April 2008 Practice Update (part two)

ASH Meets With Senate Finance Committee Chair Baucus About Proposed Medicare Bill
ASH met with Senate Finance Committee Chair Max Baucus (D-Mont) on April 11 to discuss his proposal to address Medicare physician payment. Senator Baucus is aiming for an 18-month fix to avert the scheduled Medicare payment cuts that are currently scheduled to begin on July 1; however, his legislation will be proposed with "balloon financing", which means physicians would face a payment cut of 21 percent in 2010. For more details, please see the April 11 policy and practice news item.

Senate Considers Genetic Information Nondiscrimination Legislation
After many months of delay, the Senate is scheduled to consider the Genetic Information Nondiscrimination Act (GINA) (S. 358) on April 24. Senate leaders worked with Senator Tom Coburn (R-OK) to overcome the objections he had to the bill and reached an agreement to bring a slightly modified version of the bill to the Senate floor for consideration.

GINA would prohibit health insurers from using individuals' genetic information to deny coverage or determine rates or premiums. In addition, the bill would bar employers from using individuals' genetic information when making hiring, firing, job placement, or promotion decisions. The House easily passed its version of the bill (H.R. 493) in May 2007, and similar legislation has passed the Senate in the last several Congresses. Because of slight differences between the House-passed version of the bill and the Senate bill, the House will be required to cast a final vote on GINA before it can be presented to President Bush, who has indicated his support for legislation to protect genetic information privacy.

ASH has been very active in supporting this legislation and thanks everyone who has participated in the Society’s advocacy efforts. Please visit the Policy and Practice News page for the latest news on the Senate’s consideration of GINA.

New Opportunities for Bonus From the Physician Quality Reporting Initiative (PQRI)
Medicare has announced new options under the 2008 PQRI program to encourage physician participation. Specifically, there will be a registry-based submission process that can be used for either the full year or just July 1 – December 31. CMS will be announcing the criterion to submit registries for acceptance into the PQRI program by end of this month and will determine qualified registries by the end of August.

Medicare has also instituted new outreach to increase physician participation.

Keep informed of developments by subscribing to CMS’ Physicians, Nurses, and Allied Health Open Door Forum ListServ. You may sign up for the ListServ and receive PQRI updates and Forum meeting invitations by e-mail on the CMS Web site.

More information on the measures that are relevant to hematology is available on the ASH Web site.

Medicare to Host National Provider Conference Call April 30 on PQRI
Medicare will host the second in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EDT, on Wednesday, April 30, 2008.

The call will provide an overview of increased opportunities for eligible professionals to report PQRI quality measures and the possibility to earn incentive payments for satisfactory reporting.

You must register to participate in the call.

A PowerPoint slide presentation will be posted on the CMS web site for you to download prior to the call so that you can follow along with the presenters.

Former Senate Majority Leaders Team Up to Recommend Health-Care System Overhaul
Former Senate Majority Leaders Bob Dole (R-KS), Howard Baker (R-TN), Tom Daschle (D-SD), and George Mitchell (D-ME) have launched a coalition called the Leaders' Project on the State of American Health Care to make recommendations on health-care reform. Each Senator will oversee one of four public forums on different issues, including quality and value, health care access, consumers’ role, and financing. The former senators aim to produce recommendations for the next administration sometime in 2009. This is an important event as this coalition is likely to develop viable bipartisan recommendations, and it will be able to leverage significant pressure on the new Congress and Administration to take action.

J12 MAC Announces Draft Local Coverage Determination (LCD)
Highmark Medicare Services (HMS), which was recently awarded the Medicare contract in the Jurisdiction 12 region (J12), plans to fulfill CMS' requirement to consolidate LCDs by July 11, 2008. The J12 region includes: Maryland, Pennsylvania, New Jersey, Delaware, the District of Columbia, and Northern VA counties.

All draft policies can be found on the HMS Web site and are open for public comment until May 15, 2008. ASH is currently reviewing these policies and preparing comments for all hematology-related LCDs. Once prepared, all comments will be posted on the ASH Web site and shared with ASH members in the J12 region.

ASH encourages all members in the J12 region to submit comments directly to HMS. ASH will also submit written comments as part of the open request for comments, but the local carriers and MACs are typically more sympathetic to local physicians.

Please contact ASH Government Relations and Practice Specialist Stephanie Kart (skart@hematology.org or 202-776-0544) if you have additional questions and/or would like further information.

U.S. Identifies Tainted Heparin in 11 Countries
The New York Times reports that Federal officials have discovered a clear link between a contaminant in blood thinner from China and 81 deaths in the U.S.

Insurers Increasingly Adopting Pricing System to Shift Burden of High-Cost Drugs to Patients
The New York Times reports that increasing numbers of insurers are adopting “Tier 4” pricing systems in which patients must cover a percentage of the cost of high-priced drugs as opposed to paying a flat fee.

Pharmaceutical Coalition Supports FDA Off-Label Marketing Guidelines
Representatives of pharmaceutical companies are expressing support for the Food and Drug Administration proposed guidelines that will loosen the rules regarding drug companies' ability to market medications for off-label uses. A coalition of 10 drug companies — including Pfizer, Bayer, AstraZeneca, and Johnson and Johnson favors allowing companies to distribute peer-reviewed articles that inform physicians and hospitals of off-label uses for prescription drugs.

The FDA proposed new guidelines would allow pharmaceutical and medical device companies to market their products for off-label uses. Currently, physicians can prescribe medications and medical devices for off-label uses, but companies cannot market their products for such uses. Under the guidelines, the companies could provide health professionals with peer-reviewed articles from published medical journals that use an expert editorial board; however, the companies would also need to include prominent warnings to indicate that the articles address uses for their products not approved by the FDA.