Editor Joseph S. Bailes, MD, Chair, ASCO Government Relations Council

Members of Congress Urge HHS to Address Proposed Medicare Oncology Cuts
As the U.S. House of Representatives and Senate reconvened September 8, abolishing proposed cuts to the Medicare physician fee schedule remains at the top of ASCO’s agenda.

QOPI Registration Exceeds 650 Oncology Practices
As a record number of oncology practices participate in ASCO’s quality improvement program, ASCO gets set to launch its QOPI Certification Program this fall.

ASCO Publishes Discussion Guide on Breast Cancer Risk Reduction Guideline
ASCO has published a new Discussion Guide to help health care providers talk to women at high risk for breast cancer who may be eligible to receive risk reduction agents.

New NIH Tool Makes Funding Data, Research Results and Products Searchable
Comprehensive funding information for NIH grants and contracts is now available online.

Information on Billing for Administration of H1N1 Vaccine
Information, including Medicare coverage and reimbursement rules, is available on billing for the administration of the Influenza A (H1N1) vaccine.

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Members of Congress Urge HHS to Address Proposed Medicare Oncology Cuts
As the U.S. House of Representatives and Senate reconvened September 8, abolishing proposed cuts to the Medicare physician fee schedule remains at the top of ASCO’s agenda.

Late last week, 55 Members of Congress signed a letter to Health & Human Services Secretary Kathleen Sebelius, urging the Agency to address the serious flaws in the survey used to determine the proposed cuts to oncology and cardiology before implementing any changes in payment for 2010.

ASCO is continuing to call on Congress and the Administration to withdraw the proposed 6 percent cut to oncology in the Medicare physician fee schedule. ASCO submitted comments to the Centers for Medicare & Medicaid Services (CMS) outlining the flaws with the proposed fee schedule.

Health care reform will likely dominate the legislative agenda through the fall. This week, Senate Finance Committee Chairman Max Baucus (D-MT) is releasing a draft “framework” for comprehensive health care reform. Last week, Sen. Baucus released an outline of this framework, which would establish health insurance exchanges in 2010, require health plans to report the amount of money they spend on items other than health care, and require insurers to cover pre-existing medical conditions. The proposal is slated for review by the Senate Finance Committee the week of September 21. The House Energy and Commerce Committee is expected to consider amendments to the House health reform bill, H.R. 3200, in the coming weeks.

On September 9, the President addressed a joint session of Congress, calling for health reform. Prior to the speech, the White House held a physician’s briefing call on health care reform August 25; more than 2,700 participants called in. The focus of the call was insurance reform, which the White House stated would include less out-of-pocket expenses for patients, increased consumer protections such as eliminating the pre-existing conditions exclusion, elimination of lifetime and annual coverage limits, and provision of no-cost preventative care.

ASCO's Policy Priorities Web page  highlights up-to-date information on the latest health care reform activities and other initiatives affecting the oncology community.

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

QOPI Registration Exceeds 650 Oncology Practices
As of this month, more than 650 oncology practices across the United States have enrolled in ASCO’s Quality Oncology Practice Initiative (QOPI^®), the Society’s flagship quality improvement program.

To expand upon QOPI’s success, and to continue to provide oncologist-led solutions, ASCO is preparing to launch the QOPI Certification Program, the goals of which are to:

• Promote the highest quality cancer care, as defined by experts and clinical care guidelines.
  
• Provide a trusted solution to satisfy external demand for quality care.
  
• Reduce redundant programs or requirements for oncology practices.

The purpose of the QOPI Certification Program is to recognize QOPI participants who achieve rigorous standards for cancer care. QOPI Certification is a voluntary program that will provide practices with additional quality improvement targets, as well as a demonstrable designation of achievement on oncologist-approved quality measures. Increasingly, oncologists are asked by payors, patients, and others to attest to the quality of care they provide through their practices. The QOPI Certification designation can be used by certified practices to demonstrate an advanced commitment to quality.

QOPI participation is the first step toward achieving QOPI Certification. Practices that participate in the fall QOPI data collection in September/October 2009 will be the first eligible to apply for QOPI Certification.

Visit www.asco.org/qopi or email qopi@asco.org for more information about participating in QOPI and the QOPI Certification program.

ASCO Publishes Discussion Guide on Breast Cancer Risk Reduction Guideline
ASCO has published a new Discussion Guide to help health care providers talk with women at high risk for breast cancer who may be eligible to receive risk reduction agents.

The Discussion Guide stems from ASCO’s Clinical Practice Guideline: “Update on the Use of Pharmacologic Interventions Including Tamoxifen, Raloxifene, and Aromatase Inhibition for Breast Cancer Risk Reduction” and presents the risks and benefits associated with tamoxifen and raloxifene. It highlights data from important clinical trials on these agents, in written and graphical form.

In the guideline, women at increased risk for breast cancer are defined as having five-year projected breast cancer risk greater than or equal to 1.66% (according to the National Cancer Institute Breast Cancer Risk Assessment Tool) or with lobular carcinoma in situ (LCIS).

The Discussion Guide also includes a section a clinician can provide to women, to help them think over the decision and to weigh their options after the discussion. The Discussion Guide is available online free of charge, along with a guideline summary and other resources.

New NIH Tool Makes Funding Data, Research Results and Products Searchable
Comprehensive funding information for NIH grants and contracts is now available online through the National Institutes of Health’s (NIH) Research Portfolio Online Reporting Tool (RePORT), thanks to a new system called the RePORT Expenditures and Results (RePORTER).

RePORTER combines NIH project databases and funding records, PubMed abstracts, full-text articles from PubMed Central, and information from the U.S. Patent and Trademark Office with a robust search engine, allowing users to locate descriptions and funding details on NIH-funded projects along with research results that cite NIH support.

User-defined searches allow the public to refine, export and analyze results and provide insights into NIH spending, as well as research results across NIH-funded projects, institutions, investigators or scientific concepts. Searching for grants funded by the American Recovery and Reinvestment Act is facilitated by a checkbox that limits searches to specified areas of interest.

Plans for improvements in RePORTER include allowing users to personalize their experience. NIH’s goal is to enable users to save favorite searches; set alerts for new grants, publications and patents; and export the entire RePORTER database.

RePORT is available online. The project search tool, RePORTER, is available through the RePORT site or by going directly to http://ProjectRePORTER.nih.gov.

Information on Billing for Administration of H1N1 Vaccine
A new Special Edition MLN Matters article on billing for the administration of the Influenza A (H1N1) vaccine explains Medicare coverage and reimbursement rules for the H1N1 vaccine and also addresses seasonal flu coverage and reimbursement.

Medicare will pay for seasonal flu vaccinations even if the vaccinations are given earlier in the year than normal, as such preparations are critical for the upcoming flu season, especially in planning for the H1N1 vaccine.

Though Medicare typically pays for one vaccination per year, if more than one is medically necessary, then Medicare will pay for additional vaccinations. Medicare claims processing contractors have been notified to expect and prepare for earlier-than-usual seasonal flu claims, so there should not be a problem getting those claims paid. Furthermore, if Medicare beneficiaries need both a seasonal flu vaccination and an H1N1 vaccination, then Medicare will pay for both.

If either vaccine is provided free of charge to the health care provider, then Medicare will only pay for the vaccine’s administration, not for the vaccine itself.

All providers administering the flu vaccine should review this article and be sure that their billing staffs are aware of this information.


News and Notes
Participate in QOPI and the QOPI Certification Program
ASCO’s QOPI^® Certification Program will certify oncology practices that attain 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. Details about the Certification Program, including a participation guide and introductory presentation, are available online. Visit www.asco.org/qopi or email qopi@asco.org for more information.

New Edition of Practical Tips for the Oncology Practice
Practical Tips for the Oncology Practice, 5th Edition is the premier resource for oncology practices. It 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.