August 2005 Practice Update

CMS Publishes Proposed Rule on 2006 Physician Fee Schedule
On August 8, 2005, the Proposed Physician Fee Schedule was published in the Federal Register. The rule proposes a negative update of 4.3 percent. The most significant policy change in the proposed rule are changes proposed in the methodology for calculating practice expense values under the resource-based relative PE system. The changes would be implemented incrementally over a four-year period. CMS estimates that a 1.4 percent increase for hematology/oncology would result from the changes to practice expense. We have prepared a summary for your information, and would appreciate any comments you have (mbecker@hematology.org) to include in ASH’s comments to the proposed rule, due September 30.

Join ASH’s Efforts to Prevent Physician Payment Cuts
ASH has developed an online advocacy campaign to urge Congress to stop the impending 4.3 percent physician payment cut and pass legislation that would increase payments by at least 2.7 percent in 2006. Please go to the ASH Advocacy Center to take action and send an e-mail to your congressmen.

CMS Publishes Proposed Rule on Hospital Outpatient Prospective Payments
On July 25, 2005, the Federal Register published the proposed rule on the 2006 Hospital Outpatient Prospective Payment System (HOPPS). ASH’s summary is available on line. Overall, payments for all hospitals will be going up by 3.6 percent, with a larger increase for rural sole community hospitals (other than payments for new technology payments). Payment changes for individual services and APCs will vary.

RUC 5-Year Review
The RUC 5-Year Review workgroups will meet August 25-28 to review recommendations made based on the recently acquired survey data. The workgroups are tasked with finalizing recommendations for the full RUC to review in September.

Although the cognitive subspecialty organizations worked with the surgical groups to develop physician work descriptions and vignettes, the surgical groups conducted their own survey using the jointly-developed survey content. The surgical groups cancelled a previously scheduled meeting where both groups were to compare survey data and develop joint recommendations to the RUC. It is expected that the surgical groups will oppose any increase to RVUs for physician work for E/M services.

Sam Silver, chair of ASH’s Reimbursement Subcommittee, will represent ASH at the August meeting and we will keep the committee apprised of future developments.

Pay-For-Performance Initiatives
Both Congress and CMS continue to explore incorporating pay-for-performance (P4P) into Medicare. Details about new legislation are available on the ASH Web site. The ASH P4P Task Force continues to work with CMS to ensure that any new P4P system appropriately address hematology. The Task Force has developed initial recommendations for hematology performance metrics and has submitted them to CMS. The initial recommendations can be viewed on the ASH Web site.

We will continue to keep the committee apprised of further developments.

CMS Announces Delay for Competitive Acquisition Program (CAP)
CMS has suspended the CAP vendor bidding process and announced that CAP drug delivery is not expected to begin until July 2006. In the meantime, CMS is seeking ways to improve the efficiency and attractiveness of the CAP. The comment period for the CAP interim final rule has not been suspended and ASH plans to submit comments by the September 6 deadline. The bidding process will open to vendors following the release of a final rule later this year.

The CAP Web site is available at: http://www.cms.hhs.gov/providers/drugs/compbid/default.asp.

The interim final rule may be viewed at: http://www.cms.hhs.gov/providers/drugs/compbid/default.asp.

ASH’s comments on the proposed rule may be viewed at: http://www.hematology.org/images/pdf/cap_letter.pdf.

New Policy
ASH is currently developing a policy statement regarding physician reimbursement. The policy will support fair reimbursement for hematologists without increasing their administrative burden. Additionally, the policy supports fair representation on the Relative Value Update Committee, which makes recommendations to the CMS on Medicare code values, as well revising calculations to the physician fee schedule updates to increase accuracy of the update. We will be circulating a draft for committee approval shortly.

New Staff
Pamela Ferraro, Practice Advocacy Manager, joined the ASH staff on August 1. She will be focusing initially on activities related to practice and physician reimbursement. Prior to working at ASH, Pam was employed by Medical Advocacy Services, Inc., a wholly-owned subsidiary of American College of Physicians. I strongly encourage you to contact Pam with any questions or concerns you have regarding reimbursement and other practice-related issues. Pam can be reached at pferraro@hematology.org or 202-776-0544.