Oncology Newsfeed

ACCC Submits Comments to CMS on 2011 Proposed Hospital Outpatient Prospective Payment System Rule

On August 31, 2010, the Association of Community Cancer Centers (ACCC) submitted comments to the Centers for Medicare and Medicaid Services (CMS) about its proposed rule regarding revisions to the hospital outpatient prospective payment system (OPPS), published in the Federal Register on August 3, 2010.

Although ACCC was encouraged to see that CMS has proposed to reimburse separately payable drugs without pass-through status at average sales price (ASP) plus 6 percent in 2011, ACCC remains concerned that the methodology to determine this rate remains flawed, and that the final payment rates may not be sufficient to cover the cost of drug acquisition and related pharmacy overhead services costs.

"It is imperative to continued patient access in this crucial setting that the OPPS rates in 2011 and beyond adequately reimburse hospitals for the costs of providing advanced cancer therapies."

Toward this end, ACCC recommends that CMS:

• Reimburse the acquisition cost of separately payable drugs at no less than ASP plus six Percent
• Reallocate a larger share of costs for pharmacy overhead from packaged drugs to separately payable drugs
• Use an ASP file that better reflects the time period of the claims and cost report data used to calculate drug payment rates
• Remove 340B hospital data from calculation of drug payment rates and continue to pay 340B hospitals at the same rate as non-340B hospitals
• Make separate payment for all drugs with Healthcare Common Procedure Coding System (HCPCS) codes, or, at a minimum, not increase the packaging threshold for drugs
• Reinstate separate payment for diagnostic radiopharmaceuticals and contrast agents
• Implement the new payment rates for brachytherapy sources
• Continue to apply the current policy for establishing payment for new brachytherapy sources
• Reinstate separate payment for radiation oncology guidance services
• Implement the proposal to waive beneficiary cost-sharing for certain preventive services
• Implement the adjustment to payments for PPS-exempt cancer hospitals in a truly budget neutral manner
• Work with providers and specialty societies to determine which new measures to add to the quality reporting requirement.

Posted 08/31/2010

CMS Offers National Provider Call on ICD-10 Implementation in a 5010 Environment

On Monday, September 13, 12 pm to 1:30 pm ET, the Centers for Medicare & Medicaid Services (CMS) will host a follow-up national provider conference call on "ICD-10 Implementation in a 5010 Environment." The call is designed for medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, and all Medicare fee-for-service (FFS) providers. Among the topics will be ICD-10 implementation for services provided on and after October 1, 2013; differences between ICD-10 and ICD-9-CM codes; and HIPAA Version 5010: What you need to be doing to prepare.

For more information and to register, click here. Registration will close at 12 pm ET on September 10, 2010, or when available space has been filled.

Posted 08/30/2010

New Section Page Added to the Physician Quality Reporting Initiative (PQRI) Web Page

The Centers for Medicare & Medicaid Services (CMS) announced a new section on "How to Get Started" in participating with the Electronic Prescribing Incentive (eRx) program, which is available on eRx web page.

Click here to learn more.

Posted 08/30/2010

ACCC Submits Comments to CMS on Proposed 2011 Physician Fee Schedule

On August 24 the Association of Community Cancer Centers (ACCC) submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding the proposed payment policies under the Medicare physician fee schedule (PFS). ACCC remains concerned over the proposed cut to the conversion factor due to the Sustainable Growth Rate (SGR) formula and encourages CMS to continue to work with Congress to develop a stable update formula for the future. ACCC also recommended that CMS halt the cuts to chemotherapy administration, and continue to only apply the increase in the assumed utilization rate to certain diagnostic equipment priced at more than $1 million.

Posted 08/25/2010

CMS Reconsiders Limitation on FDG PET

After "careful review," the Centers for Medicare and Medicaid Services (CMS) has issued a decision memo for "Positron Emission Tomography for Initial Treatment Strategy in Solid Tumors and Myeloma" (CAG-00181R3). CMS was asked to reconsider the April 3, 2009, NCD provision at Section 220.6.17 of the National Coverage Determinations (NCD) Manual, described below, that established an absolute frequency limitation of only one FDG PET study for the noted purposes.

"CMS will cover only one FDG PET study for beneficiaries who have solid tumors that are biopsy proven or strongly suspected based on other diagnostic testing when the beneficiary’s treating physician determines that the FDG PET study is needed to determine the location and/or extent of the tumor for the following therapeutic purposes related to the initial treatment strategy:

• To determine whether or not the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure; or
• To determine the optimal anatomic location for an invasive procedure; or
• To determine the anatomic extent of tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor."

In its recent decision memo, CMS believes that the current absolute restriction is not supported by the available evidence and, therefore, will amend 220.6.17 of the National Coverage Determinations Manual:

1. The NCD will be changed to remove the current absolute restriction of coverage to 'only one' FDG PET scan to determine the location and/or extent of the tumor for the therapeutic purposes related to the initial treatment strategy as described above.
2. CMS will continue to nationally cover one FDG PET scan to determine the location and/or extent of the tumor for the therapeutic purposes related to the initial treatment strategy as described above.
3. Local Medicare administrative contractors will have discretion to cover (or not cover) within their jurisdictions any additional FDG PET scan for the therapeutic purposes related to the initial treatment strategy as described above.

"For any individual beneficiary the usefulness of any additional FDG PET scan for initial treatment planning might be affected by the beneficiary’s specific medical problem, the availability of results of other diagnostic tests and the expertise of the interpreting physician. We believe in such situations that our local administrative contractors, who may more readily obtain this information, can make these determinations about any additional FDG PET scan for initial treatment planning within their jurisdictions. We do not believe that a national coverage determination is the most appropriate way to address coverage for any additional FDG PET scans for the therapeutic purposes related to the initial treatment strategy at this time."

Posted 08/24/2010

Nominations Open for ACCC’s 2011 David King Community Scientist Award

The David King Community Clinical Scientist Award recognizes active community clinical research leaders. Award winners have demonstrated leadership in the development, participation, and evaluation of clinical studies and/or are active in the development of new screening, risk assessment, treatment, or supportive care programs for cancer patients.

This prestigious award is named after David K. King, MD, FACP, a past president, who passed away after a brief battle with cancer. Dr. King spent his entire life caring for individuals with cancer and advocating for access to quality care, while also championing the Community Clinical Oncology Program and the value of clinical research in the community setting.

The 2010 David King Community Scientist Award will be presented at ACCC’s 37th Annual National Meeting, March 24-26, 2011, in Washington, DC.

To nominate an individual or individuals for the 2011 David King Community Scientist Award, please complete the nomination form by following the link below, as well as a letter of recommendation.
All nominations must be submitted by Wednesday, August 31, 2010.

Click here to download the nomination form.

Please contact Jason Peller, Leadership Relations Manager, at jpeller@accc-cancer.org for further information.

Posted 08/11/2010

Expanded Enrollment for 340B Opens

Expanded enrollment in the 340B discount drug program opened Aug. 2 for thousands of providers who are newly eligible to participate under the health reform law. The expansion of the 340B Drug Pricing Program included in the Patient Protection and Affordable Care Act (Pub. L. No. 111-148) makes discounted drugs available to free-standing cancer centers, as well as children's hospitals, critical access hospitals, rural referral centers, and sole community hospitals. The newly eligible facilities will save an average of 20 percent to 50 percent on covered outpatient medications, according to the Health Resources and Services Administration, the division of the Health and Human Services Department that administers the program.

As reported in the August 3 BNA Health Care Daily, under the expansion the number of facilities participating in the 340B program is expected to increase from 14,000 to nearly 20,000, including 1,500 newly eligible hospitals. Enrollment in the expansion will take place using a rolling, online admissions process that ends Sept. 30. All forms must be submitted by Sept. 27.

Posted 08/3/2010

ACCC Hosts Webinar: Guide to Best Practices in a Comprehensive Prostate Cancer Program

On Tuesday, August 3, 2010, at 2:30 pm EDT, ACCC will offer a live web presentation about best practices in a comprehensive prostate cancer program. The webinar is designed for nurses, social workers, and administrators, and will outline the process and structures used by community-based cancer programs to initiate and grow their successful prostate-specific programs. Learn how to open lines of communication among providers and develop a collaborative team approach to care. This webinar is made possible by sponsorship from sanofi-aventis US.

Click here to register.

The webinar will be archived and available to ACCC members on ACCC's Prostate Cancer "Best Practices" Project II website.

Posted 08/2/2010

CMS Posts "Tip Sheets" on EHR Incentive Programs

The Centers for Medicare & Medicaid Services (CMS) has posted "Tip Sheets" on its EHR Incentive Programs.

• Medicare EHR Incentive Payments for Eligible Professionals. This tip sheet describes which types of individual practitioners can participate in the Medicare EHR incentive program. It provides user-friendly information about incentive payment amounts and describes how they are calculated for fee for service and Medicare advantage providers. It also describes payment adjustments beginning in 2015 for EPs who are not meaningful users of certified EHR technology.
• Medicare EHR Incentive Program, PQRI and E-Prescribing Comparison. Learn what opportunities are available to Medicare Eligible Professionals to receive incentive payments for participating in important Medicare initiatives. This fact sheet provides information on eligibility, timeframes, and maximum payments for each program.

Click here to visit the CMS website. Select the Medicare Eligible Professional tab on the left, and then scroll to "Downloads."

Posted 07/30/2010

ACCC Comments on National Coverage Analysis Tracking Sheet for Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer

On July 27, 2010, the Association of Community Cancer Centers (ACCC) submitted comments to the Centers for Medicare & Medicaid Services’ (CMS) about the opening of a national coverage analysis (NCA) for autologous cellular immunotherapy of treatment of metastatic prostate cancer. ACCC is deeply concerned that CMS has opened this NCA regarding an autologous cellular immunotherapeutic agent for its Food and Drug Administration (FDA)-approved indication to treat certain forms of prostate cancer. "Not only is CMS's action contrary to Congress' intent to ensure beneficiary access to drugs and biologicals used in an anticancer chemotherapeutic regimen, but it threatens to stifle future innovation and cancer research for years to come." Accordingly, ACCC urges CMS to withdraw this NCA immediately.

ACCC also is concerned that CMS’s decision to initiate this NCA will be "detrimental to cancer research for years to come. Cancer is a deadly disease, and patients often require treatment with the most innovative and cutting-edge therapies to win their battles against it. Bringing new therapies to market is costly, however, and investors will be more hesitant to fund new research if CMS threatens to restrict coverage for medically accepted indications of cancer drugs."

Posted 07/27/2010