May 2008 Practice Update

Senate Finance Committee Engaged in On-Going Discussions About Action on Medicare Physician Payment Bill
The Senate Finance Committee is working on Medicare legislation that would delay for 18 months the scheduled 10.6 percent physician payment cut. ASH recently met with Chairman Baucus about Medicare legislation. As reported in previous Practice Updates, delaying the physician fee cut would cost between $15 billion and $18 billion over five years, which challenges the Committee to determine how to offset those costs. Committee members continue to examine reducing payments to private insurers that administer Medicare managed care plans, known as Medicare Advantage (MA), as a potential offset for the bill. Last year, however, when Congress passed a six-month delay for the physician fee cuts, Republicans took MA plans off the table as an offset. Another possible offset option could be to cut indirect medical education payments. The Bush administration has asked Congress to approve delaying the physician fee cuts by June 16 in order to avoid delays in payments that would result in additional administrative costs.

Genetic Information Nondiscrimination Act (GINA) Passes Congress
On May 1, 2008, GINA passed the House of Representatives overwhelmingly by a 414 to 1 vote, six days after it passed the Senate unanimously by a 95 to 0 vote. The House approved the version of the bill (H.R. 493) amended by the Senate. The bill now awaits the signature of President Bush, who has expressed support for GINA and is likely to sign the bill. ASH actively supported GINA for the last several years and ASH grassroots advocacy contributed to the bill’s passage.

Comments Due Next Week on J12 MAC Draft Local Coverage Determination (LCD)
ASH is developing comments for all hematology-related LCDs developed by Highmark Medicare Services (HMS) to respond to the newly named Medicare Administrative Contractor’s (MAC) public comment period on its proposed policies. ASH comments will be posted on the ASH Web site by the end of this week and will be shared directly with ASH members in the J12 region (Maryland, Pennsylvania, New Jersey, Delaware, the District of Columbia, and Northern Virginia counties) to forward to HMS as well. ASH will also submit written comments, but feedback from local physicians carry significant weight with local carriers and MACs.

The proposed policies can be found on the HMS Web site.

Public comments are due to HMS by May 15, 2008.

Please contact ASH Government Relations and Practice Specialist, Stephanie Kart, or call 202-776-0544 if you have additional questions or would like further information.

Medicare Awards Contract in Western Region
Medicare awarded a contract to the National Heritage Insurance Corporation (NHIC) of up to five years for the combined administration of Part A and Part B Medicare claims payment in the Jurisdiction 2 (J2) region. The J2 region includes Alaska, Idaho, Oregon, and Washington. 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 Posts Notice of Proposed Rulemaking for Inpatient Prospective Payment System (IPPS)
On April 14, Medicare posted the Hospital 2009 IPPS Notice of Proposed Rulemaking (NPRM), which includes expansion of the list of its Hospital Acquired Conditions (HAC) for non-payment. Beginning October 1, 2008, Medicare cannot assign a case to a higher diagnosis related groupings (i.e. a higher payment grouping) based on the occurrence of one of the selected conditions if that condition was acquired during the hospitalization. Essentially, Medicare will not pay more for conditions that were acquired in the hospital if they were reasonably preventable through the application of evidence-based guidelines. The list includes two blood-related measures. ASH is analyzing the rule to see how these measures will impact hematologists.

ASH will be closely reviewing the entire document and will provide comments on the proposed rule by June 13, 2008. Please contact ASH Senior Manager of Policy and Practice, Carol Schwartz, if you have specific concerns. ASH will continue to monitor the development of Medicare programs in hospitals and will keep you apprised of additional action. For more information, please see ASH's summary of the notice.

ASH Supports an Extension of the National Provider Identification Phase-in
ASH has signed a letter urging that physician practices be allowed to submit transactions that contain both legacy and NPI numbers for at least six additional months. Currently, the NPI contingency plan is set to expire on May 23, and there are concerns that claims processing and payment problems will result unless the deadline is extended.

Medicare Offers More Clarification of its National Coverage Decision on ESAs
Please refer to MLN Matters for clarification about "Maintenance of ESA therapy" included in the Medicare National Coverage Decision on ESAs.

Medicare Medical Home Demonstration: Potential Impact for Cognitive Physicians
The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) has submitted work relative value and direct practice expense input recommendations to Medicare on the Medicare Medical Home Demonstration project, set to begin on January 1, 2009. The three-year demonstration project was mandated by Congress through the Tax Relief and Health Care Act of 2006 (TRHCA). Of significance to physicians is that the legislation requested that Medicare use the RUC process to develop a case management fee and valuation. This is the first time that Medicare has been congressionally mandated to seek the RUC’s advice in valuing a Medicare demonstration project.

The medical home is described as a large or small medical practice where a physician provides comprehensive and coordinated patient centered medical care. The demonstration will focus on rural, urban, and underserved areas in up to eight states.

Previous medical home initiatives have shown that patients who participate in medical home programs may have less face-to-face visits, and this could have an impact on general utilization/sustainable growth rate.The medical home demonstration efforts by the RUC have focused on valuing the management of patients – versus a surgical procedure, which over the long run may benefit cognitive physicians.