September 2006 Practice Update

ASH Committee on Practice Collaborates with State Hematology and Oncology Societies to Present 2006 ASH Practice Forum and Reception
Saturday, December 9, 2006 – 6:00 p.m. to 7:30 p.m. – Orange County Convention Center, Orlando, FL

As Congress moves forward with pay-for-performance initiatives, ASH is using the 2006 Practice Forum – Pay-for-Performance; Are You Ready? – to discuss cost implications, impact on practices, and steps practitioners can take to prepare for these changes. Speakers include Dr. Rodger Winn, Director of the National Quality Forum (NQF) Cancer Quality of Care Measures Project who will be joined by a discussion panel of state hematology/oncology society practitioners including Paul Adams, MD (MSHO), Gerald Robbins, MD (FLASCO), Samuel Silver, MD (ASH/MSHO), and Lawrence Solberg, MD (ASH/FLASCO). We encourage you to join your colleagues during this session and attend the reception to follow sponsored by Genentech BioOncology/Biogen Idec.

Reminder: Medicare Payment Hold to Be Implemented
Medicare will place a hold on payments for all Medicare claims from September 22, 2006, through September 30, 2006. The hold is 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 hold on payments. Claims held during this time will be paid on October 2, 2006. Details are available on the Medicare Web site.

The Fate of Medicare Payments Remains Uncertain—Advocacy Needed To Prevent Medicare Physician Pay Cuts
The absence of Congressional action to ensure proper Medicare reimbursement will lead to cuts in physician payments by 5.1 percent in January 2007, with additional cuts scheduled in following years. New legislative proposals have been circulated by House Energy and Commerce Committee Chair, Joe Barton (R-TX), and House Ways and Means Subcommittee Chairwoman, Nancy Johnson (R-CT), that would erase the scheduled pay cut in 2007 and would provide doctors with a small increase with additional money available for those physicians reporting quality measures. However, because these proposals are estimated to cost between $6-13 billion next year and increase the Medicare beneficiary Part B premium, it is likely that these proposals will not be considered until after the November elections during the "lame duck" session. It is critical that physicians contact Congressional Members and urge Congress to ensure appropriate reimbursement for physicians. ASH encourages you to join in ASH's advocacy campaign, which provides a quick and easy way to contact your US Representative and Senators.

ASH Hematology Quality Metrics Move Forward
ASH developed hematology-specific measures that could be used in new pay-for-performance initiatives and to offer guidance to practicing hematologists/oncologists. To further the process, ASH and the American Medical Association's (AMA) Physician Consortium are co-chairing a physician workgroup meeting on September 25, 2006, at ASH Headquarters to review these measures. The hematology-specific quality measures are available for review on the ASH Web site. ASH also developed a performance improvement module (PIM) for recertification and the Society expects to complete another PIM by the end of 2006. These modules are based on the ASH created performance metrics and provide an easy way for hematologists to receive credit for both programs.

ASH Monitoring IVIG Access
ASH continues to monitor obstacles related to IVIG therapy and will attend a public meeting on IVIG therapy access on September 28, 2006. At this time, ASH has not heard from members about problems to access, but is interested in receiving feedback from practitioners who have had to modify practices related to IVIG therapy.  Please contact ASH Practice Advocacy Manager, Pamela Ferraro, at pferraro@hematology.org with examples of practice changes implemented due to obstacles in obtaining and/or administering IVIG.

Medicare Premiums Begin to Vary in 2007
Beginning in 2007, wealthier Medicare beneficiaries will pay higher Medicare premiums. A surcharge will be added to the basic premium, with higher surcharges for higher-income beneficiaries. The surcharge will be phased in beginning in 2007 and the transition will be completed in 2009. For beneficiaries with incomes over $200,000, the monthly Medicare fee is expected to exceed $375/month by 2009. Presently, the monthly Part B premium is $88.50. The changes were introduced with the Medicare Modernization Act of 2003 (MMA), though the implementation is scheduled to begin January 1, 2007. Opponents to the provision are concerned that the change will lead to wealthier beneficiaries leaving the Part B program.

Medicare Administrator Announces Resignation
Medicare Administrator Mark McClellan, MD, PhD, announced September 5 that he will be stepping down from the position. A replacement has not yet been named, though likely candidates include Herb Kuhn, Director of the Center for Medicare Management, and Leslie Norwalk, the Deputy Administrator of CMS. Dr. McClellan has been Administrator of CMS since March 2004, and was instrumental in the development and implementation of the Medicare Prescription Drug Benefit.

Von Eschenbach Moves Forward in Nomination Process to Lead the U.S. Food and Drug Administration (FDA)
The Senate Health, Education, Labor, and Pensions (HELP) Committee approved the nomination of Dr. Andrew von Eschenbach by voice vote on September 20, 2006. Dr. von Eschenbach's nomination will move to the full Senate in the next few weeks, but has potential to be held up on the floor because of the debate involving the FDA's recent approval of the emergency contraceptive "Plan B" drug. ASH will continue to monitor this issue and will update the ASH Web site with any new developments.

Medicare Part D Covers Many Anti-Cancer Drugs
According to a report released by Health Affairs, Medicare Part D (the prescription drug benefit) has improved access to anti-cancer drugs. The report Access to Cancer Drugs in Medicare Part D: Formulary Placement and Beneficiary Cost Sharing in 2006 finds that Medicare Part D formularies cover most brand and generic anticancer drugs. The report indicates that most generic anticancer drugs are covered and about 70 percent of brand anticancer drugs, though these often require prior authorization.

Register Today for the ASH/FDA Workshop on Clinical Endpoints in Multiple Myeloma
ASH along with the US Food and Drug Administration (FDA) are co-sponsoring a Workshop on Clinical Endpoints in Multiple Myeloma on October 26, 2006, in Washington, DC. Register now for this public forum where experts will discuss clinical endpoints for use in regulatory approval of agents to treat patients with multiple myeloma.

Medicare, Medicaid, and TRICARE Experienced Security Breaches
According to a report released September 5, 2006, by the Government Accountability Office (GAO), entitled Privacy: Domestic and Offshore Outsourcing of Personal Information in Medicare, Medicaid, and TRICARE, almost half of insurers who sponsor Medicare Advantage plan contractors experienced security breaches involving Medicare beneficiaries' private health records in the last two years. Forty-two percent of traditional Medicare contractors, 44 percent of Medicaid contractors, and 38 percent of TRICARE contractors experienced security breaches. According to the report, most of the security breaches happened when the insurers outsourced the processing of health records to other companies. The report calls for increased oversight and reporting of security breaches.

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.