February 2008 Practice Update (part two)

House and Senate Democrats Seek to Delay Scheduled Medicare Physician Payment Cuts for 18 Months
This week Senate Finance Committee Chair Max Baucus (D-MT) indicated he plans to delay the scheduled reduction in physician reimbursements (slated to begin July 1, 2008) for 18 months. Last December, Congress passed legislation that delayed the reduction, previously scheduled to take effect on January 1, 2008 for six months. Leaders of the House and Senate Budget committees also said that they might use the FY 2009 budget reconciliation process to pass a Medicare bill with a provision to prevent the scheduled 10 percent reduction in physician reimbursements.

While many Members of Congress tend to support preventing the physician cut, a sticking point is the cost to Medicare. According to budget analysts, the Medicare legislation could cost more than $20 billion over five years. To offset this cost, Democrats would like to trim other areas of Medicare that Republicans view as unacceptable, such as private Medicare Advantage plans. Democrats are thinking about making these changes through the budget reconciliation process, which allows legislation to move through the Senate without the threat of a filibuster. The budget reconciliation process has traditionally been used to reduce mandatory spending and taxes in order to balance the federal budget and congressional Republicans typically do not view it as a tool to enable the Congress to spend more money.

The budget committees are expected to make a decision about whether to use the budget reconciliation process next week. Debate on the budget resolution will begin on the Senate floor during the week of March 10 when ASH’s Government Affairs Committee Hill Day is scheduled. ASH will be meeting with congressional offices to support preventing the physician cut and will keep the practice community apprised of all developments.

JAMA Review Article Calls Attention to Risks of Erythropoeisis-Stimulating Agents (ESAs) in Patients with Cancer; FDA Oncology Drug Advisory Committee (ODAC) to Discuss in March
A recent JAMA review article, "Venous Thromboembolism and Mortality Associated with Recombinant Erythropoietin and Darbepoetin Administration for the Treatment of Cancer-Associated Anemia," has again called attention to the risks associated with ESA administration in cancer patients. The New York Times, USA Today, CNN.com, and others have published stories this week highlighting the risks of increased VTE and mortality rates. It is important to note, however, that none of these articles cite new published data that provides evidence contrary to the current FDA approved indications or the ASH-ASCO guidelines.

ODAC will meet March 13 to discuss the cumulative data, including recent study results, on the risks of ESAs when administered to patients with cancer. Agents to be discussed include ARANESP (darbepoetin alfa), EPOGEN (epoetin alfa), PROCRIT (epoetin alfa, Amgen, Inc.), and MIRCERA (methoxy polyethylene glycol-epoetin beta, Hoffman-La Roche Inc.). This is a followup to the May 10, 2007, Oncologic Drugs Advisory Committee Meeting. ODAC is expected to review data that is mostly unpublished. For the published articles that the committee will discuss, a number of them have design issues which make it difficult to apply to current guidelines.

ASH has been given time to present its views to the Committee. Dr. Sam Silver will present on behalf of ASH and ASCO and will share our organizations’ views on the design of a research agenda to address a number of broad areas currently unanswered about the risks of ESAs and the need for better communication tools for doctors and their patients to discuss the risks involved with this supportive therapy. He will also summarize the actions we have taken to update the guideline.

ASH will continue to keep the practice community apprised of all developments concerning ESAs.
The ASH-ASCO 2007 clinical practice guideline update on the use of epoetin and darbepoetin can be found on the Blood Web site.

President’s Medicare Legislation Introduced In Response to Funding Warning
The Medicare Funding Warning Response Act of 2008 was introduced jointly by House Majority Leader Steny H. Hoyer, D-Md., and Minority Leader John A. Boehner, R-Ohio on behalf of President Bush. The legislation is required as part of a 2003 law (PL108-173) meant to control Medicare spending. Specifically, the President must provide a plan to slow the rise in spending if and when tax revenues are required to cover more than 45 percent of Medicare’s costs over any two year period.

The President’s bill proposes achieving a reduction in costs through three principal mechanisms. There is an emphasis on value-based health care, which encourages the use of interoperable electronic health records that could potentially provide Medicare savings. In addition, to reduce excessive liability costs the proposal suggests capping non-economic damages at $250,000 and limiting the plaintiff attorney’s share of damages awarded. Finally, for beneficiaries with incomes over $82,000, or $164,000 for couples, drug coverage would decrease, shifting expenses to the beneficiary. The administration projects that this provision would save $900 million in 2009, when it would go into effect, and $3.2 billion over five years.

Outlook:
There is no requirement that Congress approve this legislation, although it must be reviewed. It is widely expected that Democrats will reject the President’s Medicare proposal and use it as an opportunity to promote their Medicare proposals, which could include cutting payments to Medicare Advantage plans and forcing the administration to negotiate drug prices for the Medicare drug benefit.

As we enter an election year, it is doubtful that there will be significant action reforming Medicare until after the new Administration and Congress take office. (House and Senate Democrats are planning to extend current Medicare legislation for 18 months – see story above.)

ASH Encourages Members to Participate in Medicare Physician Quality Reporting Initiative (PQRI)
PQRI extends payment incentives for physicians reporting 2008 Medicare quality measures.  Preliminary findings from Medicare indicate reporting on the 4 hematology measures ranged from only 8% to 10.69%.  Nationwide, the average usage for all measures was 15.74%.   For information about how to participate in PQRI and the ASH-developed hematology measures, please visit the PQRI page on the ASH Web site.  Please contact ASH Senior Manager of Policy & Practice Carol Schwartz (cschwartz@hematology.org), if you are having difficulties with PQRI. 

National Quality Forum (NQF): Hematology Measures in Comment Period
The four hematology measures currently in use by PQRI are in the approval process by the NQF. This will impact whether the measures are available in the 2009 PQRI program. At this juncture, the measures have been evaluated by the NQF Steering Committee, have had minimal need for revision, and will soon enter the public comment phase. ASH was instrumental in the development of these measures, and strongly supports their approval by the NQF and their ongoing inclusion in PQRI.