July 2007 Practice Update (part two)

Below is the latest information on the practice issues ASH has been following. We strongly encourage you to share this message with your colleagues. Please feel free to use any part of this document in your correspondence to State Society Members or colleagues.

CMS Publishes 2008 Proposed Medicare Physician Fee Schedule
The Centers for Medicare and Medicaid Services (CMS) published its Proposed 2008 Medicare Physician Fee Schedule Rule on July 12. As expected, CMS has proposed reducing physician payments by 9.9 percent in 2008.

View the physician fee schedule charts prepared by ASH that describe both the negative 9.9 percent update in the rule and the .5 percent update being considered by Congress.

ASH has developed a detailed summary of the rule, including information about proposals to report anemia quality indicators, compendia for medically accepted indications for off-label drug uses, the 2008 Physician Quality Reporting Initiative (PQRI), payment for intravenous immune globulin (IVIG), and average sales price (ASP) issues. Comments on the proposed rule are due August 31, 2007, and a final rule will be published later in the fall. The final rule will be effective for services on or after January 1, 2008.

ASH is very involved in working with Congress to avert the scheduled physician payment cuts. For the past five years, estimated cuts to the Medicare physician payment rate have been temporarily avoided through legislation. Currently, congressional committees in the U.S. House of Representatives are working on legislation to address Medicare physician payment, which they hope to have voted on by the end of July. However, even with congressional action the best scenarios would be a .5 percent increase or a freeze in the 2007 conversion factor in 2008.

View ASH's recommendations regarding changes to Medicare physician reimbursement for more information.

In addition to viewing ASH's recommendations, ASH members are also strongly encouraged to join ASH's on-line advocacy campaign to prevent the physician payment cuts. Through ASH's Advocacy Center, physicians can quickly and easily contact their Members of Congress to urge a positive physician update.

House Democrats Introduce Legislation That Would Eliminate Scheduled Physician Payments Cuts, Provide Two Years of Positive Physician Payment Updates, and Repeal PQRI
House Democrats introduced legislation that would eliminate the scheduled 10 percentcut in Medicare physician payments for 2008 and the scheduled 5 percentcut for 2009. The bill would replace the physician payment cuts with a 0.5 percent increase in reimbursement rates in each of the next two years. In addition, the bill would repeal the bonus fund for the Physician Assistance and Quality Initiative, but allow the program to continue on a voluntary basis.

These provisions are part of a larger health care package introduced by Representative John D. Dingell (D - MI), Chairman of Committee on Energy and Commerce. The bill, called the Children's Health and Medicare Protection Act (H.R. 3162), would reauthorize the State Children's Health Insurance Program (SCHIP) and increase funding for the program by $50 billion over five years.

For more information, see ASH's analysis of the bill.

National Coverage Policy for ESAs Expected by August 12
CMS will issue its national coverage determination that would govern Medicare coverage of ESAs in cancer and related neoplastic conditions by August 12. Last month ASH submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the agency's proposed national coverage policy in addition to meeting with CMS officials to express concerns, particularly that the proposed determination excludes treatment of myelodysplasia (MDS) from coverage.

Earlier this month, Blue Shield of California, the nonprofit insurer with 3.3 million members, began limiting payments for ESAs and required physicians to wait until the patient's hemoglobin dropped to 9 grams per deciliter before treating with Epogen, Procrit, or Aranesp. This week, however, the insurer changed its position. Blue Shield lifted its restrictions. The new policy, updated July 20, lets doctors start giving the drugs earlier, when a patient's hemoglobin level falls to 10 grams a deciliter of blood or lower. Unfortunately, restrictions on treating MDS patients are maintained although the new policy does allow for exceptions to be made on a case by case basis.

The Food and Drug Administration (FDA) has also announced that it plans a joint meeting of the Cardiovascular and Renal Drugs Committee and the Drug Safety and Risk Management Advisory Committee for September 11 to discuss updated information on the risks and benefits of ESAs when used in the treatment of anemia due to chronic renal failure.

ASH continues to express concerns to the Congress, Medicare carriers, and private insurers. As a result, several Members of Congress have written to CMS urging that the final coverage determination be consistent with scientific evidence and ASH's position. ASH will keep its members apprised of new developments.

CMS Proposes Clinical Trial Coverage Policy
In July, CMS issued a final Decision Memorandum on proposed revisions to rules governing Medicare coverage of services provided to beneficiaries enrolled in clinical research studies. As a result of the comments submitted by ASH and other organizations, CMS said that it was backing away from the changes proposed earlier this year.

On July 19 CMS released another proposed decision memo, Proposed Decision Memo for Clinical Trial Policy, as a reconsideration of the Clinical Trial Policy, which has been renamed Clinical Research Policy (CRP). This proposal addresses many of the issues that were included in the original proposed policy (April 2007 document) but were not finalized in the July 9, 2007 final decision memorandum. ASH has begun development of comments to CMS, which are due on August 19, 2007. View ASH's summary of issues contained in the proposal for more information.

CMS Proposes 2008 Hospital Outpatient Payment Rule
CMS published its Proposed Hospital Outpatient Rule for 2008 on July 16. ASH has developed a summary of the proposal which highlights the proposals concerning blood products, reporting of bone marrow and stem cell processing services, Part B Drugs, blood transfusion, and blood clotting factors. Of particular note is that there are improvements in payment for almost all the procedural codes of interest to hematology due to a change in the APC assignment. ASH will be developing comments to submit to CMS. If you have any questions or issues of concern, please contact the Policy and Practice Department at grassroots@hematology.org.

Register Now for the ASH SAS on Hematologic Malignancies and Cancer-Associated Thrombosis
Expert presenters, cutting-edge topics, networking opportunities, and a great location - what more could you ask from an educational opportunity? The ASH State-of-the-Art Symposium (SAS) on hematologic malignancies and cancer-associated thrombosis offers you all of this and much more.

Carol Schwartz Joins ASH Staff as Senior Manager, Policy and Practice
Carol Schwartz joined the ASH staff as the new Senior Manager, Policy and Practice. In this role, Carol will manage the Society's advocacy activities concerning physician reimbursement and quality-of-care issues and will be working closely with Mila Becker, ASH's Director of Government Relations and Practice. Carol comes to ASH with extensive experience in the association and hospital environment. Most recently Carol worked in the Maryland State House, but also held positions at Saint Joseph Medical Center in Baltimore where she directed the Center for Clinical Excellence and Professional Development; the American Urological Association where she directed its guideline development program and managed its office of research; and the Maryland State Medical Society where she coordinated a cancer prevention program.

Carol can be reached at cschwartz@hematology.org.