March 2005 Practice Update

Average Sales Price (ASP) Implementation
ASH continues to solicit information from practitioners about any problems they are having with ASP.  As we have previously reported, The Office of the Inspector General (OIG) of the Health and Human Services Department and the Medicare Advisory Commission (MedPAC) are studying the effect of the new reimbursement system on hematology/oncology.  Those studies are ongoing and are scheduled to be reported to Congress later this year.  If you are experiencing reimbursement problems with specific drugs, please contact ASH so that we can report these problems to the OIG and MedPAC.

Competitive Acquisition Process (CAP)
The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule on the Competitive Acquisition Program (CAP) for Part B drugs.  The CAP was created by the Medicare Modernization Act (MMA) as an alternative option to ASP.  Under the proposed program, a physician could elect annually to receive drugs for Medicare patients from a contracted vendor selected by CMS.  The contractor would be responsible for billing Medicare and the patient for the drugs.

The details of the program are outlined in ASH’s summary of the rule. 

ASH will be analyzing the proposed rule and providing comments to CMS.  We would like Committee on Practice members to help identify issues to include in our comments.  Please contact Mila Becker, ASH Director of Government Relations and Practice, with any feedback or questions you have about this reimbursement proposal.

Pay for Performance (P4P) for Physicians – MedPAC Releases Report & Congress Interested in Linking to 2006 Physician Update
The Medicare Payment Advisory Commission (MedPAC) earlier this month released a report focused on increasing the quality of patient care, specifically recommending implementation of a pay-for-performance (P4P) system for physicians. To improve quality for beneficiaries, MedPAC is advising that the program differentiate its payment system to pay providers more for higher quality performance.  The report proposes that Congress adopt a P4P program for hospitals, home health agencies, and physicians, in addition to Medicare Advantage and dialysis as suggested in last year’s report.

In addition to MedPAC, key congressional health committees and CMS have signaled their interest in linking a fix on the physician update for 2006 with quality initiatives. Under current law, Medicare will cut reimbursements to physicians by 5 percent next year and by more than 30 percent between 2006 and 2012.  In a meeting with ASH and other physician organizations, congressional staff requested input on quality measures and emphasized that the Congress is reluctant to address the update issue without a P4P component.  ASH will continue to follow this issue and keep you apprised of further developments.  More details and a copy of the MedPAC report are available on the ASH Web site.

CMS Advisory Committee Supports Increase for Apheresis Services
The Advisory Committee on Ambulatory Payment Classification (APCs) Groups will recommend that the Centers for Medicare and Medicaid Services (CMS) increase payment for CPT code 36515 under the Hospital Outpatient Perspective Payment System (HOPPS).  The decision was made during their annual meeting in Baltimore in February. 

ASH took the lead in asking the Advisory Committee on APC Groups to review a decision CMS made to reduce payment for the code by removing it from the payment group for apheresis services (APC 0112) and placing it with services related to blood product exchange (APC 0111).  Dr. Robert Weinstein, chair of the ASH Committee on Practice, presented evidence supporting ASH's request to restore code 36515 to its former payment with the support of the American Society of Rheumatology.  While the decision of the Advisory Committee on APC Groups is positive news, it is still up to CMS to decide if it will adopt the committee's recommendations.  ASH expects that the decision will be reflected in the 2006 HOPPS proposed rule this November.

ASH Efforts to Assist Hematology Representatives to Medicare Carrier Advisory Committees (CAC)
The Committee on Practice continues to find ways to assist hematology representatives to Medicare Carrier Advisory Committees (CAC).  ASH is planning the 7th Annual Hematology/Oncology/SGO CAC Network Meeting scheduled for July 22-23 in Washington, DC.  Please notify ASH if you are experiencing problems with your carrier so that we can provide your information to CMS as soon as possible.  In addition, please contact us if you have any issues you believe would be useful to add to the agenda for CAC Network Meeting.

Sickle Cell Disease Advocacy Alert
ASH needs your help in contacting your Senators and Representative to support funding for the Sickle Cell Treatment Act.  Please visit the ASH Advocacy Center to send a letter. 

Registration Open for the ASH State of the Art Symposium on Venous and Arterial Thrombosis
ASH will be hosting the second in a series of cutting-edge symposia April 9-10 in San Francisco, California.  This intensive, clinically focused course will use a combination of didactic lectures and case studies to provide participants with the latest advances in the prevention and treatment of venous and arterial thrombosis. Internationally renowned speakers with backgrounds in hematology, cardiology, and vascular medicine, including generalists and specialists, will cover topics such as antithrombotic drugs, venous thromboembolism, percutaneous interventions, atherothrombosis, acute coronary syndromes, and peripheral arterial disease. The inclusion of case presentations in a small group setting will encourage interactions between faculty and attendees, as well as provide an opportunity to apply this new knowledge in a clinical setting. The complete agenda, hotel information, CME information, and other details can be found online.

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