August 2006 Practice Update

ASH Committee on Practice Collaborates with State Hematology and Oncology Societies to Present the 2006 ASH Practice Forum
The 2006 ASH Practice Forum, Pay-for-Performance; Are You Ready? will be held in conjunction with ASH's 48th Annual Meeting and Exposition on Saturday, December 9, 2006, from 6:00 p.m. to 7:00 p.m. at the Orange County Convention Center in Orlando, Florida. This year's Practice Forum reflects a collaborative effort with state hematology/oncology societies to present the latest information on expected reimbursement changes resulting from new "pay-for-performance" initiatives. Dr. Rodger Winn, Director of the National Quality Forum (NQF) Cancer Quality of Care Measures Project, will present a national overview on pay-for-performance, followed by a discussion panel of state hematology/oncology society practitioners who will discuss cost implications, impact on practices, and steps practitioners can take to prepare for implementation of pay-for-performance initiatives.

Report Released on Medicare Cancer Care Demonstration
The Department of Health and Human Services Office of Inspector General (OIG) released a report today entitled Cost and Performance of Medicare’s 2006 Chemotherapy Demonstration Project. The report finds the data from the demonstration are unreliable, due to inconsistencies and anomalies that call into question the integrity of the data. Additionally, the report finds approximately $17 million in net overpayments. Medicare and beneficiaries spent approximately $275 million on the demonstration, with beneficiaries paying approximately $55 million.

ASH Comments on Proposed Medicare Five-Year Review and Practice Expense Rule
ASH submitted comments on the Medicare Five-Year Review and Practice Expense Proposed Rule. The proposed changes to practice expense may benefit some ASH members, although reimbursement for hematologists and hematologist/oncologists will vary depending on the mix of services they provide. ASH comments urged Medicare to reexamine costs related to chemotherapy administration codes and to review data on apheresis codes.

Medicare Proposes Physician Fee Schedule and Hospital Outpatient Prospective Payment System (HOPPS) Rules; ASH Developing Comments
ASH will submit comments on proposed rules concerning reimbursement. Please see the ASH Web site for details.

--The Physician Fee Schedule rule proposes a 5.1 percent decrease to Medicare physician reimbursement. Because the proposed cut is due to a statutory formula; Congressional action is needed to prevent the cut in payment. Several sources in the House and Senate have indicated that the Congress is aware that this proposed cut must be corrected before January 1 but it is critical that the Congress hear from constituents through e-mail, phone, and/or visits to ensure action. The ASH Advocacy Center provides a very simple and quick way for physicians to take action. We encourage you to use this tool and share with colleagues. The main obstacle to Congressional action will be cost and the impact on the beneficiary Part B premium. More details on the fee schedule proposed rule of interest to ASH members are available on the ASH Web site.

--The Hospital Outpatient Prospective Payment System rule proposes an approximately 3 percent increase in Medicare payments, as well as tying full reimbursement to compliance with reporting on quality measures. Read more on the HOPPS proposed rule.

As ASH develops comments on both of these proposed rules, the Society seeks input from practitioners. Please e-mail Pam Ferraro your feedback on the rules.

Short Medicare Payment Hold to Be Implemented in September
Medicare will place a brief hold on payments for all Medicare claims from September 22 through September 30, 2006, as mandated by the Deficit Reduction Act of 2005. No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments. All claims held during this time will be paid on October 2, 2006. Details are available on the Medicare Web site.

Development of Hematology Quality Metrics Continues
ASH continues work with the AMA Physician Consortium and Medicare on hematology-specific quality metrics. In a contract negotiated last December between the Congress and the AMA, the Consortium was given authority to develop and approve approximately 140 performance measures by the end of 2006. These performance measures will be utilized in future pay-for-performance programs and other health-care initiatives. ASH was able to get the Consortium to agree to include four hematology-specific quality metrics developed by ASH on its 2006 agenda for review. The metrics are available for review and comment on the ASH Web site. ASH is hosting a meeting of the hematology workgroup on September 25, 2006.

IVIG Access Coalition
ASH and other medical specialty and patient groups are exploring creating a coalition to identify obstacles in accessing intravenous immune globulin (IVIG). ASH is looking into access obstacles related to IVIG therapy and would like to hear from practitioners who have had to modify practices because of problems. Please e-mail ASH Practice Advocacy Manager Pamela Ferraro if you have changed your practice because of obstacles in obtaining and/or administering IVIG.

President Bush Signs Executive Order on Health-Care Programs
On August 22, 2006, Bush signed an executive order directing the four federal agencies that administer or support health-care programs to share health quality and cost information with beneficiaries. This order is to promote efficient delivery of health care utilizing health information technology and better incentives for federal health-care programs such as the Federal Employees Health Benefit Program, Medicare, Tricare, and others. It does not apply to Medicaid or SCHIP. Under this order, price and quality information will be made available to those enrolled in Federally-administered or sponsored programs by January 1, 2007.

Noridian Wins First A/B Medicare Administrator Contract (MAC)
Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming comprise MAC Jurisdiction 3, the first A/B MAC region under contract. Noridian Administrative Services will begin implementation activities immediately, with full claims processing services to be implemented by March 2007.

Medicare Rule Projects Reductions for Rural States
The geographic practice cost indices that provides greater payments to rural areas with lower practice costs expires at the end of 2006. This will adversely affect those geographic areas that benefited from this provision. The largest reductions in payment will occur in the most rural states, including Montana, North Dakota, South Dakota, and Wyoming.

Learn About Recent Advances in Therapy for Hematologic Malignancies at the ASH State-of-the-Art Symposium
Advance registration for the ASH State-of-the-Art Symposium on Hematologic Malignancies ends on September 13, 2006. This symposium, scheduled for September 15 - 16 at the Bellagio Hotel in Las Vegas, will enable participants to network with experts, gain CME credits, and keep up to date with the latest developments in hematology. For more information about this meeting, please visit the ASH Web site.

ASH Announces the ASH/FDA Workshop on Clinical Endpoints in Multiple Myeloma
ASH and the U.S. Food and Drug Administration (FDA) are co-sponsoring a Workshop on Clinical Endpoints in Multiple Myeloma on October 26 in Washington, DC. Details are available online for this forum where experts will discuss clinical endpoints for use in regulatory approval of agents to treat multiple myeloma.

If you have questions, or need more information about the items above, please contact ASH Practice Advocacy Manager Pamela Ferraro by e-mail or call 202-776-0544.