FDA Approves Necitumumab in Combination Regimen for Patients with Metastatic Squamous NSCLC
On Nov. 24, 2015, the U.S. Food and Drug Administration (FDA) granted approval to necitumumab (Portrazza) in combination with gemcitabine and cisplatin for first-line treatment of patients with metastatic squamous non-small cell lung cancer (NSCLC). Necitumumab is not indicated for treatment of non-squamous NSCLC.
FDA Approves Nivolumab for Advanced Renal Cell Carcinoma
On Nov. 23, 2015, the U. S. Food and Drug Administration (FDA) approved nivolumab (Opdivo Injection) for the treatment of advanced renal cell carcinoma in patients who have received prior anti-angiogenic therapy.
CMS Extends Deadline for PQRS Informal Review Process
The Centers for Medicare & Medicaid Services (CMS) announced that it is extending the 2014 Physician Quality Report System (PQRS) Informal Review period. Individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, PQRS group practices, and Accountable Care Organizations (ACOs) that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment now have until 11:59 pm ET on Dec. 11, 2015, to submit an informal review requesting CMS investigate incentive eligibility and/or payment adjustment determination. This is an extension from the previous deadline of Nov. 23, 2015.
FDA Approves Ninlaro in Combination Regimen for Previously Treated Multiple Myeloma Patients
On Nov. 20, 2015, the U.S. Food and Drug Administration (FDA) approved ixazomib (Ninlaro, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received at least one prior therapy. Ixazomib is the first approved oral proteasome inhibitor.
FDA Grants Accelerated Approval to Darzalex for Patients with Previously Treated Multiple Myeloma
On Nov. 16, 2015, the U.S. Food and Drug Administration (FDA) granted accelerated approval to daratumumab injection (Darzalex, Janssen Biotech, Inc.), administered as a single agent for the treatment of patients with multiple myeloma who have received at least three prior lines of therapy, including a proteasome inhibitor (PI) and an immunomodulatory agent, or who are double-refractory to a PI and an immunomodulatory agent.
FDA Approves Cotellic as Part of Combination Regimen for Advanced Melanoma
On Nov. 10, 2015, the U.S. Food and Drug Administration (FDA) approved Cotellic (cobimetinib) to be used in combination with vemurafenib to treat advanced melanoma that has spread to other parts of the body or can’t be removed by surgery, and that has a certain type of abnormal gene (BRAF V600E or V600K mutation).
FDA Approves Tagrisso (osimertinib) for Certain NSCLC Patients
On Nov. 13, 2015, the U. S. Food and Drug Administration (FDA) granted accelerated approval to Tagrisso (osimertinib) once daily tablets (AstraZeneca Pharmaceuticals LP) for the treatment of patients with metastatic epidermal growth factor receptor (EGFR) T790M mutation-positive non-small cell lung cancer (NSCLC), as detected by an FDA-approved test, who have progressed on or after EGFR tyrosine kinase inhibitor (TKI) therapy.
CMS Issues 2016 PFS Final Rule
On Oct. 30, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2016.
CMS finalized a number of new policies, including several that are a result of recently enacted legislation. The rule also finalizes changes to several of the quality reporting initiatives that are associated with PFS payments, including the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), and the Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare website on Medicare.gov.
This is the first PFS final rule since the repeal of the Sustainable Growth Rate (SGR) formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The final rule is scheduled for publication in the November 16, 2015, Federal Register and can be downloaded from the Federal Register here.
CMS Issues 2016 OPPS Final Rule
On Oct. 30, 2015, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period.
The CY 2016 OPPS/ASC final rule updates Medicare payment policies and rates for hospital outpatient departments (HOPDs), ASCs, and partial hospitalization services provided by community mental health centers (CMHCs), and refinements to programs that encourage high-quality care in these outpatient settings. The final rule also includes important changes to the Two Midnight Rule effective beginning in CY 2016.
The final rule will appear in the November 13, 2015, Federal Register and can be downloaded from the Federal Register here.
FDA Approves Yervoy to Reduce Risk of Melanoma Returning After Surgery
On Oct. 28, 2015, the U.S. Food and Drug Administration (FDA) expanded the approved use of Yervoy (ipilimumab) to include a new use as adjuvant therapy for patients with stage III melanoma, to lower the risk that the melanoma will return following surgery.
FDA Approves Imlygic; First-in-Class Oncolytic Virus Immunotherapy for Advanced Melanoma
On Oct. 27, 2015, the U.S. Food and Drug Administration (FDA) approved Imlygic (talimogene laherparepvec), commonly referred to as T-VEC, the first FDA-approved oncolytic virus therapy, for the treatment of melanoma lesions in the skin and lymph nodes.
FDA Approves Yondelis for Certain Soft Tissue Sarcomas
On Oct. 23, 2015, the U.S. Food and Drug Administration (FDA) approved Yondelis (trabectedin), a chemotherapy, for the treatment of specific soft tissue sarcomas (STS) – liposarcoma and leiomyosarcoma – that cannot be removed by surgery (unresectable) or is advanced (metastatic). This treatment is approved for patients who previously received chemotherapy that contained anthracycline.
CMS Extends Comment Period on Alternative Payment Models (APMs)
The Centers for Medicare & Medicaid Services (CMS) has extended the deadline on its request for information (RFI) on merit-based physician payments until Nov. 17, according to a notice issued on Oct. 15.
The Oct. 1 RFI asked for comments on the Merit-based Incentive Payment Systems (MIPS) and participation in Alternative Payment Models (APMs).
Federal Court Rules Against HRSA’s 340B Orphan Drug Policy
On Oct. 14, 2015, a federal court struck down a Health Resources and Services Administration (HRSA) 340B orphan drug policy that permitted safety-net hospitals to purchase orphan drugs at discounted prices under certain conditions.
Judge Rudolph Contreras of the U.S. District Court for the District of Columbia ruled that the Department of Health and Human Services (HHS) interpretative rule on the drug discount program, issued by HRSA in 2014, is contrary to the plain language of the governing statute Section 340B of the Public Health Act.
Source: Bloomberg BNA
FDA Expands Approved Use of Opdivo in Advanced NSCLC
On Oct. 9, 2015, the U.S. Food and Drug Administration approved Opdivo (nivolumab) to treat patients with advanced (metastatic) non-small cell lung cancer (NSCLC) whose disease progressed during or after platinum-based chemotherapy.
Read manufacturer press release here.
CMS Issues Stage 3 Meaningful Use Final Rules
On Oct. 6, the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) released two final rules setting the requirements for the final stage of the Medicare and Medicaid EHR Incentive programs. The final rule for 2015 Edition Health IT Certification Criteria (2015 Edition) and final rule with comment period for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs will "simplify requirements and add new flexibilities," CMS said. The rules shorten the 2015 reporting period for providers and hospitals in the program from a full year to 90 days.
In a fact sheet, the agency said that "As part of today’s regulations, we are announcing an additional 60 day public comment period to facilitate additional feedback about our vision for the EHR Incentive Programs going forward."
Read CMS fact sheet on EHR Incentive Programs in 2015 and Beyond.
Read CMS press release.
FDA Approves Keytruda for Advanced NSCLC
On Oct. 2, 2015, the U.S. Food and Drug Administration (FDA) granted accelerated approval for Keytruda (pembrolizumab) to treat patients with advanced (metastatic) non-small cell lung cancer (NSCLC) whose disease has progressed after other treatments and with tumors that express a protein called PD-L1. Keytruda is approved for use with a companion diagnostic, the PD-L1 IHC 22C3 pharmDx test, the first test designed to detect PD-L1 expression in non-small cell lung tumors.
FDA Approves Nivolumab in Combination with Ipilimumab for BRAF V600 Wild-Type Melanoma
On September 30, 2015, the U. S. Food and Drug Administration (FDA) granted accelerated approval to nivolumab (Opdivo Injection) in combination with ipilimumab for the treatment of patients with BRAF V600 wild-type, unresectable or metastatic melanoma.
This is the first FDA approval of a regimen of two immuno-oncology agents in cancer.
CMS Blog on ICD-10: One Week Out
In a September 24 CMS Blog post, Dr. Bill Rogers, ICD-10 Ombudsman, outlines four ways CMS will be supporting physicians and other providers as the U.S. healthcare system starts using ICD-10 on Oct. 1, 2015.
"As we come to October 1st, CMS wants to assure the medical community that we’ve tested and retested our systems, and we’re prepared to solve problems that may come up," he writes.
FDA Approves Lonsurf for Advanced Colorectal Cancer
The U.S. Food and Drug Administration (FDA) on Sept. 22, 2015, approved Lonsurf (a pill that combines two drugs, trifluridine and tipiracil) for patients with an advanced form of colorectal cancer who are no longer responding to other treatments.
HHS Releases 5-Year Health IT Strategic Plan
On Sept. 21, 2015, the U.S. Department of Health and Human Services (HHS) released the Federal Health Strategic Plan 2015-2020, the final version of its 5-year plan for encouraging health IT use among physicians and hospitals. The plan focuses on assisting non-primary care providers with EHR adoption and promoting exchange of health data among federal agencies. In addition, the plan reflects a shift in HHS policy focus toward helping patients more easily access their own health data.
NIH Releases Framework for Precision Medicine Initiative
On Sept. 17, 2015, the National Institutes of Health (NIH) Advisory Committee to the Director presented NIH Director Francis S. Collins, MD, PhD, with a detailed framework for building a national research participant group of 1 million or more volunteers to expand the knowledge and practice of precision medicine.
A step forward in President Obama's President Medicine Initiative, the design plan aims to enroll the pool of volunteer participants—called a cohort—within the next three to four years. NIH plans to move quickly to build the Precision Medicine Cohort Initiative infrastructure so that participants can begin enrolling in the cohort in 2016.
Read the statement from NIH Director Francis Collins, MD, PhD.
FDA Provides List of Compatible Devices for Treanda Injection
On March 10, 2015, the U.S. Food and Drug Administration (FDA) issued a statement warning healthcare professionals not to use chemotherapy drug Treanda Injection (45 mg/0.5 mL or
180 mg/2 mL solution) with closed system transfer devices (CSTDs), adapters, and syringes containing polycarbonate or acrylonitrile-butadiene-styrene (ABS).
As an update, on September 4, 2105, the FDA provided information on specific devices tested by Treanda manufacturer Teva Pharmaceuticals and found compatible with Treanda injection.
Read the Sept. 4 FDA notice here.
Read the Teva Pharmaceuticals’ Dear Health Care Provider letter here.
FDA Approves Varubi for CINV
On Sept. 2, 2015, the U.S. Food and Drug Administration (FDA) approved Varubi (rolapitant) to prevent delayed phase chemotherapy-induced nausea and vomiting (CINV). Varubi is approved in adults in combination with other drugs (antiemetic agents) that prevent nausea and vomiting from initial and repeat chemotherapy regimens, including emetogenic and highly emetogenic chemotherapy.
Zarxio (filgrastim-sndz) Launched, First Biosimilar in U.S.
Sandoz, a Novartis company, announced Sept. 3, 2015, that Zarxio (filgrastim-sndz) is now available in the United States. Zarxio, a biosimilar version of Neupogen (filgrastim), was approved by the U.S. Food and Drug Administration in March.
FDA Issues Draft Guidance on Biosimilars Naming
The U.S. Food and Drug Administration (FDA) Aug. 27 issued draft guidance on the nonproprietary naming of biological products, including biosimilars. The FDA also released a related proposed rule on the naming of biologic drugs and biosimilars.
The guidance proposes the use of suffixes as part of nonproprietary names for biosimilars and reference biologics. The FDA also seeks comments on improvements to pharmacovigilance systems to monitor the safety of biological products, as well as naming of interchangeable products.
Notices on the draft guidance and proposed rule were published in the Friday, Aug. 28 Federal Register.
The comment deadline on the draft guidance is Oct. 27, 2015.
HRSA Releases 340B "Mega-Guidance"
The Health Resources and Services Administration (HRSA) Aug. 27 released its much-anticipated mega-guidance for the 340B Drug Pricing Program. ACCC is currently analyzing the omnibus guidance and will provide a summary with key takeaways to ACCC membership shortly.
The guidance is scheduled for publication in the August 28 Federal Register.
CMS Issues 2014 Medicare ACOs Quality & Financial Performance Results
The Centers for Medicare & Medicaid Services (CMS) Aug. 25 issued Medicare ACO 2014 quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) continue to improve the quality of care for Medicare beneficiaries, while creating financial savings. According to the results, 20 ACOs in the Pioneer ACO Model and 333 Medicare Shared Savings Programs generated more than $411 million in total savings in 2014. Ninety-seven ACOs qualified for shared savings payments of more than $422 by meeting quality standards and their savings thresholds, CMS stated.
CMS to Host “Virtual Office Hours” Session on PQRS & 2016 MPFS
The Centers for Medicare & Medicaid Services (CMS) is offering a Virtual Office Hours session on the 2016 PQRS and the 2016 Medicare proposed Physician Fee Schedule (PFS) rule on Thursday, September 3 from 2:00 pm – 3:00 pm ET.
To participate, please register here. Space is limited.
The session will allow stakeholders an opportunity to ask a CMS representative questions about the new proposed PQRS requirements for program year 2016. Also included will be information on the deadline for public comments, and the next steps for the 2016 PFS rule.
Adcetris Approved for Classical Hodgkin Lymphoma Patients at High Risk for Relapse, Progression
On Aug. 17, 2015, Seattle Genetics announced that the U.S. Food and Drug Administration (FDA) has approved Adcetris (brentuximab vedotin) for the treatment of patients with classical Hodgkin lymphoma (HL) at high risk of relapse or progression as post-autologous hematopoietic stem cell transplantation (auto-HSCT) consolidation.
Read the press release here.
CMS Adds Wolters Kluwer Lexi-Drugs® to Medicare Anti-Cancer Treatment Compendia List
On August 12, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a decision adding Wolters Kluwer Lexi-Drugs® to the list of compendia in Chapter 15, section 50.4.5 of the Medicare Benefit Policy Manual, for use in the determination of a "medically-accepted indication" of drugs and biologicals used off-label in an anticancer chemotherapeutic regimen, unless the Secretary has determined that the use is not medically appropriate or the use is identified as not indicated in one or more such compendia.
Read the CMS decision here.
In its May 20 comment letter to the agency, ACCC urged CMS to add Lexi-Drugs to the list of recognized compendia.
FDA Approves Sonidegib (Odomzo) for Locally Advanced Basal Cell Carcinoma
On July 24, 2015, the U. S. Food and Drug Administration (FDA) approved sonidegib (Odomzo Capsules, Novartis Pharmaceuticals Corporation) for the treatment of patients with locally advanced basal cell carcinoma (BCC) that has recurred following surgery or radiation therapy, or those who are not candidates for surgery or radiation therapy.
FDA Approves Carfilzomib (Kyprolis) for Relapsed and Refractory Multiple Myeloma
On July 24, 2015, the U. S. Food and Drug Administration (FDA) approved carfilzomib (Kyprolis, Onyx Pharmaceuticals, Inc., an Amgen subsidiary) in combination with lenalidomide and dexamethasone for the treatment of patients with relapsed multiple myeloma who have received one to three prior lines of therapy.
FDA Approves Gefitinib (Iressa) for Metastatic EGFR-Mutated NSCLC
On July 13, 2015, the U. S. Food and Drug Administration approved gefitinib (Iressa) for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 (L858R) substitution mutations as detected by an FDA-approved test. This approval of gefitinib is being approved concurrently with a labeling expansion of the therascreen EGFR RGQ PCR Kit, a companion diagnostic test for patient selection.Read FDA announcement here.
House Passes 21st Century Cures Bill
On July 10, the U.S. House of Representatives by an overwhelming 344-77 vote passed the 21st Century Cure bill (H.R. 6). The legislation represents a tremendous step toward advancing research in the field of oncology and healthcare, as well as improving the process for bringing new technologies into oncology programs nationwide.
CMS to Host Provider Call on 2016 PFS Proposals for Quality Reporting Programs
Registration is open for a MLN Connects® National Provider Call that will provide an overview of proposed changes to quality reporting programs in the 2016 Physician Fee Schedule Proposed Rule.
When: Thursday, July 16; 1:30 pm—3 pm ET
What: This presentation will cover proposed updates to the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (Value Modifier), Electronic Health Record (EHR) Incentive Program, and Comprehensive Primary Care (CPC) Initiative. A question and answer session will follow the presentation.
Visit the call details page for more information.
To Register: click here. Space may be limited, register early.
CMS Releases Proposed 2016 PFS Rule
On July 8, 2015, the Centers for Medicare & Medicaid Services (CMS) released the proposed calendar year 2016 Physician Fee Schedule (PFS) rule, the first update to the PFS since repeal of the sustainable growth rate (SGR) through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The proposed rule contains a number of provisions focused on patient-centered care and continues the commitment to move the Medicare program to a system based on quality and healthy outcomes. The proposed rule will be published in the July 15 Federal Register.
In the proposed rule, CMS is seeking comments on implementation of certain MACRA provisions, including the new Merit-based Incentive Payment System (MIPS).
The proposed 2016 PFS rule includes updates to payment policies, proposals to implement statutory adjustments to physician payments based on misvalued codes, updates to the Physician Quality Reporting System, and updates to the Physician Value-Based Payment Modifier.
The proposed rule also seeks comments on a proposal that would make advance care planning services a separately payable service under Medicare.
CMS is accepting comments on the CY 2016 PFS proposed rule, until September 8, 2015.
Access a CMS fact sheet on the proposed 2016 PFS rule here.
Access the CMS press release here.
Access the proposed 2016 PFS rule here.
ICD-10: CMS & AMA Announce Efforts to Help Providers Be Prepared
The Centers for Medicare & Medicaid Services (CMS) July 6 announced efforts by the agency and the American Medical Association (AMA) to help providers be prepared for the switch from ICD-9 to ICD-10. The new ICD-10 code set is slated for implementation on October 1, 2015.
Responding to requests from the provider community, the agency is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD-10 code set.
CMS and the AMA will be working to educate providers through webinars, on-site training, educational articles, and national provider calls to help physicians and other healthcare providers learn about the updated codes and prepare for the transition.
CMS Releases 2016 OPPS Proposed Rule
On July 1, 2015, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule, which includes proposed changes to the Two-Midnight Rule and Quality Reporting for 2016.
The proposed rule will appear in the July 8, 2015, Federal Register and can be downloaded from the Federal Register here.
CMS will accept comments on the proposed rule until August 31, 2015, and will respond to comments in a final rule to be issued on or around November 1, 2015.
ACCC is currently analyzing the proposed rule and will provide more in-depth information to members shortly.
Access the CMS detailed fact sheet on the proposed 2016 OPPS rule.
A separate CMS fact sheet on the proposed changes to the Two Midnight Rule is available here.
CMS Posts Open Payments Full-Year 2014 Financial Data
On June 30, 2015, the Centers for Medicare & Medicaid Services (CMS) published 2014 Open Payments program data on transfers of value by drug and medical device makers to healthcare providers. CMS states that the data includes information about 11.4 million financial transactions attributed to more than 600,000 physicians and over 1,100 teaching hospitals, totaling $6.49 billion.
The Open Payments program, created under the Affordable Care Act, requires drug and device manufacturers to report transfers of value (i.e., payments, honoraria, or research grants) to healthcare providers, as well as other industry-related investments providers may have. The program relies on voluntary participation by physicians and teaching hospitals to review the information submitted by these companies. Registered physicians and teaching hospitals reviewed nearly 30 percent of the total value of the reported data, the agency said.
CMS will update the Open Payments data at least annually to include updates to data disputes and other data corrections made since the initial publication.
View information from CMS on the Open Payments program.
Access CMS Opens Payments facts.
Read the CMS press release here.
Supreme Court Upholds ACA Subsidies in King v. Burwell
On June 25, the U.S. Supreme Court issued their decision in the King v. Burwell case, ruling that the more than 7 million people currently purchasing insurance through a federal exchange can continue to access subsidies. Chief Justice John Roberts and Justice Anthony Kennedy were the swing votes in the 6-3 decision.
For more, read our ACCCBuzz blog post.
ASCO Releases Value Framework
On June 22, 2015, the American Society of Clinical Oncology (ASCO) issued a conceptual framework for assessing the value of new cancer treatment options based on clinical benefit, side effects, and costs. The initial version of the ASCO Value Framework was published online in the Journal of Clinical Oncology. It will serve as the basis for user-friendly, standardized tools that physicians can use with their patients to discuss the relative value of new cancer therapies compared with established treatments, according to ASCO. The framework was developed by the ASCO Value in Cancer Care Task Force.
Visit www.asco.org/value to access the JCO article, a feedback survey, a patient/survivor companion resource, and related information.
HRSA Issues Proposed Rule on 340B Drug Manufacturer Penalties
The Health Resources and Services Administration (HRSA) June 16 issued a proposed rule regarding the calculation of the 340B ceiling price and the imposition of civil monetary penalties on manufacturers that knowing and intentionally overcharge 340B Drug Pricing Program covered entities.
The proposed rule was published in the June 17 Federal Register. Comments on the proposed rule are due by Aug. 17, 2015.
Federal Oral Parity Legislation Introduced
The Association of Community Cancer Centers (ACCC) applauds the recent introduction of the Cancer Drug Coverage Parity Act of 2015, HR 2739/S 1566. This legislation would eliminate the disparity in patient out-of-pocket costs between oral and intravenous chemotherapy, ensuring that cancer patients have access to needed treatments. This bipartisan, bicameral effort is led by Senators Al Franken (D-MN) and Mark Kirk (R-IL), and Representatives Leonard Lance (R-NJ) and Brian Higgins (D-NY). Read Representative Lance’s press release.
ACCC has long advocated for legislation at the federal and state levels that would require health insurance plans to cover orally administered chemotherapy at the same rate as IV-infused counterparts. Learn more.
Contact your legislators to express support for oral cancer drug parity.
CMMI Extends OCM Application Deadline to June 30
The Center for Medicare and Medicaid Innovation (CMMI) has responded to the request by ACCC and other stakeholders to extend the Oncology Care Model (OCM) application deadline to 5:00 pm EDT on June 30, 2015, to ensure practices have enough time to gather the information needed to produce a strong application.
CMS Releases Medicare ACO Final Rule
On June 4, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule making changes affecting accountable care organizations (ACOs) under the Medicare Shared Savings Program (MSSP). The final rule:
- Creates a new Track 3, a two-sided risk model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools.
- Establishes a waiver of the 3-day stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3; and
- Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings.
Read CMS press release here.
CMS Posts Updated Payment Data on Hospitals & Physicians
On June 1, 2015, the Centers for Medicare & Medicaid Services (CMS) posted the third annual release of the Medicare hospital utilization and payment data (both inpatient and outpatient) and the second annual release of the physician and other supplier utilization and payment data.
The hospital utilization and payment data consists of information for 2013 on the average amount a hospital bills for services that may be provided in an inpatient stay or outpatient visit. The hospital data includes information for services that may be provided in connection with the 100 most common Medicare inpatient stays and 30 selected outpatient procedures at more than 3,000 hospitals in all 50 states and the District of Columbia.
The Medicare Part B physician, practitioner, and other supplier utilization and payment data consists of information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The data also shows payment and submitted charges, or bills, for those services and procedures by provider. The new 2013 dataset includes information for more 950,000 healthcare providers who collectively received $90 billion in Medicare payments.
View CMS fact sheet on the 2013 hospital charge data here.
View CMS fact sheet on the 2013 physician data here.
21st Century Cures Draft Advances
In a comment letter, ACCC commends the House Energy and Commerce Committee for advancing 21st Century Cures legislation (HR 6). This collaborative legislation would support biomedical research and promote the discovery of innovative therapies, providing a pathway to better health outcomes for cancer patients. Read our ACCCBuzz blog post.
The bill will head to the Ways and Means Committee and is expected to reach the House floor for a vote sometime in June.
Open Payments Correction Period—May 21 to June 5
The Open Payments 15-day data correction period began May 21 and runs until June 5. During this period, applicable manufacturers and group purchasing organizations (GPOs) should acknowledge and resolve disputes initiated by physicians and teaching hospitals during the review and dispute period conducted between April 6 and May 20, 2015. The 2014 Open Payments data will become public on June 30, 2015.
More information is available on the Resources page of the CMS Open Payments website.
CMS Issues Proposed Medicaid Managed Care Rule
On May 26, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule (CMS-2390-P) that will modernize the way Medicaid and Children’s Health Insurance Program (CHIP) managed care is regulated. The proposed rule is the first major update to Medicaid and CHIP managed care regulation in more than 10 years.
"This proposal will better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing quality, coordinated care to millions of Americans with Medicaid or CHIP insurance coverage," said Andy Slavitt, Acting Administrator of CMS, in a statement.
The proposed rule will be published in the June 1 Federal Register. Comments are due July 27, 2015.
Read CMS fact sheet here.
21st Century Cures Draft Moves Forward
ACCC applauds the House Energy and Commerce committee for advancing 21st Century Cures Legislation (HR 6) today. This collaborative legislation would support biomedical research and promote the discovery of innovative therapies, providing a pathway to better health outcomes for cancer patients. Read the Committee’s press release. Next up? The bill heads to the House floor for a vote.
340B "Mega-Guidance" Under Review at OMB
The much anticipated Health Resources and Services Administration (HRSA) “mega-guidance” around the 340B Drug Pricing Program is now under review at the Office of Management and Budget (OMB). The document, listed as “340B Program Omnibus Guidelines,” could include topics such as patient definition, hospital eligibility, contract pharmacy, and audits. While OMB typically has up to 90 days to review submissions, the guidance could be released as early as June. ACCC is monitoring this closely; stay tuned.
CMMI Releases OCM Practice Letter of Intent Submission List
The Center for Medicare and Medicaid Innovation (CMMI) released the list of physician practices who submitted Letters of Intent (LOIs) to participate in CMS’ first-ever oncology-specific payment reform model, the Oncology Care Model. The list includes 443 diverse practices, many of whom are ACCC members. This marks the first step in applying to participate in the model; final applications are due June 18th. According to CMS, they hope to enroll 100 diverse practices. For more information, visit ACCC’s Oncology Resource Center.
CDC Report Finds Progress on Cancer Screenings Lacking
A new report, published in the May 8 Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report, finds that in 2013, screening rates for colorectal, breast, and cervical cancers were either lower than previous rates or showed no improvement.
National Health Interview Survey (NHIS) data from 2013, the most recent data available, were used to assess progress toward the Healthy People 2020 targets for cancer screening test use.
Pioneer ACOs Saved More Than $384 Million Over Two Years, Study Finds
The Pioneer Accountable Care Organization (ACO) Model saved more than $384 million over its first two years, according to a study released May 4, 2015, by the Centers for Medicare & Medicaid Services (CMS). The study was published May 4, in the Journal of the American Medical Association.
Read Department of Health and Human Services (HHS) press release here.
CMS Releases New Part D Drug Cost Data
On April 30, 2015, the Centers for Medicaid & Medicare Services (CMS) made available of new, privacy-protected data on Medicare Part D prescription drugs prescribed by physicians and other healthcare professionals in 2013.
The data set includes information from more than 1 million distinct healthcare providers who collectively prescribed about $103 billion in prescription drugs and supplies paid under Part D, the agency said. The data characterize prescribing patterns for more than 3,000 drug products. For each prescriber and drug, the data includes the total number of prescriptions dispensed, including original prescriptions and any refills, and the total drug cost paid by beneficiaries, Part D plans, and other sources.
Senators Ask GAO to Study Cybersecurity Risks to EHRs
In an April 27 letter, leaders of the Senate Health, Education, Labor and Pensions Committee asked the Government Accountability Office (GAO) to identify the types of cyber threats to health information technology (IT) systems and the potential impact of those threats. The senators also asked the GAO to look into whether any gaps exist in federal regulations on healthcare cybersecurity.
The senate health committee leaders announced April 29 a bipartisan, full committee working group to identify ways to improve EHRs. Read press release here.
CMS Issues 2013 PQRS and eRX Incentive Report
The Centers for Medicare & Medicaid Services (CMS) has released the 2013 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program Experience Report.
The annual PQRS/eRx Experience Report provides trends on participation, incentive eligibility, and incentive payments since the start of PQRS and the eRx Incentive Program, including measure performance and program participation by specialty and state. Statistics on the 2015 PQRS payment adjustment are available to the public for the first time through this report. The full report is available here.
- Participation in the PQRS program increased by 47 percent from 2012 to 2013
- 469,755 eligible professionals were subject to a 2015 PQRS negative payment adjustment. Of those professionals subject to the adjustment, 98 percent did not attempt to participate in PQRS.
- 2013 participation in the eRx program rose by 9 percent from 2012.
FDA Approves Ramucirumab as Second-Line Therapy for mCRC
On April 24, 2015, the U. S. Food and Drug Administration (FDA) approved ramucirumab (CYRAMZA®, Eli Lilly and Company) for use in combination with FOLFIRI for the treatment of patients with metastatic colorectal cancer (mCRC) whose disease has progressed on a first line bevacizumab-, oxaliplatin- and fluoropyrimidine-containing regimen.
Free ASCO April 28 Webinar on Medicare Oncology Payment Model
The American Society of Clinical Oncology (ASCO) will hold a free webinar on CMMI's Oncology Care Model (OCM) on Tuesday, April 28, 2015 at 4:00 p.m. ET. Attendees will learn about OCM's purpose and key features, payment methodology, six practice requirements, quality and performance measures, practice implications, and navigating the application process.This ASCO webinar, moderated by Elaine L. Towle, CMPE, director of ASCO’s Analysis and Consulting Services, will feature:
- Kavita K. Patel, MD, MSHS, managing director for clinical transformation and delivery at the Engelberg Center for Health Care Reform of the Brookings Institution.
- Ronald Kline, MD, Medical Officer, CMMI, part of the program team directing CMS’s Oncology Care Model.
- Ronald Barkley, MS, JD, president of the Cancer Center Business Development Group, and Co-Founder and National Co-Chair of the Cancer Center Business Summit, and an expert in alternate payment initiatives in oncology.
Registration for the ASCO webinar is now open.
CMS OCM Webinar Today: FAQs & Application Overview
The Oncology Care Model team will host a webinar on CMMI’s Oncology Care Model (OCM) Frequently Asked Questions and Application Overview on Wednesday, April 22, 2015, at 12:00 pm EDT. No password is required for the webinar.
How to Join:
Webinar presentation materials will be available here
No password required
Telephone Call-In Information (US/Canada):
Access code: 665 947 599
President Obama Signs H.R. 2 into Law
On April 16, 2015, President Barack Obama signed into law H.R. 2., the Medicare Access and CHIP Reauthorization Act (MACRA), legislation that permanently replaces Medicare's sustainable growth rate (SGR) formula for physician reimbursement with new value-based systems for establishing annual reimbursement updates for physician services.
The law went into effect on signing.
For more on what MACRA will mean for Medicare physician reimbursement, read our ACCCBuzz blog post, SGR is Over: What Does it Mean for Providers?
Senate Passes SGR Repeal!
Late on April 14, 2015, the U.S. Senate overwhelmingly by a 92-8 vote passed H.R. 2, legislation that permanently repeals Medicare’s sustainable growth rate (SGR) for physician reimbursements. The vote came just hours before a scheduled cut to physician' payments would have gone into effect.
The bill now goes to President Barack Obama, who has said he will sign it.
H.R. 2 would replace the current SGR formula with new value-based systems for setting the annual updates to payment rates for physician services provided to Medicare beneficiaries.
CMS to Host April 15 Call for Providers on Open Payments
CMS is hosting a MLN Connects National Provider Call on April 15 that will provide a brief overview of the Open Payments program and highlight the parts of the program timeline when it is most critical for physicians and teaching hospitals to be aware and get involved. The call aligns with the beginning of the program phase when physicians and teaching hospitals are able to enter the Open Payments system and review the accuracy of data submitted about them, prior to the publication of this data on the CMS website.
Open Payments (Sunshine Act) 2015—Prepare to Review Reported Data
Wednesday, April 15, 2015
2:00 PM - 3:30 PM ET
Registration information is available here.
The Open Payments website has important information about the program, including educational materials. CMS encourages all physicians and teaching hospitals, plus physician office staff members to visit this resource and become familiar with the Open Payments program.
This MLN Connects Call is being evaluated by CMS for CME and CEU continuing education credit (CE). More information is available on the call detail page.
CMS to Host Call on 2016 MSSP Application Process
CMS will hold a call on April 7, 2015, at 1:30 pm EST to provide information on what you can do to prepare for the Medicare Shared Savings Program (Shared Savings Program) application process for the January 1, 2016, start date. Register here.
CMS Deadline for ICD-10 End-to-End Testing Volunteer Forms
During the week of July 20 through 24, 2015, a third sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. Volunteer forms are due April 17, and are available on MAC websites.
CMS to Hold Provider Claims until April 15
The current "doc fix" patch to Medicare's sustainable growth rate (SGR) formula expired on March 31, 2015. In an April 1 notice, the Centers for Medicare & Medicaid Services (CMS) told providers that the agency is holding physicians' claims until April 15. CMS said the agency will notify providers on or before April 11 with more information.
CMS has also announced that the agency is delaying enforcement of the "two midnight" payment policy for short hospital stays until the end of April. This delay gives Congress time to pass the SGR repeal legislation when it reconvenes on April 13. The SGR repeal bill includes a six-month delay in enforcement of this payment rule. Source: Modern Healthcare
No Senate Vote on SGR Until After Its Recess
The U.S. Senate recessed on Friday, March 27, without voting on SGR repeal legislation.
The Senate is recessed for two weeks, but is still expected to act on the permanent SGR repeal bill when it reconvenes on April 13.
Modern Healthcare reports that despite the fact that the current SGR “patch” will expire on April 1, physicians will not face a 21% pay cut as CMS “has indicated that it can delay processing claims for a period of time to keep the cut from being implemented.”
House Passes H.R. 2, SGR Repeal Legislation
On March 26, by a vote of 392-37 the U.S. House of Representatives overwhelmingly passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, legislation to permanently repeal and replace Medicare’s sustainable growth rate (SGR) formula for physician reimbursement. Read a summary of the legislation here.
Rep. Michael C. Burgess, MD, (R-Texas), the bill’s primary sponsor, said in a statement, “This is the work of a collaborative body. . . .It is time to end the SGR. Let us never speak of this issue again.”
The White House has expressed support for the bill.
The Senate is expected to vote on the bill March 27.
According to analysis by the Congressional Budget Office (CBO), the bill would increase the federal deficit by $141 billion through 2025.
FDA: Don’t Use Treanda Injection (Solution) With Certain CSTDs
The U.S. Food and Drug Administration (FDA) is warning healthcare professionals not to use Treanda Injection (45 mg/0.5 mL or 180 mg/2 mL solution) with closed system transfer devices (CSTD), adapters, and syringes containing polycarbonate or acrylonitrile-butadiene-styrene (ABS). CSTDs are devices that are used to prepare and administer hazardous drugs for intravenous infusion, such as chemotherapy drugs. Most marketed CSTDs contain either polycarbonate or ABS and are not compatible with Treanda Injection (45 mg/0.5 mL or 180 mg/2 mL solution).
Treanda (bendamustine hydrochloride), manufactured by Teva, is used to treat patients with chronic lymphocytic leukemia (CLL) and indolent B-cell non-Hodgkins lymphoma (NHL) that has progressed during or within six months of treatment with rituximab or a rituximab-containing regimen.
Treanda is available in two formulations:
- a solution, Treanda Injection (45 mg/0.5 mL or 180 mg/2 mL solution); and
- a lyophilized powder, Treanda for Injection (25mg/vial or 100 mg/vial lyophilized powder).
The FDA is recommending healthcare professionals use Treanda Injection (45 mg/0.5 mL or 180 mg/2 mL solution) only with polypropylene syringes containing a metal needle and a polypropylene hub. If a CSTD would be used with Treanda Injection (45 mg/0.5 mL or 180 mg/2 mL solution), the FDA advises healthcare professionals to verify with the CSTD manufacturer or Teva U.S. Medical Information (1-800-896-5855) that the CSTD is compatible with Treanda Injection (45 mg/0.5 mL or 180 mg/2 mL solution) prior to preparing the drug. Alternatively, healthcare professionals can use Treanda for Injection (25mg/vial or 100 mg/vial lyophilized powder) with a CSTD.
Read FDA notice here.
Read Teva Pharmaceuticals' Dear Health Care Provider letter here.
HHS Issues Stage 3 EHR Incentive Programs Proposed Rule
On Mar. 20, 2015, the U.S. Department of Health and Human Services (HHS) released a Stage 3 Medicare and Medicaid EHR Incentive Programs proposed rule.
According to the agency, the proposed rule will support “efforts to increase simplicity and flexibility in the program while driving interoperability and a focus on patient outcomes in the meaningful use program.”
The comment period for proposed Stage 3 rule will close on May 29, 2015.
Also on Mar. 20, the Office of the National Coordinator (ONC) released a proposed rule covering 2015 Edition Health IT Certification Criteria for EHR products used by meaningful use program participants.
House Leaders Introduce Legislation to Permanently Repeal and Replace SGR
On Mar. 24, 2015, bipartisan leaders of the House Energy and Commerce and House Ways and Means Committees introduced H.R. 2 the Medicare Access and CHIP Reauthorization Act (MACRA) to permanently replace the Medicare Sustainable Growth Rate (SGR). H.R. 2 builds upon H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act, bipartisan legislation released March 19 that would replace the SGR with incentives for doctors to focus on value-driven care.
On Friday, Mar. 20, the bipartisan committee leaders released a working framework of these additional proposals, some of which will help to help offset the costs of this package. Read the complete bill online here.
The House is expected to vote on the legislation Mar. 26, Bloomberg BNA reported.
Read a statement from the House Energy and Commerce Committee.
OCM Letter of Intent Deadlines Extended
The Centers for Medicare & Medicaid Services (CMS) Innovation Center has extended the deadlines for physician practices and payers to submit letters of intent (LOIs) to participate in the Oncology Care Model (OCM). The new submission deadlines are:
- April 9, 2015 — Payer LOIs
- May 7, 2015 — Practice LOIs
- June 18, 2015 — ALL Applications (unchanged)
The Innovation Center will publicly post the list of payers who submit LOIs and agree to public posting on April 16, 2015, and will post the list of practices who submit LOIs and agree to public posting on May 14, 2015. These lists will appear on the OCM website to allow interested payers and practices to engage with one another and coordinate participation in the OCM.
House, Senate Leaders Introduce SGR Legislation
On Mar. 19, 2015, leaders in the U.S. Senate and House introduced bipartisan, bicameral legislation (HR 1470) to replace the broken Medicare Sustainable Growth Rate (SGR) formula with an improved payment system that rewards quality, efficiency, and innovation. The bipartisan, bicameral bill seeks to end the cycle of annual “doc fix” crises that have created uncertainty for millions of Medicare providers and beneficiaries for over a decade.
- Repeal the SGR, while instituting a 0.5% payment update each year for five years.
- Improve the fee-for-service system by streamlining Medicare’s existing web of quality programs into one value-based performance program. It increases payment accuracy and encourages physicians to adopt proven practices.
- Incentivize the use of alternative payment models to encourage doctors and providers to focus more on coordination and prevention to improve quality and reduce costs.
- Make Medicare more transparent by giving patients more access to information and supplying doctors with data they can use to improve care.
ACCC is analyzing the proposed legislation and will keep members updated.
NCCN Publishes New Guidelines for Smoking Cessation
On March 13, 2015, the National Comprehensive Cancer Network (NCCN) announced publication of new NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Smoking Cessation. The guidelines, which are written for the treatment of smokers diagnosed with cancer, recommend treatment plans that include evidence-based pharmacotherapy and behavior therapy.
CMS Announces Next Generation ACO Model
On March 10, 2015, the Centers for Medicare & Medicaid Services (CMS) announced the new Next Generation ACO Model. The new model “sets predictable financial targets, enables greater levels of financial risk so that providers have more opportunities to coordinate beneficiaries’ care,” the agency said in a press release.
The Next Generation ACO Model is for ACOs that are experienced in coordinating care for populations of patients. Under this model, provider groups will be allowed to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP), the agency said.
CMS expects approximately 15 to 20 ACOs to participate in the Next Generation ACO Model with representation from a variety of provider organization types and geographic regions. The Model will consist of three initial performance years and two optional one-year extensions.
Details and specific eligibility criteria are available on the Next Generation ACO Model webpage.
Read CMS fact sheet on the Next Generation ACO Model here.
FDA Approves New Antifungal Drug Cresemba
On March 6, 2105, the U.S. Food and Drug Administration (FDA) approved Cresemba (isavuconazonium sulfate), a new antifungal drug product used to treat adults with invasive aspergillosis and invasive mucormycosis, rare but serious infections.
Aspergillosis is a fungal infection caused by Aspergillus species, and mucormycosis is caused by the Mucorales fungi. These infections occur most often in people with weakened immune systems.
Cresemba belongs to a class of drugs called azole antifungal agents, which target the cell membrane of a fungus. Cresemba is available in oral and intravenous formulations.
FDA Approves First Biosimilar Zarxio (filgratim-sndz)
On March 6, 2015, the U.S. Food and Drug Administration (FDA) approved filgrastim-sndz (Zarxio Injection, Sandoz Inc.), as a biosimilar to US-licensed Neupogen for the five indications for which US-licensed Neupogen is approved. The formulation of Zarxio differs from that of US-licensed Neupogen in one inactive component, according to the FDA press release.
The approval of Zarxio was based on review of evidence that included comparative structural and functional characterization, animal studies, human pharmacokinetic (PK) and pharmacodynamics (PD), and clinical immunogenicity data, and other clinical safety and effectiveness data which demonstrate Zarxio is highly similar to US-licensed Neupogen notwithstanding minor differences in clinically inactive components and that there are no clinically meaningful differences between Zarxio and US-licensed Neupogen, the FDA press release said.
FDA Launches Drug Shortages Mobile App
On March 4, 2015, the U.S. Food and Drug Administration (FDA) launched the agency’s first mobile application (app) designed to speed public access to valuable information about drug shortages.The app identifies current drug shortages, resolved shortages and discontinuations of drug products. The app is available for free download via iTunes (for Apple devices) and the Google Play store (for Android devices) by searching “FDA Drug Shortages.”
FDA Approval Opdivo for Patients with Previously Treated Metastatic Squamous NSCLC
On March 4, 2015, the U. S. Food and Drug Administration (FDA) granted approval to nivolumab (Opdivo, Bristol-Myers Squibb Company) for the treatment of patients with metastatic squamous non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy.
Nivolumab was previously approved in December 2014, for the treatment of previously treated unresectable or metastatic melanoma. Nivolumab is a monoclonal antibody that binds to the PD-1 receptor and blocks its interaction with PD-L1 and PD-L2, thereby releasing PD-1 pathway-mediated inhibition of the immune response, including anti-tumor immune response.
CMS Update on Health Care Payment Learning and Action Network
On Feb. 27, 2015, the Centers for Medicare & Medicaid Services (CMS) released a fact sheet on the newly created Health Care Payment Learning and Action Network (the "Network"). The Network will serve as a forum where payers, providers, employers, purchasers, state partners, consumer groups, individual consumers, and others can discuss how to transition towards alternative payment models that emphasize value.
According to the fact sheet, the Network will be supported by an independent contractor that will act as convener and facilitator for the Network.
The fact sheet describes the structure, management, and activities of the Network, and outlines the following Network functions:
- Serve as a convening body to facilitate joint implementation of new models of payment and care delivery,
- Identify areas of agreement around movement toward alternative payment models and define how best to report on these new payment models,
- Collaborate to generate evidence, share approaches, and remove barriers,
- Develop common approaches to core issues such as beneficiary attribution, financial models, benchmarking, quality and performance measurement, risk adjustment, and other topics raised for discussion, and
- Create implementation guides for payers, purchasers, providers, and consumers.
Invitation to Participate
According to the fact sheet, all payers, providers, employers, purchasers, states, consumer groups, individual consumers, and others can participate in the Health Care Payment Learning and Action Network. All interested individuals and organizations are invited to register at innovation.cms.gov/initiatives/Health-Care-Payment-Learning-and-Action-Network/.
View the Health Care Payment Learning and Action Network webpage here.
FDA Approves Farydak for Treatment of Multiple Myeloma
On February 23, 2015, the U.S. Food and Drug Administration (FDA) today approved Farydak (panobinostat) for the treatment of patients with multiple myeloma.
Farydak is the first HDAC inhibitor approved to treat multiple myeloma. It is intended for patients who have received at least two prior standard therapies, including bortezomib and an immunomodulatory agent. Farydak is to be used in combination with bortezomib, a type of chemotherapy, and dexamethasone, an anti-inflammatory medication.
CMS Announces New ACA Enrollment Period for Tax Season
On Feb. 20, 2015, the Centers for Medicare & Medicaid Services (CMS) announced a special enrollment period for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). This special enrollment period, which will run from March 15 through April 30, will allow eligible consumers to enroll in 2015 health insurance coverage through the FFM.
Those eligible for this special enrollment period live in states with a Federally-facilitated Marketplace and:
- Currently are not enrolled in coverage through the FFM for 2015,
- Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
- Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.
FDA Expands Indication for Revlimid Plus Dexamethasone to Include Patients Newly Diagnosed with Multiple Myeloma
On Feb. 18, 2015, Celgene Corporation announced that the U.S. Food and Drug Administration (FDA) has expanded the existing indication for Revlimid (lenalidomide) in combination with dexamethasone to include patients newly diagnosed with multiple myeloma.
Read company press release here.
FDA Approves Lenvima for Differentiated Thyroid Cancer
On Feb. 13, 2015, the U. S. Food and Drug Administration (FDA) approved lenvatinib (Lenvima) for the treatment of patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer.
CMS Innovation Center Announces Oncology Care Model
On Feb. 12, 2015, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced the Oncology Care Model, a new performance-based payment model that aims to provide higher quality, more highly coordinated oncology care at a lower cost. The Oncology Care Model (OCM) is a multi-payer model in which practices enter into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients. OCM is a five-year model that will begin in spring 2016.
According to an Innovation Center announcement, key facets of the model include:
- episode-based payment with a payment structure that targets chemotherapy and related care during a six-month period following the start of chemotherapy treatment
- emphasis on practice transformation, requiring physician practices to engage in practice transformation to improve quality and coordination of care
- multi-payer design with Medicare fee-for-service and other payers working in tandem to promote care redesign for oncology patients.
Physician group practices and solo practitioners that provide chemotherapy for cancer and are currently enrolled in Medicare may apply to participate. Other payers, including commercial insurers, Medicare Advantage plans, state programs, and Medicaid managed care plans, are also encouraged to apply.
Interested practices must submit letters of intent by 5:00 pm., EDT on April 23, 2015.
A webinar introducing the core concepts of OCM, including application instructions, will be available to the public from 12:00 – 1:00 pm EST on February 19, 2015. Advance registration is not required. Additional webinar information is available here.
More information is available on the Oncology Care Model webpage.
CMS Issues Final Rule on Medicare Advantage, Part D Changes for 2016
On Feb. 6, the Centers for Medicare & Medicaid Services (CMS) issued a rule that makes policy and technical changes to Medicare Advantage (MA) and the Medicare Part D prescription drug program for contract year 2016.
According to the CMS fact sheet, the rule does not finalize any of the following provisions that appeared in a previous proposed rule:
- Lifting the protected class designation on three drug classes – antidepressants, antipsychotics and immunosuppressants for transplant rejection;
- Requiring Medicare Part D sponsors to include any pharmacy willing to accept the terms and conditions to participate in narrower pharmacy networks that offer preferred cost sharing to beneficiaries;
- Reducing the number of Part D plans a sponsor may offer; and
- Codifying CMS interpretation of the Part D non-interference provision.
Medicare to Cover Lung Cancer Screening with LDCT, CMS Issues Final NCD
On Feb. 5, the Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination (NCD) that provides for Medicare coverage of screening lung cancer with low dose computed tomography (LDCT). The coverage is effective immediately.
Medicare will now cover lung cancer screening with LDCT once per year for Medicare beneficiaries who meet all of the following criteria:
- they are age 55-77, and are either current smokers or have quit smoking within the last 15 years;
- they have a tobacco smoking history of at least 30“pack years”(an average of one pack a day for 30 years); and
- they receive a written order from a physician or qualified non-physician practitioner that meets certain requirements.
Medicare coverage includes a visit for counseling and shared decision-making on the benefits and risks of lung cancer screening. The NCD also includes required data collection and specific coverage eligibility criteria for radiologists and radiology imaging centers, consistent with the National Lung Screening Trial protocol, U.S. Preventive Services Task Force recommendation, and multi-society multidisciplinary stakeholder evidence-based guidelines.
FDA Approves Ibrance for Advanced Breast Cancer
On Feb. 3, 2015, the U.S. Food and Drug Administration (FDA) granted accelerated approval to Ibrance (palbociclib) to treat advanced (metastatic) breast cancer in postmenopausal women.
Ibrance works by inhibiting molecules, known as cyclin-dependent kinases (CDKs) 4 and 6, involved in promoting the growth of cancer cells. Ibrance is intended for postmenopausal women with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer who have not yet received an endocrine-based therapy. It is to be used in combination with letrozole, another FDA-approved product used to treat certain kinds of breast cancer in postmenopausal women.
Read the FDA press release here.
ONC Issues 10-Year Draft Plan; Sets 2017 Target for Health IT Interoperability
On Jan. 30, the Office of the National Coordinator for Health Information Technology (ONC) issued a draft plan that aims to ensure that a majority of healthcare providers across the care continuum will be able to “send, receive, find, and use a common set of electronic clinical information at the nationwide level by the end of 2017.”
The plan, "Connecting Health and Care for the Nation: A Shared Nationwide Interoperatiblity Roadmap," calls for the ONC to identify a set of technical standards to enable “core interoperability functions” in electronic health records and other health IT.
Comments on the plan are due by April 3.
Source: Bloomberg BNA
Obama Administration Unveils Details on Precision Medicine Initiative
On Jan. 30 the Obama Administration announced that the Precision Medicine Initiative referenced by President Obama in his State of the Union Address will be launched with a $215 million investment in the President’s 2016 Budget.
According to a White House fact sheet, the President’s 2016 budget will provide:
- $130 million to the National Institutes of Health (NIH) for development of a voluntary national research cohort of a million or more volunteers to propel understanding of health and disease and set the foundation for a new way of doing research through engaged participants and open, responsible data sharing.
- $70 million to the National Cancer Institute (NCI), part of NIH, to scale up efforts to identify genomic drivers in cancer and apply that knowledge in the development of more effective approaches to cancer treatment.
- $10 million to FDA to acquire additional expertise and advance the development of high quality, curated databases to support the regulatory structure needed to advance innovation in precision medicine and protect public health.
- $5 million to Office of the National Coordinator for Health Information Technology (ONC) to support the development of interoperability standards and requirements that address privacy and enable secure exchange of data across systems.
Read the White House fact sheet.
Read the White House blog post.
Read the NCI blog post on Precision Medicine Initiative and Cancer Research by Harold Varmus, MD.
CMS Will Propose Changes to EHR Incentive Programs for 2015
The Centers for Medicare & Medicaid Services (CMS) announced that the agency intends to propose changes to update the Medicare and Medicaid EHR Incentive Programs in rulemaking this spring. In a Jan. 29 agency blog post, Patrick Conway, MD, CMS chief medical officer and deputy administrator for innovation and quality, said that the proposed rule would address provider concerns about software implementation and information exchange readiness.
Specifically, the agency is considering proposals to change the hospital reporting period for the meaningful use program from the fiscal year to the calendar year, and to shorten the EHR reporting period in 2015 from a full year to 90 days.
The blog post clarifies that the proposed rule would be separate from the Stage 3 meaningful use rule expected to be released in early March.
FDA Approves Imbruvica for Waldenstrom's Macroglobulinemia
On January 29, 2015, the U. S. Food and Drug Administration (FDA) approved ibrutinib (Imbruvica Capsules, Pharmacyclics, Inc.) for the treatment of patients with Waldenstrom’s macroglobulinemia.
Ibrutinib was initially approved in November 2013 for the treatment of patients with mantle cell lymphoma (MCL) who have received at least one prior therapy. Ibrutinib also received approval in February 2014 for the treatment of chronic lymphocytic leukemia (CLL) in patients who received at least one prior therapy and in July 2014 for the treatment of CLL with 17p deletion.
Read FDA press release here.
Read FDA announcement here.
HHS Announces Timeline for Expanding New Medicare Payment Models
U.S. Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell has announced a timeline and measurable goals to shift Medicare, and the healthcare system at large, toward paying providers based on quality or value, rather the volume of care provided.
In a Jan. 26 meeting with leaders representing consumers, insurers, providers, and business leaders, Secretary Burwell announced that HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payments models, such as accountable care organizations (ACOs) or bundled payment arrangements, by the end of 2016, and tying 50 percent of payments to these models by the end of 2018. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality and value by 2016 and 90 percent by 2018 through programs such as the Hospital Value-Based Purchasing and Hospital Readmissions Reduction programs.
To help make these goals scalable beyond Medicare, HHS is creating the Health Care Payment Learning and Action Network, the agency said in a press release. Through this network, HHS will work with private payers, employers, consumers, providers, states, and state Medicaid programs, and other partners to expand alternative payment models into their programs. The Network’s first meeting is slated for March 2015, the press release said.
Read a "Perspective" article by Secretary Burwell in the New England Journal of Medicine here.
Read a blog post from Secretary Burwell here.
New IOM Report on Sharing Clinical Trial Data
A new report from the Institute of Medicine (IOM) Sharing Clinical Trial Data: Maximizing Benefits, Minimizing Risk calls for professional standards for responsible sharing of clinical trial data.
The report calls for stakeholders in clinical trials to encourage a culture in which data sharing is the expected norm and commit to responsible strategies aimed at maximizing the benefits, minimizing the risks, and overcoming the challenges of sharing data. Included in the report are recommended guidelines about which data from a clinical trial should be shared and when. The report recommends data that supports results be shared no later than six months after publication.
The report’s recommendations for which specific data should be shared after key times in a clinical trial are:
- At the time of trial registration
- At the completion of a study
- After a publication reports the results of a clinical trial
- For studies of products or new indications that are approved
- For studies of new products or new indications for a marketed product that are abandoned.
CMS to Hold 2015 Date-of-Service Claims for Services Paid Under the MPFS for Two Weeks
In a Dec. 29, 2014, MLN Connects Provider eNews, the Centers for Medicare & Medicaid Services (CMS) states that in order to implement corrections to technical errors discovered after publication of the 2015 Medicare Physician Fee Schedule (MPFS) rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015 (i.e., Thursday Jan. 1 through Wednesday Jan. 14). According to CMS, the hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.
MPFS claims for services rendered on or before Wednesday Dec. 31, 2014, are unaffected by the 2015 claims hold and will be processed and paid under normal procedures and time frames.
FDA Approves Opdivo for Advanced Melanoma
On Dec. 22, 2014, the U. S. Food and Drug Administration (FDA) granted accelerated approval to Opdivo (nivolumab), a new treatment for patients with unresectable or metastatic (advanced) melanoma who no longer respond to other drugs.
Opdivo works by inhibiting the PD-1 protein on cells, which blocks the body’s immune system from attacking melanoma tumors. Opdivo is intended for patients who have been previously treated with ipilimumab and, for melanoma patients whose tumors express a gene mutation called BRAF V600, for use after treatment with ipilimumab and a BRAF inhibitor.
Opdivo is marketed by Princeton, New Jersey-based Bristol-Myers Squibb.