October 2005 Practice Update

Senate Finance Considers Physician Reimbursement on Monday
On Monday, October 24, the Senate Finance Committee is scheduled to mark up a budget reconciliation bill that includes a provision to replace the scheduled 2006 Medicare physician payment cut of 4.4% with a one-year positive update of not less than 1%.  Please visit the ASH Advocacy Center now to send an e-mail to your senator urging support of a positive update. Click ASH Comments to CMS to view ASH’s letter to CMS on the Medicare Physician Fee Schedule update and SGR.

Senate Bill Includes Pay-for-Performance for Physicians
On Monday, October 24, the Senate Finance Committee is scheduled to mark up a budget reconciliation package that includes Pay-for-Performance (P4P) for physicians. The P4P proposal is the “Medicare Value Purchasing Act of 2005” (S. 1356) that would establish a two-phase implementation of paying providers bonuses for delivering high quality care to patients. In the first phase, providers’ reimbursement would be tied to reporting quality data in much the same way hospitals were required to do under the MMA. In the second phase, Medicare providers would voluntarily participate in “value-based purchasing,” under which a portion of their payments would be set aside to create a quality pool. These funds would be given to providers meeting quality standards or those making progress toward meeting them. This phase would begin in 2008 for physicians. P4P payments would begin at 1 percent of Medicare payments for each provider group, rising to 2 percent within five years. CMS would be charged with developing the quality measures, working with a new quality organization established under the bill, health care providers, and other organizations.

The Practice Committee’s P4P Task Force has been working closely with CMS to develop appropriate quality measures for hematology and already has recommended several hematology measures to the agency. CMS has stated that it is so committed to P4P that even if the Congress is unable to pass legislation this year, it plans to implement a national P4P demonstration.  

OIG Releases Report on Part B Drug Reimbursement
The Office of Inspector General released the anticipated report on reimbursement for Part B cancer drugs that was mandated in the MMA. While the report found that many hematology and hematology/oncology practices could “generally” purchase drugs for treatment of cancer patients for less than reimbursement rates under ASP methodology, it also raised concerns that “generally” may not meet the needs of the cancer community. The report may be viewed by clicking OIG Report.

Committee Meeting on December 9th
The Practice Committee will meet on Friday, December 9, 2005, from 2:00-5:00 p.m. in Atlanta, Georgia. The Committee will be tasked with prioritizing objectives. Committee members will be asked to rate existing objectives prior to the meeting. For more information on the annual meeting, click here.

RUC 5 Year Review
The RUC 5-Year Review continues the lengthy process of evaluating codes reimbursed under the Medicare physician fee schedule. ASH continues to work with other cognitive groups in an effort to achieve fair reimbursement. To review the letter to Dr. Mark McClellan requesting the review of evaluation and management codes, click on the following link: Letter to Dr. McClellan.

Medicare Part D Approaches
The Prescription Drug Benefit, Medicare Part D, is expected to begin January 1, 2006. Medicare has recently released educational information to beneficiaries, some of which contains inaccurate information regarding Part D premiums. ASH will continue to provide updates on this new program. For more provider information on the program, including educational materials, please go to: Provider Materials.

For beneficiary information on Part D, click here: Beneficiary information.