California Oncology Weekly Newsletter 8.29.17

 

This Weekly’s Hot Topics

  • Medicare regulations on bundling and unbundling of chemotherapy services. (Noridian News)
  • ATTENDthe 2017 ASH Meeting on Hematologic Malignancies (MHM) (Affiliate News)
  • Anthem/AIM prior authorization process for Oncotype Dx. (Industry News)

 

The Sacramento Bee published an op-ed from Deborah Goldberg, a mother living with cancer in Los Altos, about the importance of hope and innovation to those battling cancer, and the potentially negative impact of regulations like SB 17 on patients like Deborah. Deborah urges legislators not to support legislation that would stifle investment in innovation and take away the hope of new therapies for people with cancer. For more information click here and go to California News.

Recent CERT reviews have revealed errors regarding insufficient documentation for Chronic Care Management (CCM) services. For more information click here and go to Noridian News.

Specialty drugs can be covered under the pharmacy benefit, the medical benefit, or both depending on the benefit design of the payer. The medical benefit specialty drug pipeline is very robust with near-term (2016) oncology agents. For more information click here and go to DHCS/Medi-Cal News.

The Quality Payment Program’s first performance period began on January 1, 2017 and ends on December 31, 2017. Participation in MIPS can start as early as January 1, 2017 or as late as October 2, 2017. The first payment adjustments based on performance go into effect on January 1, 2019. CMS encourages subscribers of the PQRS listserv to sign up for the new CMS Quality Payment Program listserv. The Quality Payment Program is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and includes two tracks — Advanced Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS). For more information click here and go to CMS News.

The 340B program provides an important safety net for high numbers of uninsured, poor, or vulnerable patients, by giving discounts on prescription drugs to certain hospitals and health clinics. Unfortunately, abuse of the 340B program is hurting the cancer care system and the very patients it is supposed to help – cancer patients, who face quotas, wait lists, and significantly higher costs for care at 340B hospitals. For more information click here and go to Affiliate Association News.

Genomic Health informs MOASC & ANCO of the new Anthem/AIM prior authorization process and how to complete a Prior Authorization request for Oncotype Dx.  Effective July 1, 2017, Anthem’s AIM subsidiary will perform Prior Authorizations (Pas) for all genomic tests. For more information click here and go to Industry News.

 

To view the complete California Oncology Weekly Newsletter, click on the date below.

 

August 29, 2017

This Weekly’s Hot Topics

  • No-cost technical assistance on MACRA for California physicians. (California News)
  • FDA Reauthorization Act of 2017 signed into (National News)
  • DHHS has delayed the 340B final rule (CMS News)

 

The price disclosure bill, SB 17 by state Sen. Ed Hernandez (D-Azusa), is now one of five measures, in Sacramento, that have been proposed to tackle prescription costs. The California Cancer PAC is “watching” this bill as it goes through various iterations. For more information click here and go to California News.

The Health Services Advisory Group, in partnership with the California Health Information Partnership & Services Organization, is providing no-cost technical assistance to physician offices in California to help them prepare for and participate in the Quality Payment Program, established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). For more information click here and go to California News.

This Friday, August 25th, the Department of Managed Health Care (DMHC) invites you to a public meeting on the development of the standard formulary template as required by Senate Bill 1052 (2015). The meeting will be held at 980 9th Street, 5th Floor, Sacramento, 95814, beginning at 10:00 a.m. and ending after the last public comment is received. Seating is limited for in-person attendance and will be on a first-come, first-served basis. For more information click here and go to DMHC News.

The need to have end-of-life planning conversations with your critically ill patients, taking a half hour or more for those talks is covered by Medicare. CMS finalized the creation of the new codes in the 2016 physician fee schedule and allowed clinicians to bill Medicare for those conversations. The CMS rates range from $80 to $86 for the first 30 minutes and about $75 for each additional 30 minutes. The creation of this new billing code has been an important catalyst for ensuring that providers, Medicare beneficiaries and their families all know the patient’s desired care for his or her final days and preventing unwanted, intensive medical interventions from being performed. For more information click here and go to CMS News.

NCCN has published and/or updated their Chemotherapy Order Templates; Clinical Practice Guidelines in Oncology, Drugs & Biologics Compendium; Evidence Blocks; Guidelines for Patients; Imaging Appropriate Use Criteria; and/or, Radiation Therapy Compendium for hepatobiliary cancers (V3.2017); Smoking Cessation (V2.2017).  NCCN  published the following correction to the NCCN Chemotherapy Order Templates (NCCN Templates®):  A dosing error that would lead to underdosing of methotrexate was found on the following chemotherapy order template.  For more information click here and go to Affiliate Association News.

To view the complete California Oncology Weekly Newsletter, click on the date below.

August 22, 2017

This Weekly’s Hot Topics

  • CMA Board of Trustee Meeting summary (California News)

 

The Institute for Clinical and Economic Review (ICER) has posted a Draft Scoping Document on chimeric antigen receptor t-cell (CAR-T) therapies for treatment of B-cell malignancies. The document will be open to public comment for three weeks until August 29, 2017 at 2pm PT. For more information click here and go to California News.

Noridian has published the ICD-10 Coding Revision to NCDs CR10184. Change Request (CR) 10184 outlines edits to International Classification of Diseases, 10th Revision (ICD-10) and other coding updates specific to National Coverage Determinations (NCDs) that will be included in subsequent, quarterly releases as needed. For more information click here and go to Noridian News.

The Department of Managed Health Care (DMHC) invites you to a public meeting on the development of the standard formulary template as required by Senate Bill 1052 (2015). The meeting will be held at 980 9th Street, 5th Floor, Sacramento, 95814, on August 25, 2017, beginning at 10:00 a.m. and ending after the last public comment is received. For more information click here and go to DMHC News.

Subscribers of the PQRS listserv are encouraged to sign up for the new CMS Quality Payment Program (QPP) listserv. The Quality Payment Program is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and includes two tracks — Advanced Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS). For more information click here and go to CMS News.

As we have discussed in our Weekly, COA has been in discussion since last year regarding Express Scripts and other commercial plans excluding oncology practice pharmacies from network. Last April 1, 2016 ESI gave notice that the 25 drugs they listed would be filled outside of the oncology-practice pharmacies.  There are others, like Argus, not allowing oncology-practice pharmacies to be in network. For more information click here and go to Afilliate News.

To View the complete California Oncology Weekly Newsletter, click on the date below.

August 15, 2017

This Weekly’s Hot Topics

  • TODAY, tips to improve and enhance patients’ communications. (California News)
  • TOMORROW, Grand Opening of the UCI’s new digestive disease center. (MOASC News)
  • TOMORROW, What You Need to Know about CMS’ Proposed 2018 OPPS and PFS Rules(Affiliate Assoc. News)

 

TODAY, Tuesday, August 8th, at 5pm PT, Noam Z. Drazin, MD, Cedars Sinai Medical Group, will share helpful tips to improve and enhance patients’ communications with their health care team and empower participants to advocate for themselves when discussing individual concerns including screening, fertility, fear of recurrence, new research, clinical trials, and immunotherapy. A peer supporter will share their personal story and a live question and answer session will follow the presentation. For more information click here and go to California News.

In the June 27, 2017 edition of the California Oncology Weekly, MOASC asked for reader feedback on Blue Shield’s pilot cancer care program (Blue Shield Letter) with an update in the July 11, 2017 publication, where we shared the California Department of Managed Health Care response to MOASC. MOASC is now in receipt of Blue Shield’s response to the CMA’s persistence. For more information click here and go to MOASC News.

The annual Medicare open enrollment period begins on October 15, 2017, and ends on December 7, 2017. During this time, Medicare beneficiaries can choose health and drug plans for 2018 by comparing their current coverage and plan quality ratings to other plan offerings or choose to remain in traditional Medicare. CMS anticipates releasing the premiums and costs for Medicare health and drug plans for the 2018 calendar year in mid-September. For more information click here and go to CMS News.

ACCC and the Advisory Board Oncology Roundtable are collaborating on a comprehensive survey to capture the challenges and successes of cancer programs across the countryThe Trending Now in Cancer Care survey examines the hottest topics in oncology today, including hospital and physician alignment strategies, value-based care models, EHR use and interoperability, clinical staffing challenges, and more!. For more information click here and go to Affiliate Association News.

The Community Oncology Alliance (COA) announces the launch of the COA Fellows Initiative that seeks to engage and educate oncology fellows on the value of practicing in the community setting. The initiative is designed to inform and assist oncology fellows as they prepare for their career in the practice of medicine. For more information click here and go to Affiliate Association News.

 

To view the complete California Oncology Weekly Newsletter, click on the date below.

August 8, 2017

This Weekly’s Hot Topics

  • Significant health care program changes in the 2017-18 California State Budget. (California News)
  • MEET WITH YOUR MEMBER OF CONGRESS! (National News)
  • TOMORROW is the deadline to submit an abstract for ASH’s annual meeting (Affiliate News)

Tuesday, August 8th, at 5p.m. (PT) Noam Z. Drazin, MD, Cedars Sinai Medical Group, will share helpful tips to improve and enhance patients’ communications with their health care team and empower participants to advocate for themselves when discussing individual concerns including screening, fertility, fear of recurrence, new research, clinical trials, and immunotherapy. For more information click here and go to California News.

ASP Medicare Part B Drug Pricing Files and Revisions – October 2017 CR10187. Make sure your billing staffs are aware of these changes. Change Request (CR) 10187 instructs MACs to download and implement the October 2017 and, if released, the revised July 2017, April 2017, January 2017, and October 2016, ASP drug pricing files for Medicare Part B drugs via the Centers for Medicare & Medicaid Services (CMS) Data Center (CDC). For more information click here and go to Noridian News.

Health and Human Services Secretary Tom Price, a former orthopedic surgeon, has taken a number of steps that are favored by his former physician colleagues, including quietly rolling back regulations that have been criticized by provider groups. For more information click here and go to National News.

The legal team at Johnson & Johnson created “2018 MACRA QPP Proposed Rule Update” highlights and Q&A documents. These provide a concise summary of the 2018 MACRA QPP Proposed Rule.  CMS is accepting comments until August 21, 2017. For more information click here and go to CMS News.

TOMORROW, Wednesday, August 2, at 11:59 p.m. PT is the deadline to submit an abstract for ASH’s annual meeting in Atlanta, GA, December 9-12, where the best scientific research in all areas of hematology will be showcased.  For more information click here and go to Affiliate News.

 

To view the complete California Oncology Weekly Newsletter, click on the date below.

August 1, 2017