March 2008 Practice Update (part two)

Legislation Introduced to Prevent Medicare Physician Payment Cuts
On March 13, Senator Debbie Stabenow (D-MI) introduced the Save Medicare Act of 2008 (S.2785). The bill would provide a 0.5 percent update through the end of 2008, averting the July 1 anticipated 10.6 percent cut. In addition, it would provide physicians with a 1.8 percent update for 2009, extend a provision benefiting rural payment level, and continue the 1.5 percent payment bonus for the Physician Quality Reporting Initiative (PQRI) through 2010.

ASH has endorsed this legislation and is working with the Senate to ensure passage of legislation to avert the payment cut before July 1. We will keep you apprised of all developments and notify you about future legislative action alerts.

Republican Congressmen Introduce Legislation to Address Physician Payment Reforms
Senator John Cornyn (R-TX) and Representative Michael Burgess (R-TX) have introduced the Ensuring the Future Physician Workforce Act of 2008 (S. 2729/ H.R. 5545). This legislation was developed with the Texas Medical Association. This legislation would repeal the sustainable growth rate (SGR) formula beginning in 2010 and replace it with the Medicare Economic Index, which is CMS's conservative measure of physician practice cost inflation. The bill also resets the SGR spending targets to 2007 levels, effective for July 1, 2008, through 2009. The legislation includes incentives of increases to 3 percent for participation in the PQRI program and a three percent bonus from 2008-2011 to encourage adoption of health information technology. The bill also focuses on quality reporting for the ten highest-cost disease conditions in 2010, provides safe harbor from anti-kickback laws so that hospitals can assist physicians with Health Information Technology implementation, and gives confidential reports to physicians and to beneficiaries. Since both Sen. Cornyn and Rep. Burgess are not in the majority party, the legislation is currently under review by Senate and House Committees, but is not likely to be a lead vehicle for Medicare reform. The bill, however, helps call attention to the issue of physician payment and is a starting point for debate.

Updated Medicare Average Sales Price Payments Available
The Centers for Medicare and Medicaid Services (CMS) has made available the Medicare Part B Drug and Biological Average Sales Price Payment Amounts for April 1, 2008, to June 30, 2008, on the CMS Web site in the "Downloads" section. Scroll down to "Related Links Inside CMS," and select "MLN Product Ordering Page" to access this information.

Medicare Expands Use of Home Anticoagulation Management
Medicare has expanded the coverage for Prothombin Time Monitoring to include chronic atrial fibrillation and venous thromboembolism, under certain conditions.

Proper anticoagulation remains a significant problem for Medicare beneficiaries. Despite numerous guidelines recommending anticoagulation for several indications, thousands of patients are not adequately anticoagulated. This underutilization disproportionately affects Medicare beneficiaries since most patients needing anticoagulation are in the Medicare-age population. Refer to the decision memo for details.

Medicare Physician Fee Schedule Fact Sheet Available
The revised Medicare Physician Fee Schedule Fact Sheet (January 2008), which provides general information about the Medicare Physician Fee Schedule, is now available in print format from the CMS Medicare Learning Network.

Medicare Awards Contracts in Eastern Region
CMS recently awarded contracts to National Government Services (NGS) and Highmark Medicare Services (HMS) of Camp Hill Pennsylvania. The NGS award includes a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in the Jurisdiction 13 region. This area includes Connecticut and New York. The recently restored HMS award includes administration of Part A and Part B Medicare claims payment in the Jurisdiction 12 region, which includes: Maryland, Pennsylvania, New Jersey, Delaware, and the District of Columbia. To learn more about these awards and the status of other regions, visit the CMS Web site.

ASH will continue to monitor reforms in all regions and hematology-related local carrier policies. Please contact Government Relations and Practice Specialist Stephanie Kart or call 202-776-0544 for additional information and insight on the status of reforms and policies in your area.

Medicare Clarifies ESA Coverage Memo
Medicare announced a clarification to a recent Medicare Learning Network Matters article concerning maintenance of ESA therapy. Maintenance of ESA therapy is the "starting dose if the hemoglobin level remains below 10g/dL four weeks after initiation of therapy and the rise in hemoglobin is >1g/dL." Refer to the CMS Web site to assure that your claims are covered.

Additional information on Medicare coverage of ESA therapy and the recent FDA Oncologic Drugs Advisory Committee meeting is available.