February 2008 Practice Update

President's Budget Proposal Includes Medicare Cuts; Physician Reimbursement Left Unclear
On February 4, President Bush released a $3.1 trillion FY 2009 budget request that would increase discretionary spending for health care and other domestic programs by less than 1 percent and would reduce spending and growth in Medicare by $182 billion. The President's Medicare cuts include a reduction of indirect medical education (IME) add-on payments; cuts affecting teaching hospitals; and reduced updates for long-term care hospitals, inpatient rehabilitation hospitals, skilled nursing facilities, hospices, home health agencies, ambulatory surgery centers, and ambulance services. The Administration's Medicare proposals do not address the 10.1 percent reduction in physician payments scheduled to begin July 1, 2008. While Congress must consider the President's budget request, it may also take up its own legislative alternatives. In a presidential election year with a "lame-duck" president, it is expected that the democratic-led Congress will not further President Bush's proposals. In fact, the day the President's budget request was released, the chairs of both the House of Representatives and Senate committees with jurisdiction over the Medicare program announced that the Medicare proposals were "dead on arrival."

Outlook: As noted above, the President's Medicare proposals have been received unfavorably by the House and Senate and are not expected to move forward. The Senate Finance Committee has begun to discuss repealing the scheduled physician payment cuts. ASH is working with members of Congress to prevent the cuts and will keep ASH members informed of all developments. In addition, ASH will be launching a grassroots advocacy campaign concerning physician reimbursement and encourages all members to participate.

Read ASH's summary of the President's budget to learn more.

ESA Update: ODAC to Continue ESA Discussions in March
The FDA's Oncologic Drugs Advisory Council (ODAC) will be meeting on March 12-13 and will address recent study results on the risks of erythropoiesis-stimulating agents (ESAs) in the cancer population. This is a continuation of ODAC discussions from last May that helped prompt the Centers for Medicaid and Medicare Services (CMS) restrictions in its National Coverage Determination (NCD). ASH will present its views on the design of a research agenda on ESAs with the American Society of Clinical Oncology at the March meeting. The upcoming meeting will also address the biologic license application for romiplostim for specific treatment issues in chronic idiopathic thrombocytopenic purpura and supplemental license application for peginterferon alfa-2b for adjuvant treatment of melanoma. ASH will keep members informed of developments.

ASH Works with Pennsylvania Members on Recently Released Draft ESA Policy
Highmark released a draft local coverage decision in Pennsylvania concerning ESA coverage for myelodysplastic syndrome (MDS) patients. ASH is working with doctors in Pennsylvania to ensure the policy is consistent with key points from ASH's Model Policy for Local Medicare Carriers on MDS. The Society will also submit the model policy formally as part of the open request for comments.

ASH will continue to monitor the development of local carrier policies concerning ESA coverage in all areas. Please contact Government Relations and Practice Specialist Stephanie Kart or call 202-776-0544 for additional assistance and insight on the ESA coverage policy for your state.

FDA Release on Heparin
The FDA advises health care practitioners to limit use of Baxter heparin due to serious allergic reactions and hypotension. Baxter has temporarily stopped manufacturing multiple-dose vials of the injectable heparin.

Medicare Reimbursement for Radioimmunotherapy Agents for Non-Hodgkin Lymphoma Continues to be Controversial
Despite legislative language included in the Medicare, Medicaid, and SCHIP Extension Act of 2007, the 2008 hospital outpatient payment level does not cover the full costs of the radioimmunotherapies (RIT) of Bexxar (tositumomab/iodine I131 tositumomab) and Zevalin (indium111 ibitumomab tiuxetan/yttrium 90 ibitumomab tiuxetan) used as treatment options for non-Hodgkin lymphoma.

ASH is concerned that inadequate payment will jeopardize patient access to this important therapy. ASH has been actively involved in this issue and has expressed its concerns in a letter to CMS and a letter to the Senate Finance Committee. Consequently, a Senator on the Finance Committee has asked ASH to help draft new legislative language and work with CMS to understand the intent of the current legislation. ASH also will attend the March APC Meeting where RITs will be discussed and continue to monitor the situation. If you become aware of any reluctance by hospitals to provide radioimmunotherapy treatment to Medicare patients because of cost considerations, contact Carol Schwartz, Senior Manager of Policy and Practice.

Senate Finance Committee Leadership Supports Continuation of PQRI Program
Senate Finance Committee chair Max Baucus (D-MT) and ranking member Chuck Grassley (R-IA) have indicated their interest in continuing the Physician Quality Reporting Initiative (PQRI) and have encouraged CMS to collaborate with various health groups to ensure that PQRI succeeds in its development and implementation of quality measures. As they have previously, the Senators indicated their belief that financial incentives for quality reporting will lead to increased quality and efficiency in the Medicare program.

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) extended the 1.5 percent payment incentives for physicians reporting quality measures in 2008 and removed a cap on calculation of incentive payments for reporting in 2008 and 2009. The Senate is expected to work on legislation that would extend incentive payments for 2009 and future years.

ASH members can participate in PQRI by reporting on four hematology and two information technology measures. For detailed information about participating, please visit the PQRI section of the ASH Web site. In addition, ASH is currently working to assure that the current hematology measures are approved for 2009.

CMS Develops New Educational Tools
CMS has announced the availability of a provider education product entitled Guided Pathways to Medicare Resources for Medicare Fee-for-Service Health Care Professionals. This resource allows easy access to CMS Web site resources and can also serve as an introduction to the Medicare Program. It is located in the Medicare Learning Network, a CMS source of free materials to promote national consistency of information for Medicare fee-for-service initiatives.