subcommittee identify two projects from its broad list of proposed activities to prepare a formal proposal and budget for review at the Executive Committee April meeting.  Quality Subcommittee members will be contacted shortly to participate in a conference call.

President Bush’s Proposed Budget

On Monday, President Bush submitted his FY 2006 budget request.  The President’s Budget proposes cutting millions of dollars from NIH and other key Department of Health and Human Services agencies.  The budget contains no legislative proposals that would affect physician reimbursement, including ways to avoid a projected five percent payment reduction in 2006.  For more details of the budget, please see ASH’s summary online.

ASH Committee on Practice Spring Meeting

The ASH Committee on Practice Spring Meeting for full committee members has been scheduled for May 3-4 in Washington, DC.  The meeting will consist of a business meeting and advocacy training, followed by visits to Capitol Hill.  Committee members should complete the meeting forms and return them to Stephanie Kart by March 7.  

If you have questions, or need more information, please contact ASH Director of Government Relations and Practice Mila Becker at (202) 776-0544.