CMS Issues Rule Finalizing Oct. 1, 2015 as ICD-10 Compliance Date
On July 31, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a rule (CMS-0043-F) making Oct. 1, 2015, the new compliance date for healthcare providers, health plans, and healthcare clearinghouses to transition to ICD-10. “This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015,” the agency said in a statement.
Read the CMS press release here.
FDA Expands Approved Use of Imbruvica for CLL
On July 28, 2014, the U.S. Food and Drug Administration (FDA) expanded the approved use of Imbruvica (ibrutinib) to treat patients with chronic lymphocytic leukemia (CLL) who carry a deletion in chromosome 17 (17p deletion), which is associated with poor responses to standard treatment for CLL. Imbruvica received a breakthrough therapy designation for this use.
The FDA is also approving new labeling to reflect that Imbruvica’s clinical benefit in treating CLL has been verified. In February 2014, Imbruvica received accelerated approval to treat CLL based on its effect on overall response rate. New clinical trial results examining progression-free survival and overall survival have confirmed the drug’s clinical benefit.
Read the FDA press release here.
FDA Approves Zydelig for Three Types of Blood Cancers
On July 23, 2014, the U.S. Food and Drug Administration (FDA) approved Zydelig (idelalisib) to treat patients with three types of blood cancers.
Zydelig is being granted traditional approval to treat patients whose chronic lymphocytic leukemia (CLL) has returned (relapsed). Used in combination with Rituxan (rituximab), Zydelig is to be used in patients for whom Rituxan alone would be considered appropriate therapy due to other existing medical conditions (co-morbidities). Zydelig is the fifth new drug with breakthrough therapy designation to be approved by the FDA and the third drug with this designation approved to treat CLL.
The FDA is also granting Zydelig accelerated approval to treat patients with relapsed follicular B-cell non-Hodgkin lymphoma (FL) and relapsed small lymphocytic lymphoma (SLL), another type of non-Hodgkin lymphoma. Zydelig is intended to be used in patients who have received at least two prior systemic therapies.
Read the FDA press release here.
Upcoming MLN Connects Call on Open Payments: Registration, Review, & Dispute
Phase 2 of the Open Payments (Sunshine Act) roll out allows providers to register in the Open Payments system, and then review and—if needed—dispute any of the data reported by the industry before public posting of the data. During an upcoming MLN Connects National Provider Call, CMS experts will give a brief overview about Open Payments and provide a step-by-step review of the registration, review, and dispute process.
Open Payments (Sunshine Act): Registration, Review, and Dispute
Tuesday, July 22
2:30 pm – 4:00 pm ET
To register: Visit MLN Connects™ Upcoming Calls. Space may be limited, register early.
More information is available here.
CMS Announces New Prospective Health Care Innovation Awardees
July 9, 2014, U.S. Department of Health and Human Services Secretary Sylvia Mathews Burwell announced new prospective awardees to test innovative care models under the Health Care Innovations Awards program. This brings the total amount of funding to as much as $360 million for 39 recipients spanning 27 states and the District of Columbia. These models are designed to deliver better health care and lower costs under the Health Care Innovation Awards program.
The new prospective (not yet final) awards range from an expected $2 million to $23.8 million over a three-year period. These awards, made possible by the Affordable Care Act, round out the anticipated recipients for round two of the Health Care Innovation Awards program.
Read HHS press release here.
Learn more about Health Care Innovation Awards Round Two here.
CMS Releases 2015 Medicare PFS Proposed Rule
On July 3, 2014, the Centers for Medicare & Medicaid Services (CMS) released the 2015 Medicare Physician Fee Schedule (PFS) Proposed Rule. In a fact sheet, CMS states that the agency is proposing a new process for establishing PFS payment rates that will be more transparent and allow for greater public input prior to payment rates being set. Under the proposed new process, beginning in 2016, payment changes would go through notice and comment rulemaking before being adopted.
The proposed rule is scheduled for publication in the July 11, 2014 Federal Register. CMS will accept comments on the proposed rule until Sept. 2, 2014.
More information is available here.
ACCC is currently analyzing the proposed rule and will be provide more in-depth information to members shortly.
View additional fact sheets on the Value-Based Payment Modifier (Value Modifier) and quality provisions in the 2015 PFS proposed rule here.
CMS Releases 2015 OPPS Proposed Rule
On July 3, 2014, the Centers for Medicare & Medicaid Services (CMS) released the 2015 Outpatient Prospective Payment System (OPPS) Proposed Rule. Under the proposal payments for outpatient hospitals would increase 2.1 percent in 2015.
The proposed rule is scheduled for publication in the July 14, 2014 Federal Register and can be downloaded from the Federal Register here.
CMS will accept comments on the proposed rule until Sept. 2, 2014, and will respond to comments in a final rule scheduled for release on or around Nov. 1, 2014.
ACCC is currently analyzing the proposed rule and will be provide more in-depth information to members shortly.
Read a separate CMS fact sheet on quality provisions in the proposed rule here.
FDA Approves Beleodaq to Treat Rare Form of non-Hodgkin Lymphoma
On July 3, 2014, the U. S. Food and Drug Administration (FDA) granted accelerated approval to belinostat (BELEODAQ, Spectrum Pharmaceuticals, Inc.) for the treatment of patients with relapsed or refractory peripheral T-cell lymphoma (PTCL).
As a condition of this accelerated approval, FDA requires the sponsor to conduct a dose-finding trial of belinostat when combined with CHOP (cyclophosphamide, vincristine, doxorubicin and prednisone) and a subsequent phase 3 trial to characterize the comparative efficacy and safety of belinostat in combination with CHOP versus CHOP alone.
Read the FDA announcement here.
Read FDA press release here.
Navigator Grants Opportunity in Federally-Facilitated and State Partnership Marketplaces Announced by CMS
The Centers for Medicare & Medicaid Services (CMS) has announced a total of $60 million in available funding to support Navigators in federally-facilitated and state partnership Marketplaces in 2014-2015. Navigators provide unbiased information to consumers about health insurance, the Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.
The funding opportunity for navigator grants is open to eligible individuals, as well as private and public entities, applying to serve as Navigators in states with a Federally-facilitated or State Partnership Marketplace. It is open to new and returning Navigator applicants. Applications are due by July 10, 2014.
Last month, CMS finalized regulations that update the requirements applicable to Navigators. The final rule is available here.
The CMS funding opportunity announcement is available here, search for CFDA # 93.332.
More information about Navigators is available here.
FDA Warns Docetaxel May Cause Symptoms of Alcohol Intoxication After Treatment
In a June 20, 2014, drug safety communication, the U.S. Food and Drug Administration (FDA) warns that the intravenous chemotherapy drug docetaxel contains ethanol, also known as alcohol, which may cause patients to experience intoxication or feel drunk during and after treatment. The FDA is revising the labels of all docetaxel drug products to warn about this risk. The FDA announcement states that healthcare professionals should consider the alcohol content of docetaxel when prescribing or administering the drug to patients, particularly in those whom alcohol intake should be avoided or minimized and when using it in conjunction with other medications.
View the FDA drug safety communication on docetaxel here.
MedPAC Makes Short- and Long-Term Recommendations for Strengthening ACOs
On June 16, the Medicare Payment Advisory Commission (MedPAC) provided comments to the Centers for Medicare & Medicaid Services (CMS) that raise five key issues regarding the Pioneer ACOs.
In the short-term, MedPAC said that CMS needs to improve beneficiary assignment and simplify the quality measurement and evaluation process. Among the longer term issues that need to be addressed is the necessity to move toward a program in which ACOs share risks as well as savings. The MedPAC comment letter states that: "Almost all MSSP ACOs have chosen to be one-sided (bonus only) rather than two-sided risk. However, incentives for improvement are much stronger in a two-sided model."
The 18-page comment letter addresses "...issues essential to the success of the program that will require changes in either regulation or legislation to be resolved...."
Read the MedPAC comment letter here.
Lung-MAP Collaborative Clinical Trial Launched
On June 16, 2014, the launch of a unique public-private collaborative clinical trial, the Lung Cancer Master Protocol (Lung-MAP) trial was announced. The trial represents a collaborative effort among the National Cancer Institute (NCI), SWOG Cancer Research, Friends of Cancer Research, the Foundation for the National Institutes of Health (FNIH), five pharmaceutical companies (Amgen, Genentech, Pfizer, AstraZeneca, and AstraZeneca’s global biologics R&D arm, MedImmune), and Foundation Medicine.
Lung-MAP is a multi-drug, multi-arm, biomarker-driven clinical trial for patients with advanced squamous cell lung cancer. The trial will use genomic profiling to match patients to one of several different investigational treatments that are designed to target the genomic alterations found to be driving the growth of their cancer.
“Lung-MAP represents the first of several planned large, genomically-driven treatment trials that will be conducted by NCI’s newly formed National Clinical Trials Network (NCTN),” said Jeff Abrams, MD, Associate Director of NCI’s Cancer Therapy Evaluation Program in a press release. “The restructuring and consolidation of NCI’s large trial treatment program, resulting in the formation of the NCTN, is quite timely, as it now can offer an ideal platform for bringing the benefits of more precise molecular diagnostics to cancer patients in communities large and small.”
Initially, the trial will test five experimental drugs—four targeted therapies and an anti-PD-L1 immunotherapy. Estimates are that between 500 and 1000 patients will be screened per year for over 200 cancer-related genes for genomic alterations. The results of this test will be used to assign each patient to the trial arm that is best matched to his or her tumor’s genomic profile.
Read the press release here.
Learn more about the Lung-MAP trial here.
American Cancer Society Releases New Prostate Survivorship Guidelines
New Prostate Cancer Survivorship Care guidelines from the American Cancer Society (ACS), released on June 10, outline post-treatment clinical follow-up care for the long-term and late effects that the estimated 2.8 million prostate cancer survivors in the U.S. may face. The guidelines report is published early online in the ACS journal, CA: A Cancer Journal for Clinicians.
The guidelines are designed to promote optimal health and quality of life for post-treatment prostate cancer survivors by facilitating the delivery of comprehensive post-treatment care by primary care clinicians, the ACS said. The new guidelines are based on recommendations from an expert panel convened through the National Cancer Survivorship Resource Center, a collaboration between ACS and The George Washington University Cancer Institute, which is funded by a 5-year cooperative agreement from the Centers for Disease Control and Prevention (CDC).
Read the ACS press release here.
ONC Releases 10-Year Plan for Health IT Interoperability
The Office of the National Coordinator (ONC) for Health Information Technology has issued a 10-year general plan for achieving an interoperable health IT infrastructure. The plan focuses on the need to resolve interoperability issues in order to realize the promise of health IT to improve care, create efficiencies, and save money. The 13-page plan outlines three-, six- and 10-year agendas for interoperability and data sharing.
Read “A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure” here.
QOPI Approved as Pathway to Meet CMS's Quality Reporting Requirements
The Centers for Medicare & Medicaid Services (CMS) has approved the American Society of Clinical Oncology’s (ASCO) Quality Oncology Practice Initiative (QOPI®) as a pathway for oncologists to meet the agency’s quality reporting requirements. Starting in the fall of 2014, oncology practices registered with QOPI will have the opportunity to fulfill CMS’s Physician Quality Reporting System (PQRS) or Qualified Clinical Data Registry (QCDR) reporting requirements through QOPI, according to an ASCO press release.
FDA Approves Aloxi for Pediatric Patients
On May 28, Eisai Inc. and Helsinn Group announced U.S. Food and Drug Administration (FDA) approval of Aloxi® (palonosetron HCl) injection for the prevention of acute nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy, including highly emetogenic cancer chemotherapy, in children aged 1 month to less than 17 years.
Sunshine Act Phase 2 Data Submissions to Start June 1
Sunshine Act Phase 2 data collection will begin June 1, 2014, according to a recent blog post from the Centers for Medicare & Medicaid Services (CMS).
From June 1 through June 30, applicable drug manufacturers and group purchasing organizations will be able to complete their registration in the Open Payments system and confirm the accuracy of any data submitted during Phase 1. All payment data must be submitted by June 30.
Also beginning June 1, physicians and teaching hospitals will be able to register in the CMS Enterprise Portal, and review data submitted about them by pharmaceutical manufacturers and GPOs.
The CMS blog post states:
"Physicians and teaching hospitals will be able to review data submitted by the manufacturers and GPOs, and if needed, they should report and dispute inaccuracies before the data is included in the public database. They can review the information submitted about them by registering in our Enterprise Portal starting June 1, 2014. Then, in July, physicians and teaching hospitals can begin to register in the Open Payments system. Those registered will be notified when data has been submitted about them, allowing them to review and dispute data submitted by health care manufacturing companies and GPOs prior to public data posting."
FDA Approves Panitumumab for Use with FOLFOX in Wild-Type KRAS mCRC
On May 23, 2014, Amgen announced that the U.S. Food and Drug Administration (FDA) has approved a new indication for Vectibix® (panitumumab) specifically for use in combination with FOLFOX, an oxaliplatin-based chemotherapy regimen, as first-line treatment in patients with wild-type KRAS (exon 2) metastatic colorectal cancer (mCRC).
The FDA also approved the therascreen® KRAS RGQ PCR Kit developed by QIAGEN (therascreen KRAS test) as a companion diagnostic for Vectibix. Vectibix is not indicated for the treatment of patients with KRAS-mutant mCRC or for whom KRAS mutation status is unknown.
ACR Launches Designated Lung Cancer Screening Center Program
On May 8, 2014, the American College of Radiology (ACR) announced that it is accepting applications for its new ACR Lung Cancer Screening Center program. The program recognizes facilities committed to providing quality screening care to patients at the highest risk for lung cancer.
To apply for the ACR Lung Cancer Screening Center designation, centers must have an active ACR CT accreditation in the chest module and meet specific equipment, personnel, and imaging protocol requirements.
FDA Approves Synribo for Injection for Home Administration
On May 5, 2014, Teva Pharmaceutical Industries Ltd. announced that the U.S. Food and Drug Administration (FDA) has approved Synribo® (omacetaxine mepesuccinate) for injection, for subcutaneous use, to include home administration, and also approved a related Medication Guide and Instructions for Use. With this approval, physicians who treat adults with chronic or accelerated phase CML who are no longer responding to, or who could not tolerate, two or more tyrosine kinase inhibitors will now have the option to allow their patients to administer Synribo® therapy at home.
Teva is working to finalize a comprehensive specialty pharmacy support program which will help facilitate successful home administration of Synribo for healthcare providers, their patients, and caregivers. This program is expected to “go live” as early as possible in the second quarter of 2014.
HHS Bulletin Mentions Special Enrollment Period for COBRA-Eligible People
On May 2, 2014, the U.S. Department of Health and Human Services (HHS) issued a guidance bulletin, titled “Special Enrollment Periods and Hardship Exemptions for Persons Meeting Certain Criteria” with information on three types of special enrollment periods for those seeking to enroll in qualified health plans (QHPs) through the Federally-facilitated Marketplace (FFM).
The guidance states that “special enrollment periods” will be allowed for people eligible for Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage after losing or changing jobs. Those individuals will be able to select QHPs in the FFM 60 days from the date of the bulletin, through July 1, 2014, the bulletin said.
Altogether, the bulletin addresses three types of special enrollment periods for those seeking to enroll in QHPs through the FFM, and two hardship exemptions available for eligible consumers in FFM and state-based marketplaces.
MEDCAC Gives CT Lung Screening Low-Confidence Vote
On Wednesday, May 1, 2014, the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) voted a mean of 2.2 on a 5.0 scale for confidence regarding annual low-dose CT lung cancer screening for high-risk individuals.
The panel’s vote does not align with the United States Preventive Services Task Force (USPSTF) December 2013 recommendation.
MEDCAC is slated to release its proposed decision in November, followed by a 30-day comment period, with a final determination 90 days later.
Read ACCC’s comment letter to CMS in support of low-dose CT screening as recommended by the USPSTF.
FDA Grants Orphan Drug Designation to Demcizumab for Pancreatic Cancer
On May 2, 2014, OncoMed Pharmaceuticals Inc., announced that the U.S. Food and Drug Administration (FDA) has granted orphan drug designation to demcizumab (anti-DLL4, OMP-21M18) for the treatment of pancreatic cancer. OncoMed is currently conducting a Phase 1b clinical trial of demcizumab in combination with Abraxane® (nab-paclitaxel) and gemcitabine in first-line Stage IV pancreatic cancer patients.
The FDA's Orphan Drug program provides orphan status to drugs and biologics that are intended for the treatment of rare diseases that affect fewer than 200,000 people in the U.S.
Read the company statement here.
CMS Releases Proposed Inpatient Hospital Payment Update
On April 30, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update fiscal year (FY) 2015 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals. CMS states that the proposed rule would strengthen the tie between payment and quality improvement.
The agency projects that the payment rate update to general acute care hospitals will be 1.3 percent in FY 2015. However, under the proposed rule, aggregate payments (operating and capital) are expected to drop $241 million, the agency said, as reported by Bloomberg BNA.
The proposed rule will be published in the May 15 Federal Register. CMS will accept comments on the proposed rule until June 30, 2014, and will respond to comments in a final rule to be issued by August 1, 2014.
Read the CMS press release here.
CMS Issues Medicare PPS Rule for FQHCs
On April 29, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that establishes a Medicare Prospective Payment System for Federally Qualified Health Centers (FQHCs). The payment system could increase Medicare payments to FQHCs by as much as 32 percent, CMS said. FQHCs provide access to medical services to patients in or from medically underserved areas.
The Affordable Care Act requires that the new Medicare Prospective Payment System (PPS) for FQHCs account for a number of factors, including the type, intensity, and duration of services provided in this setting. The new payment system will be implemented beginning on October 1, 2014. FQHCs will be transitioned to the new payment system throughout 2015.
The final rule will be published in the May 2, 2014, Federal Register. CMS is seeking comments on modifications of a few proposals including: a simplified method for calculating coinsurance when a preventive and non-preventive service is on the same claim; the establishment of Medicare-specific payment codes to be used for Medicare encounter-based payment under the new PPS; and ways in which payment for chronic care management services could be adapted for FQHCs and rural health clinics. CMS will accept comments until July 1, 2014, and will respond to them in a final rule to be issued in 2014.
Read the CMS press release here.
FDA Approves Zykadia for Late-stage Lung Cancer
The U.S. Food and Drug Administration, on April 29, 2014, granted accelerated approval to Zykadia (ceritinib) for patients with a certain type of late-stage (metastatic) non-small cell lung cancer (NSCLC).
Zykadia is an anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor that blocks proteins that promote the development of cancerous cells. It is intended for patients with metastatic ALK-positive NSCLC who were previously treated with crizotinib, the only other approved ALK tyrosine kinase inhibitor.
The FDA is approving Zykadia under the agency’s accelerated approval program, which allows approval of a drug to treat a serious or life-threatening disease based on clinical data showing the drug has an effect on a surrogate endpoint reasonably likely to predict clinical benefit to patients. This program provides earlier patient access to promising new drugs while the company conducts confirmatory clinical trials.
Read the FDA press release here.
More information is available here.
FDA Approves Oral Suspension of Mercaptopurine
On April 28, 2014, the FDA approved an oral suspension of mercaptopurine (Purixan, NOVA Laboratories Limited). Mercaptopurine is a 20 mg/ml oral suspension. Purixan is indicated for the treatment of patients with acute lymphoblastic leukemia (ALL) as part of a combination regimen.
Read the FDA announcement here.
FDA Approves Ramucirumab for Advanced Gastric or GEJ Cancer
On April 21, 2014, the U. S. Food and Drug Administration approved ramucirumab (Cyramza, Eli Lilly and Company) for use as a single agent for the treatment of patients with advanced or metastatic, gastric or gastroesophageal junction (GEJ) adenocarcinoma with disease progression on or after prior treatment with fluoropyrimidine- or platinum-containing chemotherapy. Ramucirumab is a recombinant monoclonal antibody of the IgG1 class that binds to vascular endothelial growth factor receptor-2 (VEGFR-2) and blocks the activation of the receptor.
Read the FDA announcement here.
FDA Approves Ofatumumab in Combination with Chlorambucil, for Previously Untreated CLL
On April 17, 2014, the U. S. Food and Drug Administration approved ofatumumab (Arzerra Injection, for intravenous infusion; GlaxoSmithKline) in combination with chlorambucil, for the treatment of previously untreated patients with chronic lymphocytic leukemia (CLL), for whom fludarabine-based therapy is considered inappropriate.
Read the FDA announcement here.
FDA Grants Orphan Drug Designation to Volasertib for AML
On April 17, 2014, Boehringer Ingelheim Pharmaceuticals, Inc., announced that the U.S. Food and Drug Administration (FDA) has granted Orphan Drug Designation to volasertib for acute myeloid leukemia (AML). Volasertib is currently being evaluated in a Phase III clinical trial for the treatment of patients aged 65 or older, with previously untreated AML, who are ineligible for intensive remission induction therapy. Volasertib has not been approved by the FDA; its safety and efficacy have not been established.
In the U.S. Orphan Drug Designation is a status given to investigational compounds intended to treat a rare disease or condition that has limited treatment options. To qualify for FDA’s Orphan Drug Designation, the drug must, among other requirements, address a disease that affects fewer than 200,000 total people in the U.S.
Read company press release here.
NCI GEM Initiative Webinar on April 17
The National Cancer Institute's Grid Enabled Measures (GEM) initiative is presenting a webinar on GEM Care Planning: Advancing Survivorship Care Planning Through Community Engagement on Thursday, April 17, 2014, 2-3PM EST.
NCI's Carly Perry, PhD, MA, MSW, and University of Pittsburgh's Ellen Beckjord, PhD, MPH, will present on the GEM-Care planning (GEM-CP) initiative and related science. They will share insights into the GEM-CP platform and movement to develop consensus on measures to evaluate survivorship care planning as well as discuss results of the initiative. Learn more about GEM here: www.gem-measures.org.
To access the webinar online, go to https://webmeeting.nih.gov/gems and log in as a Guest at 1:45 pm. When the login screen appears, select the option to Enter as a Guest, enter your full name and click on the Enter Room button. Once you have entered the Adobe Connect Webmeeting, call the teleconference call number and follow the prompts:
Teleconference Number: 1-866-398-2885
Teleconference Passcode: 6381864930
ASCO Releases Three Guidelines on Survivorship Care
On April 14, the American Society of Clinical Oncology (ASCO) issued three evidence-based clinical practice guidelines on the prevention and management of symptoms that affect many cancer survivors—neuropathy, fatigue and depression, and anxiety. The guidelines are the first three in a planned series of guidelines on survivorship care.
Learn more here.
NCI Statement Outlines Changes in Clinical Trials Programs
The National Cancer Institute (NCI) issued a statement on April 4 that briefly outlines the changes now being made in the enterprises that conduct clinical trials under the auspices of the NCI. This includes creation of the new National Clinical Trials Network (NCTN), and consolidation of NCI’s several existing community-based clinical trials programs into an NCI Community Oncology Research Program (NCORP).
Read the NCI statement here.
More information is available here.
PQRS and eRx Incentive Program Participation Grows, CMS Says
The Centers for Medicare & Medicaid Services (CMS) reports increased participation in the Medicare Physician Quality Reporting System (PQRS) and the Electronic Prescribing Incentive (eRx) Program between 2011 and 2012. On April 3, CMS released “The 2012 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program Experience Report.” The report finds:
- Participation in the PQRS program grew by 36 percent from 2011. Approximately 36 percent of the 1,201,363 professionals who were eligible to participate in 2012 participated in PQRS. The 2012 PQRS incentive payments totaled $167,815,193.
- PSQRS participation is highest among eligible professionals who see the most Medicare patients. While the overall PQRS participation rate is 36%, participation is at 53% among those who treat more than 200 Medicare beneficiaries a year.
- Participation in the eRx program increased by 22 percent from 2011. Approximately 44 percent of the 778,904 professionals who were eligible to participate in 2012 participated in the eRx program. The 2012 eRx incentive payments totaled $335,331,216.
Read the CMS press release and access the full report here.
Senate Passes 1-Year SGR Extension
On March 31 the U.S. Senate approved sustainable growth rate (SGR) "patch" legislation to extend current Medicare physician payment rates through March 15, 2015. The House had approved the legislation on March 27. President Obama is expected to sign the bill, Bloomberg BNA reports.
The legislation would also delay implementation of ICD-10 until Oct. 1, 2015.
Update on Doxil Supply
In a March 24, 2014, Dear Healthcare Professional letter, Janssen Products, LP, provides an update on the doxil supply.
CMS Issues Meaningful Use 2014 CEHRT Hardship Exception Guidance
On March 10, the Centers for Medicare & Medicaid Services (CMS) issued hardship exception guidance for Medicare-participating eligible providers (EPs) and eligible hospitals unable to implement the 2014 Edition of Certified Electronic Health Record (EHR) Technology in time to successfully demonstrate meaningful use for the 2014 reporting year.
The guidance is to help EPs and hospitals who participated in Stage 1 of the meaningful use program but have been unable to update their EHR systems this year to comply with the 2014 Edition EHR certification criteria from the Office of the National Coordinator of Health IT.
Payment adjustments based on the 2014 reporting period will go into effect in 2016. CMS notes that the payment adjustments only apply to the Medicare EHR Incentive Program.
CMS issued separate one-page guidance for Medicare-participating EPs and Medicare-participating hospitals.
Read the guidance for eligible professionals here.
In additional guidance for eligible professionals and eligible hospitals updated in March, CMS indicated that additional exceptions may be granted for other reasons such as being newly practicing EPs, practice at multiple locations, and “unforeseen circumstances.”
CMS Will Not Finalize Several Provisions of Part D Proposal
In a March 10 letter, the Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner told Congress the agency will not move ahead with four provisions of a Part D proposed rule, including the proposal to lift the "protected class" definition of three drug classes.
In the letter, Tavenner said: “Give the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time.”
Read the letter here.
CMS Seeks Comments on Transforming Physician Payment Models
The Centers for Medicare & Medicaid Services (CMS) is seeking comments on the best methods for assisting physician practices in the move from a fee-for-service reimbursement model to alternative payment models. On March 5, CMS issued a request for information (RFI) on delivery system reform. The agency is asking for input on policy considerations about large scale transformation of clinical practices with the aim of better care and better health at lower costs. CMS may use the information collected from this RFI to test new payment and service delivery models.
The deadline for comments is April 8, 2014.
Administration’s Proposed FY 2015 Budget Includes $1 Trillion in Health Spending
On March 4 the Obama administration proposed a fiscal year (FY) 2015 budget that includes nearly $1 trillion for federal health programs administered by the Department of Health and Human Services (HHS). Included are legislative proposals for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) that the administration says will save more than $400 billion through 2024.
However, it is unlikely that the administration’s proposals in their current form will be passed by Congress. Many of the proposals have been included in previous budgets proposed by the administration and have not been acted upon.
The proposed FY 2015 budget includes the following Medicare-specific proposals:
- Increase premiums under Part B and Part D for higher income beneficiaries
- Reduce reimbursements for Part B drugs from 106 percent of average sales price to 103 percent
- Align Medicare drug payment policies with Medicaid policies for low-income beneficiaries
- Prohibit critical access hospital designation for facilities that are less than 10 miles from the nearest hospital
- Strengthen the Independent Payment Advisory Board (IPAB) for Medicare by lowering the target rate for triggering IPAB recommendations to Congress.
Read the Health and Human Services FY 2015 Budget in Brief here.
FDA Grants Accelerated Approval to Ibrutinib for CLL
On Feb. 12, 2014, the U. S. Food and Drug Administration (FDA) granted accelerated approval to ibrutinib (IMBRUVICA, Pharmacyclics, Inc.) for the treatment of patients with chronic lymphocytic leukemia (CLL) who have received at least one prior therapy.
Ibrutinib previously received accelerated approval on November 13, 2013, for the treatment of patients with mantle cell lymphoma who have received at least one prior therapy.
Sunshine Act Data Collection to Begin Feb. 18, CMS Says
The Centers for Medicare & Medicaid Services (CMS) has announced the agency will start the first phase of Sunshine Act data collection on Feb. 18, 2014. During the initial phase, some manufacturers and group purchasing organizations will start submitting data to CMS on payments made to healthcare providers, including gifts, consulting fees, and research activities. Phase two, which will begin in May, will include industry registration in the CMS Open Payments system, submission of detailed 2013 payment data, and legal attestation to the accuracy of the data, Bloomberg BNA reports.
CMS Extends Medicare EHR Attestation Deadline for EPs; Offers Hospitals Attestation Help
On Feb. 7, the Centers for Medicare & Medicaid Services (CMS) announced a one-month extension—from 11:59 pm on February 28 to 11:59 pm on March 31, 2014—of the deadline for physicians and other eligible professionals (EPs) to meet the requirements of Medicare Meaningful Use program in 2013.
The hospital deadline was Dec. 1, 2013. However, the agency said that hospitals that experienced problems in attesting in 2013 can retroactively submit their attestation data in 2014. Hospitals that want to retroactively submit 2013 data must contact CMS by March 15, 2014.
The one-month deadline extension applies only to the Medicare EHR Incentive Program and not to the Medicaid EHR Incentive Program or the Physician Quality Reporting System EHR Incentive Program, the agency said.
Zaltrap Issued Permanent J Code
The Centers for Medicare & Medicaid Services (CMS) has granted Zaltrap® (ziv-aflibercept) Injection for Intravenous Infusion a permanent J Code: J9400. This new HCPCS code is effective for dates of service on or after January 1, 2014.
HHS Agency Suspends New Medicare Appeals for 2 Years, Due to Backlog
A memorandum from the Department of Health and Human Services (HHS) Office of Medicare Hearings and Appeals (OMHA) states that it is suspending the assignment of new Medicare appeals to administrative law judges for at least two years in order to work through an increasing backlog of appeals, according to Bloomberg BNA Health Care Daily Report (01/16, 2014). However, new beneficiary-initiated appeals will not be suspended.
The memorandum, authored by OMHA’s Chief Administrative Law Judge Nancy J. Griswold, said the suspension was effective as of July 15, 2013, and will affect most Medicare appeals at the ALJ appeal level. Griswold said the suspension applied to “Medicare providers and suppliers, and Medicaid state agencies,” BNA reports.
However, the letter stated that appeals filed directly by Medicare beneficiaries will continue to be assigned and processed “to ensure [beneficiaries’] health and safety is protected.”
OMHA will hold an Medicare Appellant Forum in Washington on February 12 to address the impact of the appeals suspension.
HHS Report Provides Demographic Information on Insurance Marketplace Enrollees
From Oct. 1 to Dec. 28, 2013, almost 2.2 million people selected plans through the Affordable Care Act’s state and federal insurance Marketplaces, according to a report released Jan. 13, by the U.S. Department and Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE). The report presents a “snapshot” of Marketplace enrollment-related activity during the initial open-enrollment period, based on available data. Highlights from the report include:
Marketplace Plan Selection by Age
- 24% of those who have selected a Marketplace plan are between the ages of 18 and 34.
- 30% of those who have selected a Marketplace plan are between the ages of 0 and 34.
Marketplace Plan Selection by Metal Level
- 60% of those selecting a Marketplace plan opted for a “Silver” tier plan.
- 20% have selected a Bronze tier plan.
- 13% have selected a Gold tier plan.
- 7% have selected a Platinum tier plan.
- 1% have selected a Catastrophic plan.
Marketplace Plan Selection by Financial Assistance
- 79% of those who have selected a Marketplace plan have selected a plan with financial assistance.
The report includes state-by-state information.
FDA Approves Mekinist in Combination with Tafinlar for Advanced Melanoma
The U.S. Food and Drug Administration (FDA) has approved Mekinist® (trametinib) for use in combination with Tafinlar® (dabrafenib) for the treatment of patients with unresectable melanoma or metastatic melanoma with BRAF V600E or V600K mutations. These mutations must be detected by an FDA-approved test. Tafinlar is not indicated for treatment of patients with wild-type BRAF melanoma.
The FDA approved the combination of Mekinist and Tafinlar under the agency’s accelerated approval program.
USPSTF Releases Final Recommendation on Screening for Those at High Risk of Lung Cancer
On Dec. 30, 2013, the U.S. Preventive Services Task Force (USPSTF) released its final recommendation on screening those at high risk of lung cancer, grading annual low-dose CT screening for individuals at high risk for lung cancer with a B grade.
The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
USPSTF Finds Benefit in Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-related Cancer for Small Group of High-Risk Women
On Dec. 24, 2013, the U.S. Preventive Services Task Force (USPSTF) issued its final recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women. The USPSTF recommends that women with family members who have had breast, ovarian, tubal, or peritoneal cancer talk with a healthcare professional to learn if their history might put them at risk for carrying a BRCA mutation. Women who screen positive should receive genetic counseling and, if indicated after counseling, BRCA testing. Additionally, for the vast majority of American women (90 percent), who do not have a family history associated with an increased risk for the inherited mutations, the USPSTF continues to recommend against genetic counseling and testing.
CMS Announces 123 New Provider Groups to Participate in MSSP as ACOs
On December 23, 2013, the Centers for Medicare & Medicaid Services (CMS) announced 123 new provider groups that will be participating in the Medicare Shared Savings Program (MSSP) in 2014 as accountable care organizations (ACOs), Bloomberg BNA reports.
The agency said that the new ACOs represent a diverse cross-section of healthcare providers, including those providing care in underserved areas. According to CMS, the new ACOs will deliver care for about 1.5 million more Medicare beneficiaries. The performance period for the new ACOs starts Jan. 1, 2014.
Annual Report to the Nation Shows Lung Cancer Deaths Continue to Decline
The Annual Report to the Nation on the Status of Cancer, covering the period 1975–2010, showed death rates for lung cancer, which accounts for more than one in four cancer deaths, dropping at a faster pace than in previous years. The recent larger drop in lung cancer deaths is likely the result of decreased cigarette smoking prevalence over many years, and is now being reflected in mortality trends. The report showed, however, that death rates increased for some cancers, including cancers of the liver and pancreas for both sexes, cancers of the uterus in women, and, in men only, melanoma of the skin and cancers of the soft tissue in this 10 year period.
The Report, produced annually since 1998, is co-authored by researchers from the National Cancer Institute (NCI); the American Cancer Society (ACS); the Centers for Disease Control and Prevention (CDC); and the North American Association of Central Cancer Registries (NAACCR). The Report appeared online in the journal Cancer on Dec. 16, 2013.
The Annual Report to the Nation on the Status of Cancer, 1975-2010, Featuring Prevalence of Comorbidity and Impact on Survival Among Persons With Lung, Colorectal, Breast, or Prostate Cancer is available here.
Federal Pre-Existing Condition Insurance Plan Extended One Month
The federal government’s Pre-Existing Condition Insurance Plan (PCIP), which was set to expire on Dec. 31, 2013, will be extended for one month while the government works to fix the Affordable Care Act health exchange that is intended to serve as an alternative, according to Bloomberg BNA Health Care Daily Report (Dec. 13, 2013). Individuals in the program who have not obtained coverage will be able to stay through the end of January, Aaron Albright, a CMS spokesperson said in a Dec. 12 email, BNA reports.
The extension does not affect high-risk insurance pools for sick people independently run by 35 states. Expiration dates for those plans vary and, in some states, will extend beyond Jan. 1, BNA reports.
CMS Delays Start of Stage 3 Meaningful Use
On Dec. 6, 2013, the Centers for Medicare & Medicaid Services (CMS) announced it will delay the start of Stage 3 Meaningful Use for one year, according to Bloomberg BNA Health Care Daily Report. Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2.
Hospitals and providers who have received incentive payments for at least two years under Stage 1 of the Meaningful Use program will still be required to move into Stage 2 in 2014. But the delay will provide an additional year of reporting under Stage 2 before they must move to Stage 3.
The revised timeline will not affect the 2016 Medicare payment penalties scheduled for providers and hospitals that do not meet meaningful use requirements, a CMS spokesperson told BNA.
CMS Releases 2014 PFS Final Rule
On Nov. 27, 2013, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2014 Physician Fee Schedule (PFS) final rule. Among the provisions included in the 2014 PFS final rule are the following:
Primary Care and Chronic Care Management. Medicare will begin making a separate payment for chronic care management services beginning in 2015. The rule indicates that CMS intends to establish practice standards necessary to support payment for furnishing care management services through future notice-and-comment rulemaking.
Misvalued Codes. Consistent with amendments made by the Affordable Care Act, CMS has been engaged in a vigorous effort over the past several years to identify and review potentially misvalued codes, and make adjustments where appropriate. The agency is continuing this effort as the values for around 200 codes were finalized and approximately 200 additional codes had their work relative value units changed on an interim basis for 2014.
CMS is not finalizing its proposal to adjust relative values under the PFS to effectively cap the physician practice expense payment for procedures furnished in a non-facility setting at the total payment rate for the service when furnished in an ambulatory surgical center or hospital outpatient setting. Instead, CMS will take additional time to consider issues raised by the public commenters and plans to address this issue in future rulemaking.
Compliance with State Law for “Incident To” Services. CMS is requiring as a condition of Medicare payment that “incident to” services be furnished in compliance with applicable state law. CMS also eliminated redundant regulations for each type of practitioner by consolidating the “incident to” requirements for all practitioners that are permitted to bill Medicare directly for their services, reducing the regulatory burden and making it less difficult for practitioners to determine what is required in order to bill Medicare for “incident to” services.
ACCC is continuing to review the final 2014 PFS rule and will have a more complete summary available later this week. ACCC will also host a members-only conference call on the 2014 OPPS and PFS final rules on Thursday, December 12.
The 2014 PFS final rule will appear in the December 10 Federal Register.
CMS Releases 2014 OPPS Final Rule
On Nov. 27, 2013, the Centers for Medicare & Medicaid Services (CMS) released the final calendar year (CY) 2014 Hospital Outpatient Prospective Payment System (OPPS) rule. The final rule updates the OPPS market basket by 1.7 percent for CY 2014.
Under the final rule, changes to hospitals OPPS payments and policies include:
Items and Services to be “Packaged” or Included in Payment for a Primary Service. For 2014, CMS finalizes five new categories of supporting items and services rather than the seven proposed. For certain cases, a separate payment would be made if the item or service is furnished on a different date of service as the primary service. The five final categories are:
1) Drugs, biologicals, and radiopharmaceuticals that function as supplies when used in a diagnostic test or procedure;
2) Drugs and biologicals that function as supplies; when used in a surgical procedure, including skin substitutes. Skin substitutes will be classified as either high cost or low cost and will be packaged into the associated surgical procedures with other skin substitutes of the same class;
3) Certain clinical diagnostic laboratory tests;
4) Certain procedures described by add-on codes;
5) Device removal procedures.
In addition to packaging these five categories, CMS finalizes its proposal to create 29 comprehensive APCs to replace 29 existing device-dependent APCs, but with a modification to apply a complexity adjustment for the most complex multiple device claims. CMS is delaying the implementation of these comprehensive APCs until CY 2015.
Collapsing Five Levels of Visits to One. The final rule streamlines the current five levels of outpatient clinic visit codes, replacing them with a single Healthcare Common Procedure Coding System (HCPCS) code describing all clinic visits.
The final rule does not finalize the proposal to replace the current five levels of codes for each type of emergency department visits. CMS intends to consider options to improve the codes for these services in future rulemaking.
Part B Drugs in the Outpatient Department. The rule finalizes the proposal to continue paying at ASP+6 percent for non-pass-through drugs and biologicals that are payable separately under the OPPS.
ACCC is continuing to review the final 2014 OPPS rule and will have a more complete summary available later this week. ACCC will also host a members-only conference call on the 2014 OPPS and PFS final rules on Thursday, December 12.
The 2014 OPPS final rule will appear in the December 10 Federal Register, and can be viewed here.
FDA Approves Nexavar to Treat Metastatic Differentiated Thyroid Cancer
On Nov. 22, 2013, the U.S. Food and Drug Administration (FDA) expanded the approved uses of Nexavar (sorafenib) to treat late-stage (metastatic) differentiated thyroid cancer. Differentiated thyroid cancer is the most common type of thyroid cancer.
Nexavar works by inhibiting multiple proteins in cancer cells, limiting cancer cell growth and division. The drug’s new use is intended for patients with locally recurrent or metastatic, progressive differentiated thyroid cancer that no longer responds to radioactive iodine treatment.
The FDA approved Nexavar to treat advanced kidney cancer in 2005. In 2007, the agency expanded the drug’s label to treat liver cancer that cannot be surgically removed.
Commission on Cancer to Modify Standard 1.3
The Accreditation Committee of the American College of Surgeons Commission on Cancer (CoC) has approved a motion to modify Standard 1.3, Cancer Committee Attendance. The modification will allow for an appointed individual and one designated alternate for both physician and non-physician members of the Cancer Committee. The individual appointment and alternate designation would be set at the beginning of the year when membership is confirmed. The revision to the standard would allow for the attendance of the appointed individual and the designated alternate to be combined to meet the percentage attendance requirement.
The CoC’s Standards Advisory Group of Excellence (SAGE) recommended that the Accreditation Committee approve the changes which will be implemented Jan. 1, 2014.
PCORI Board Approves More than $1 Billion in Funding for CER
The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors recently approved a two-year commitment to spend more than $1 billion in funding for comparative effective research (CER) projects in fiscal years 2014 and 2015, Bloomberg BNA Health Care Daily reports. At a November 18 meeting, the PCORI board also accepted the revised version of its methodology report that sets the groundwork for standards and types of research methods that can be used to develop CER.
PCORI has also adopted a new strategic plan that outlines three goals to advance patient-centered outcomes research: These are:
- To substantially increase the quantity, quality, and timeliness of useful, reliable evidence to improve healthcare decision making;
- To speed the implementation and use of findings from patient-centered outcomes research; and
- To influence clinical and healthcare research funded by others to be more patient-centered.
FDA Grants Crizotinib Regular Approval for Metastatic NSCLC
On November 20, 2013, the U. S. Food and Drug Administration (FDA) granted regular approval for crizotinib (Xalkori) capsules for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors are anaplastic lymphoma kinase (ALK)-positive as detected by an FDA-approved test.
The approval was based on demonstration of superior progression-free survival (PFS) and overall response rate (ORR) for crizotinib-treated patients compared to chemotherapy in patients with ALK-positive NSCLC with disease progression after platinum-based doublet chemotherapy.
An open-label, active-controlled, multinational, randomized trial enrolled 347 patients with ALK-positive, metastatic NSCLC. Patients were required to have progressed following platinum-based chemotherapy and to have ALK expression in tumor specimens detected by fluorescence in situ hybridization on central laboratory testing. Patients were randomized to receive either crizotinib 250 mg orally twice daily (n=173) or chemotherapy (n=174). Patients randomized to chemotherapy received pemetrexed (58%) or docetaxel (42%) if they had received prior pemetrexed. Approximately 64% of patients on the chemotherapy arm subsequently received crizotinib.
The trial demonstrated significantly prolonged progression-free survival (PFS) for crizotinib treatment compared to chemotherapy [HR=0.49, (95% CI: 0.37, 0.64), p<0.0001].
Crizotinib was previously granted accelerated approval in August 2011, based on durable, objective response rates (ORR) of 50% and 61% in two single-arm, open-label studies.
FDA Approves Imbruvica for Mantle Cell Lymphoma (MCL)
On Nov. 13, 2013, the U.S. Food and Drug Administration approved Imbruvica (ibrutinib) to treat patients with mantle cell lymphoma (MCL), a rare and aggressive type of blood cancer.
MCL is a rare form of non-Hodgkin lymphoma and represents about 6 percent of all non-Hodgkin lymphoma cases in the U.S. By the time MCL is diagnosed, it usually has already spread to the lymph nodes, bone marrow, and other organs.
Imbruvica is intended for patients with MCL who have received at least one prior therapy. It works by inhibiting the enzyme needed by the cancer to multiply and spread. Imbruvica is the third drug approved to treat MCL. Velcade (2006) and Revlimid (2013) are also approved to treat the disease.
Imbruvica is the second drug with breakthrough therapy designation to receive FDA approval. The Food and Drug Administration Safety and Innovation Act, passed in July 2012, gave the FDA the ability to designate a drug a breakthrough therapy at the request of the sponsor if preliminary clinical evidence indicates the drug may offer a substantial improvement over available therapies for patients with serious or life-threatening diseases.
FDA Approves Gazyva (obinutuzumab) for CLL
On November 1, 2013, the U.S. Food and Drug Administration (FDA) approved obinutuzumab (Gazyva™ injection, for intravenous use, previously known as GA101) for use in combination with chlorambucil for the treatment of patients with previously untreated chronic lymphocytic leukemia (CLL).
Obinutuzumab is approved with a BOXED WARNING regarding Hepatitis B virus reactivation and Progressive Multifocal Leukoencephalopathy. Patients should be advised of these risks and assessed for Hepatitis B virus and reactivation risk. Infusion reactions are included in the WARNING and PRECAUTIONS section of the label.
Read the FDA press release here.