October 2007 Practice Update (part three)

"ASH-ASCO 2007 Clinical Practice Guideline Update on the Use of Epoetin and Darbepoetin" Released
On Tuesday, October 22, ASH prepublished the "ASH-ASCO 2007 Clinical Practice Guideline Update on the Use of Epoetin and Darbepoetin" in its scientific journal Blood. Visit ASH Policy and Practice News for more details.

ESA Coverage Update: ASH Briefs Congressional Staff and Meets with CMS to Urge Reopening of Coverage Policy
ASH continues to urge the Centers for Medicare and Medicaid Services (CMS) to reopen its coverage policy on erythropoiesis-stimulating agents (ESAs). The Society met with CMS Administrator Kerry Weems and briefed congressional staff. Visit ASH Policy and Practice News for more details.

ASH Model Policy for Local Medicare Carriers on Myelodysplastic Syndromes (MDS)
To assist its members on the local level, ASH, working with a task force with expertise in MDS, developed a model policy on coverage for ESA treatment of anemia for patients with MDS.

Congress Considers Physician Payment Fix
Congressional leaders continue to debate the best means of relief for the 10 percent cuts in Medicare physician reimbursement payments scheduled to take effect on January 1, 2008. Senator Max Baucus (D-MT) has proposed a $25 billion to $30 billion two-year fix, paid for in part by an $8 billion to $12 billion reduction in reimbursements to Medicare managed care plans. Many Republicans instead favor a one-year suspension of the anticipated cuts, financed without reducing plan payments.

TAKE ACTION: Visit the ASH Advocacy Center and support ASH’s efforts to help Congress to prevent physician payment cuts before the end of the year.

ASH Urges Flexibility for PQRI Measures
On October 19, ASH, joining 43 other Medical and Professional Societies, sent a letter to CMS urging the agency to adopt a flexible approach when deciding what quality measures to include in the Physician Quality Reimbursement Initiative (PQRI). The letter expressed concern that administrative deadlines at CMS could lead to the exclusion of many important measures developed over the last year, significantly delaying the ability of many physicians to participate in the program. Currently, there are four hematology-specific measures developed by ASH incorporated into the 2007 PQRI.

CMS Announces Two New MACs
On October 26, CMS announced contracts for the combined administration of Part A and Part B Medicare claims payments in two jurisdictions. These awards represent the fourth and fifth Medicare Administrative Contractors (MACs) named by CMS. The MAC contracts are part of an effort to streamline the fee-for-service payment.

Highmark Medicare Services Inc., is responsible for Jurisdiction 12, which includes the states of Delaware, Maryland, New Jersey, and Pennsylvania as well as the District of Columbia. Palmetto GBA will serve Jurisdiction 1, which includes California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands. These contractors will immediately begin implementation activities. Highmark Medicare Services will assume full responsibility for claims processing no later than September 2008, and Palmetto GBA will assume full responsibility by June 2008.

ASH Monitoring Congressional Action on Electronic Quality Reporting Legislation
The Senate continues to consider the Wired for Health Care Quality Act (S. 1693). This legislation has the potential to be an important first step in the development of an efficient and effective health information technology system in the United States. The potential of many of the bill’s provisions to improve quality of care, provide important macro-level health data and increase the efficiency of care delivery.

The bill, however, does raise some concerns. There is a question as to whether or not the nation’s health information technology infrastructure is sufficiently developed, or has appropriate standards of quality and interoperability to make the system-wide implementation of quality measures feasible and accurate. There is also concern that, absent the development of robust risk-adjustment mechanisms, the bill could create incentives to avoid treating high-risk patients. Concerns of patient privacy must also be appropriately addressed.

This legislation remains in its early stages, and ASH will follow and keep practitioners appraised of further developments.