June 2008 Practice Update

Senate Stalls Medicare Legislation
June 12, 2008 - This afternoon, the U.S. Senate failed to advance Medicare legislation that would prevent the 10.6 percent physician pay cut.  According to Senate rules, the body needed to have 60 votes to begin consideration of the Medicare legislation (S. 3101, the Medicare Improvements for Patient and Providers Act).  With a vote of 54 to 38, the Senate came up short.  Senate leadership had indicated earlier this week that it would not be able to avert the physician payment cut set to begin on July 1 if legislation did not move forward this week. ASH continues to monitor this issue closely. Please see the full Policy and Practice news item for more information.

ASH Submits Comments on Proposed Rulemaking for Inpatient Prospective Payment System (IPPS)
ASH submitted comments supporting retaining incompatible blood transfusion as a Hospital Acquired Condition (HAC) and opposing having deep-vein thrombosis/pulmonary embolism (DVT/PE) as an HAC in response to Hospital 2009 IPPS Notice of Proposed Rulemaking (NPRM). Beginning October 1, 2008, 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. Specifically, the hospital will not be allowed to assign a higher diagnosis related grouping (i.e. a higher payment grouping) based on the occurrence of one of the selected conditions if that condition was acquired during the hospitalization. ASH is opposed to DVT/PE being considered an HAC because it can neither be always detect or prevented by the use of guideline-concordant practice.

ASH Plays Role in Local Medicare Carrier Coverage Decisions
ASH continues to track local Medicare carrier transition activities and coverage decisions. The Society recently submitted comments in response to the newly named Jurisdiction 12 (J12) Medicare Administrative Contractor’s (MAC) public comment period.

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

Medicare Recognizes New Compendium for Covering Cancer Drugs
The Medicare program will recognize a new source of information, the National Comprehensive Cancer Network (NCCN) Drugs and Biologics Compendium, for determining which drugs may be covered under Medicare Part B to treat cancer patients.

CMS did not accept the application for Thomson Micromedex DrugPoints as an approved compendium because it does not explicitly note when the use of a drug or biologic is not recommended, nor does it explicitly note an "Equivocal" listing when validated evidence is equivocal.

The agency also said it will cease using the American Medical Association Drug Evaluations (AMA-DE) compendium, as the compendium has not been updated since 1995.

Please see the CMS Web site for more information.

Agency for Healthcare Research and Quality (AHRQ) Releases "Your Guide to Coumadin®/Warfarin"
The AHRQ has a new consumer publication that educates patients about their anti-coagulant therapy and potentially dangerous side effects, explains how to communicate effectively with their health-care providers and provides tips for lifestyle modifications. This brochure also provides information on remembering when to take the medicine, learning how to stay safe while taking the medicine, maintaining a consistent diet and alerting health-care providers to concurrent drugs and/or supplements patients are taking to avoid any potential adverse interactions.

Center for Medicaid and Medicare Services Updates
The Center for Medicare and Medicare Services (CMS) has added new modifiers for Erythropoiesis-Stimulating Agents (ESAs) Reporting. CMS has also updated its Average Sales Price (ASP) and its Medicare Remit Easy Print, that enables physicians to view and print remittance information.

ASH Recommends E-Prescribing Standards
On May 27, ASH, along with thirty-two other organizations, signed on to a letter to members of the House of Representatives and the Senate that offered a series of recommendations to assist in the timely adoption of e-prescribing standards across the country. The letter recommended that Congress:

• Finalize all e-prescribing standards well before mandating their widespread adoption.
• Allow a two-year transition period following the issuance of uniform standards to let providers prepare for their implementation.
• Provide adequate, direct, and early financial incentives to encourage the adoption of e-prescribing.
• Lift the prohibition on e-prescribing controlled substances.

ASH will continue to monitor the issue of e-prescribing and will keep members informed of any new developments.

HHS Releases Strategic Plan to Advance Health Information Technology
On June 3, the Office of the National Coordinator for Health Information Technology (HIT) in the Department of Health and Human Services (HHS) released a strategic plan to guide various government agencies in the construction of a nationwide HIT system. The plan addresses issues of privacy and security, supports the creation of uniform standards to allow for the easy transmission of health data, and guides the establishment of multi-stakeholder decision making to build the best possible HIT system. The document establishes a timeline with milestones to measure progress in HIT adoption.

The plan comes in response to a 2004 executive order issued by President Bush that created the National Coordinator for Health IT. At that time, the President Bush announced a goal of granting most U.S. residents access to electronic health records by 2014. ASH will continue to monitor regulatory and legislative developments in the area of health information technology and will keep members apprised of any developments.

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