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www.scosonline.com Spring/Summer 2006 |
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Reimbursement in 2006 is finding a new focus on the private payer market. Without much fanfare, we are noticing that private payers are quicker with the uptake of changes initiated by Medicare. In our oncology practices, we cannot understate the importance of payments from commercial health insurance to compensate for lower revenues received from Medicare and Medicaid. Practices that have paid close attention to commercial contracts and once sat at the table to negotiate reimbursement rates are losing bargaining power, and—along with those practices that paid little attention to the terms of their agreements—are being offered take-it-or-leave-it contracts. While the decrease in the number of private payers certainly is affecting this trend, the momentum of the quality movement is also proving to be the driver for constraining reimbursement with little regard for the impact it has on practices. Oncology is especially at a disadvantage since there are so few oncologists employed by the payers and costs for the specialty are not clearly understood. One of the latest trends we are noticing in the private payer world in 2006 is imaging cost control efforts. Private payers are adopting a policy that is intended to save billions of dollars on wasted, unnecessary, and inappropriate care. The payers are ramping up their preauthorization process for many imaging procedures that have increased explosively over the past few years. Some payers expect to see a 25 percent reduction in utilization of non-emergency imaging services by eliminating testing that they deem unnecessary and duplicative. This clamping down on utilization is a way to move reimbursement away from payment for services, which is what the current reimbursement model pays for, towards reimbursement for care that is recommended based on evidence to improve a condition. Despite these trends, it is still important to develop strong relationships with the private payers in your market... |
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Two proposed rules offer some protection to practitioners that donate software and services used for electronic prescription (e-prescription) systems to certain categories of individuals.
On May 31, 2006, the Centers for Medicare and Medicaid Services (CMS) announced an extension to the physician election period for the Medicare Part B Drug Competitive Acquisition Program (CAP). The
extension began on June 3, 2006, and will continue through June 30, 2006. Physicians whose completed physician election forms are received by their local carrier and whose forms are postmarked on or
after June 3, but no later than June 30, 2006, will begin participation in the CAP starting on August 1, 2006.
Here are brief highlights of advances in cancer research presented at ASCO’s 2006 Annual Meeting.
Low blood levels of vitamin D may worsen bone loss associated with exemestane. Findings support the use of vitamin D as well as calcium supplementation
for postmenopausal women in general, and for those receiving aromatase inhibitors in particular.
Do you want to refer patients to cancer clinical trials but don’t know how? Are you new to conducting clinical trials in a practice setting but want to know more? If so, the National Cancer Institute (NCI) has a course for you. "Incorporating Cancer Clinical Trials Into Your Practice" is a free Web-based tutorial for health care professionals—oncologists, family physicians, internists, nurses, and other clinical staff—who are new to the clinical trials process. The course emphasizes the importance of participating in cancer clinical trials and how to do so, either through patient referral or becoming a clinical trials investigator.
The Association of Community Cancer Centers (ACCC) will present its 23rd National Oncology Economics Conference in St. Louis, Mo., on Sept. 13-16, 2006. For every paying Society/ACCC-member registrant, you may bring a colleague at half price! But hurry. This offer is valid only until August 15. It does not apply to industry representatives and cannot be used in conjunction with any other promotional coupons or discounts. This meeting offers the perfect opportunity for your entire cancer care team (physicians, nurses, administrator, and billers/coders) to strengthen their skills and network with their colleagues. |
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© Copyright 2006 Association of Community Cancer Centers. All Rights Reserved |
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