Editor: Joseph S. Bailes, MD, Chair, ASCO Government Relations Committee

ASCO Counters CMS Fee Schedule Proposal, Stating Oncology Practices Cannot Sustain Further Cuts
CMS released its proposed physician fee schedule for 2010 last week, which included cuts to oncology care. ASCO is working to ensure that proposed reductions in payments to oncology practices are blocked.

OIG Releases Report on Medicare Part B Payments for Chemotherapy Administration
On June 30, the Department of Health and Human Service’s Office of the Inspector General released a new report as to whether Medicare paid appropriately for Part B services billed as chemotherapy administration from 2005 to 2007.

New ASCO Workforce Study Will Examine the Role of Non-Physician Practitioners in Treating Cancer Patients
On June 30, ASCO announced a new study, funded by Susan G. Komen for the Cure®, to determine how non-physician practitioners, such as nurse practitioners and physician assistants, can provide vital services to address projected oncology workforce shortages.

ASCO Comments on the Online Presentation of Clinical Trials Data
On June 22, ASCO submitted comments to NIH on the development of regulations that govern how clinical trials data will be represented on www.clinicaltrials.gov.

Sen. Baucus and Pharmaceutical Industry Announce Assistance to Patients to Cover Medicare Part D Drug Costs
On June 20, the Pharmaceutical Research and Manufacturers of America announced a new program that will provide discounts in brand-name drugs for patients covered under the Medicare Part D prescription drug plan.

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ASCO Counters CMS Fee Schedule Proposal, Stating Oncology Practices Cannot Sustain Further Cuts
On July 1, the Centers for Medicare and Medicaid Services (CMS) released its proposed physician fee schedule for 2010, which includes a 6 percent cut in Medicare payments for medical oncology services. This cut is on top of a scheduled 21 percent reduction to the Medicare conversion factor due to the flawed sustainable growth rate (SGR) formula.

While Congress has indicated a willingness to provide a fix to the SGR to avert the 21 percent reduction, it is unclear how or when this would happen. Even taken alone, the 6 percent cut in overall payment, if implemented, would severely hamper the ability of oncologists to continue providing care to people with cancer.

This week, Members of Congress return to Washington, and now is the time to fight. ASCO is redoubling efforts to ensure that oncology practices are heard and that any proposed reductions in payments to oncology practices are blocked. ASCO will make CMS and Congress aware in no uncertain terms that any payment cuts to essential cancer care services will devastate patient care in this country.

On July 2, ASCO sent out an alert to the membership detailing the aggressive steps that ASCO is taking to address these proposed cuts in care.

ASCO will continue to provide updates on the proposed physician fee schedule for 2010 over the upcoming days and weeks. If you have any questions about ASCO’s efforts to counter these proposed payment cuts, or would like to receive ASCO’s Cancer Policy Alerts, contact ASCO’s Cancer Policy & Clinical Affairs Department at 571-483-1670 or publicpolicy@asco.org.

OIG Releases Report on Medicare Part B Payments for Chemotherapy Administration
On June 30, the Department of Health and Human Service’s Office of the Inspector General (OIG) released a new report on its study undertaken to determine whether Medicare paid appropriately for Part B services billed as chemotherapy administration from 2005 to 2007.

The report found that Medicare data are insufficient to determine consistently whether chemotherapy administration payments are appropriate, and that carriers do not have consistent chemotherapy administration coding policies and review procedures.

The OIG recommended that CMS should:

• Establish a process to determine which drugs qualify for the chemotherapy administration payment rate.
• Instruct carriers that have not done so to consider undertaking a probe review of unmatched chemotherapy administration claims.
• Ensure that drug administration claims are coded correctly and paid appropriately.

ASCO will actively engage OIG regarding any implementation of these recommendations. For more information on Medicare payment and policies, contact ASCO’s Cancer Policy & Clinical Affairs Department at 571-483-1670 or practice@asco.org.

New ASCO Workforce Study Will Examine the Role of Non-Physician Practitioners in Treating Cancer Patients
On June 30, ASCO announced a new study, funded by Susan G. Komen for the Cure®, to determine how non-physician practitioners, such as nurse practitioners and physician assistants, can provide vital services to address projected future oncology workforce shortages.

The study, to be conducted for ASCO by Oncology Metrics, will be a comprehensive analysis of how oncology practices provide patient care, through collaborative care teams made up of oncologists, nurse practitioners, and physician’s assistants. The study of up to 40 private and hospital-based oncology practices will specifically examine the satisfaction, efficiency and productivity of each collaborative care team in order to establish “best practices.” The practices included in the survey will vary in size, patient population, and location.

ASCO’s Workforce Advisory Group identified the increased use of non-physician practitioners in an oncology practice as a possible way to narrow the gap between supply and demand for oncology services.

The study results are expected to be released in early 2011. For more information, contact Amy Hanley in ASCO’s Cancer Policy & Clinical Affairs Department at 571-483-1640 or Amy.Hanley@asco.org.

ASCO Comments on the Online Presentation of Clinical Trials Data
On June 22, ASCO submitted comments to the National Institutes of Health (NIH) on regulations that govern how clinical trials data will be represented on www.clinicaltrials.gov. NIH had published a request for comments in the Federal Register on March 23.

ASCO recommended that NIH should:

• Develop a process for building content on clinical trials that either relies on the existing peer-review process or replicates critical elements of this process. Outcomes data should not be reported on ClinicalTrials.gov or otherwise in the absence of an unbiased analysis of the quality of the study.
• Phase in data submission requirements on the results of clinical trials, beginning with studies that have been published in reputable, peer-reviewed journals.
• Set a reporting deadline based on the date that a study reaches its primary endpoint, to ensure sufficient time to analyze trial data.
• Ensure that adequate summary information of the protocol is provided, so data on published results are interpreted appropriately. Publication of the full trial protocol for the public and scientific community to evaluate the results is not necessary. However, the information provided in a published abstract is insufficient to enable critical, informed consideration of trial results.
• Regarding the reporting of summaries of clinical trials written in non-technical, unbiased language for the general public, ASCO urged NIH to exercise significant caution. Summaries should be prepared by individuals with expertise in preparing such communications and only be reported after approval is obtained by both the government officials and the appropriate investigators.

Through its National Library of Medicine, NIH has maintained an online clinical trial database since 2000. As of March 2009, ClinicalTrials.gov included information on more than 69,000 clinical trials conducted in more than 160 countries.

For more information, contact ASCO’s Cancer Policy & Clinical Affairs Department at 571-483-1670 or researchpolicy@asco.org.

Sen. Baucus and Pharmaceutical Industry Announce Assistance to Patients to Cover Medicare Part D Drug Costs
On June 20, the Pharmaceutical Research and Manufacturers of America (PhRMA) announced a new program through which drug companies will provide a 50 percent discount on brand-name medicines to most Medicare beneficiaries when the yearly amounts they pay for medication fall within the so-called “doughnut hole” under Medicare’s Part D prescription drug plan.

In total, PhRMA is committing $80 billion in funding to cover Medicare prescription drug costs for seniors. Sen. Max Baucus (D-MT), who worked to secure this financial commitment from PhRMA, said that this new coverage will mean affordable prices on prescription drugs when Medicare benefits don’t cover the cost of prescriptions.

Although most chemotherapy drugs used to treat cancer patients are infused and do not fall under Part D coverage, patients who receive oral forms of chemotherapy are covered under Part D and tend to reach the “doughnut hole” quickly. These patients may see some cost savings under this new program.

President Obama also praised the agreement, stating that the United States is at a turning point in America's journey toward health care reform. "The agreement by pharmaceutical companies to contribute to the health reform effort comes on the heels of the landmark pledge many health industry leaders made to me last month, when they offered to do their part to reduce health spending $2 trillion over the next decade,” President Obama said.

News and Notes

Participate in QOPI and the QOPI Certification Program
ASCO recently announced the QOPI® Certification Program, a new program to certify oncology practices that achieve rigorous, oncologist-defined standards for high-quality cancer care. Practices that participate in the fall 2009 QOPI data collection process will be the first eligible to receive certification in early 2010. Visit www.asco.org/qopi or email qopi@asco.org for more information on QOPI or the QOPI Certification Program.

Next CMS Open Door Forum Call for Physicians, Nurses and Allied Health Professionals
CMS has scheduled the next Physician, Nurses and Allied Health Professionals Open Door Forum to take place July 9, from 3:30 pm to 4:30 pm EDT, to discuss the proposed 2010 Physician Fee Schedule Rule. To participate, dial 1-800-837-1935 and reference conference ID number 16842257.

New Edition of Practical Tips for the Oncology Practice
Practical Tips for the Oncology Practice, 5th Edition is the premier resource for oncology practices. This publication provides guidelines on coding, billing and coverage of oncology-related services and outlines the laws and regulations that affect an oncology practice. Practical Tips contains explanations of many Medicare initiatives and provides excerpts from Medicare manuals. This resource is a must-have for oncology practices. Order yours today by visiting www.asco.org/practicaltips or by calling ASCO’s Customer Service hotline at 888-273-3508.

Join ASCO's Advocacy Network
Advocacy is most effective when Members of Congress and government agencies hear from you, their constituents. By participating in ASCO's Advocacy Network, you will develop ongoing relationships with your legislators while helping ASCO raise awareness on important cancer issues. To join the Advocacy Network, visit ASCO's Grassroots Action Center.