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CAN CALL
Thursday, May 26th, 2:00 pm ET
1© 2015 Community Oncology Alliance
Kim Woofter
Michiana Hematology Oncology
Maryann Roefaro
Hematology Oncology Associates of
Central New York
CAN Co-Chairs:
▪The audio portion of the call will be recorded. Playback instructions will be sent later.
▪Callers will be muted once the call begins. Toggle between mute and unmute with *6.
▪Please do not place our call on “hold” while unmuted.
Reminders:
Robert Anderson, Valley Medical Oncology Consultants
Tonia Bateman, New Mexico Cancer Center
Brigitta Braxton, Peninsula Cancer Center
Wilma Colon, Charleston Cancer Center
Sara Davila, Clermont Oncology Center
Jennifer Ewing, Michiana Hematology Oncology, PC
Susan Fleecs, Washington University
Welcome to :
Annalynn Hall, Cancer Care Associates, PC
Amanda Hodges, The Center for Cancer and Blood Disorders
Shelli Johnson, Cancer Care Centers of Brevard
Denise Johnstone, Essex Oncology of North Jersey PA
Lynn Lanning, McFarland Clinic
Kristine Li, Valley Medical Oncology Consultants
Laura Marez, NMOHC
Welcome to - continued:
Jaime McCoy, Medical Associates of Brevard
Maria Rincon San Miguel, Advanced Hematology &
Oncology Group of PR
Phillip Millard, Southeastern Medical Oncology Center
Amy Oefinger, The START Center for Cancer Care
Shiela Plasencia, Oklahoma Cancer Specialists & Research
Institute
Sylvia Radziszewski, Summa
Welcome to - continued:
Kathy Ricceri, Nebraska Cancer Specialists
Kelly Richards, Dayton Physicians
Susan Rose, Cancer Center Oncology Medical Group
Todd Schonherz, Florida Cancer Specialists
Ginnie Sebastian, Hem/Oncology Assoc. of Fredericksburg
David Sorrells, Urology Centers of Alabama
Barbara Sutherland, Comprehensive Cancer and Hematology
Specialists
Welcome to - continued:
8© 2015 Community Oncology Alliance
CAN Call
Update from Ted
▪ Part B “experiment”
• Status
▸ KEEP UP the pressure!!!
▸ H.R. 5122 & next stops
▪ Payment Reform: MACRA (MIPS & APMs), Legislation
(H.R. 1934 & Senate version), OCM, Payer Summit
▪ Site Neutrality & 340B
Update from Ted
9© 2015 Community Oncology Alliance
▪ GREAT NEWS!!
▪ Peer-to-peer – CAN-DO team!
• Tools
• Resources
• Questions/Issues identification
• Unified voice
• OCM and beyond
▪ Great progress to date and MORE to come
OCM Planning and Support
10© 2015 Community Oncology Alliance
▪ Progress to date:
• Financial modeling/budgeting tool
• Education templates for providers/care
teams
• Small groups for IT issues/needs
• Consolidating questions/issues
▪ Let Bo Gamble know if you are interested in these
resources [email protected]
▪ Then…you can join your peers in working through the
details in this model.
▪ Stay tuned for more
OCM Planning and Support
11© 2015 Community Oncology Alliance
MACRA – MIPS/APM
12© 2015 Community Oncology Alliance
MACRA – MIPS/APM
13© 2015 Community Oncology Alliance
▪ What we know so far:
• ALL Physicians
• Complicated – another math formula
• Lots and lots and lots of measures and formulas
• Replaces the Sustainable Growth Rate
(Remember the big box of band aids)
• Replaces MU, PQRS, VM
• Weighted score
▸ Resources (Cost) - 10% weight (year 1)
▸ Clinical Practice Improvement Activities – 15% weight
▸ Advancing Care Information – 25% weight
▸ Quality – 50% weight
• What you do in 2017…will be rewarded or punished in 2019 (+/- 4%)
MACRA – MIPS/APM
14© 2015 Community Oncology Alliance
▪ What we do not know:
• Promoted as being flexible – how flexible for the care team?
• Resource (cost) measures – not established and extra confusing
40 Measures ?
• Exactly when and how it impacts 2-sided risk OCM?
• Will ACOs, MIPS, OCMs coordinate – if so, how?
• What about Clinical Data Repositories
• Is the healthcare system ready for this dramatic change
• BIG question – what is the most efficient and effective way for
cancer care teams to prepare for MIPS?
• Other and lots of other ?????
Comments on Proposed Rule
15© 2015 Community Oncology Alliance
▪ Due by 5:00 pm ET June 27th, 2016
▪ Submit to:
https://www.regulations.gov/#!docketDetail;D=CMS-2016-0060
▪ COA has Lexicon and is preparing comments
▪ Posted comments can be viewed here:
https://www.regulations.gov/#!searchResults;rpp=25;po=0;s=cms
-5517-p;fp=true;ns=true
Coding Update
What Is The Medicare ICD-10-CM Flexibility Period?There will be no denials for codes that are valid for lack of specificity if they are in the right 3-character category for one year◦ An example is C81 (Hodgkin’s lymphoma) – which by itself is not a valid code.
Examples of valid codes within category C81 contain 5 characters, such as: ◦ C81.00 Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site
◦ C81.03 Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes
◦ C81.10 Nodular sclerosis classical Hodgkin lymphoma, unspecified site
◦ C81.90 Hodgkin lymphoma, unspecified, unspecified site
◦ During the 12 month after ICD-10 implementation, using any one of the valid codes for Hodgkin’s lymphoma (C81.00, C81.03, C81.10 or C81.90) would not be cause for an audit under the announced flexibilities.
REMEMBER this only applies to Medicare PART B claims—not hospital, Medicare Advantage, or private insurance claims
Medicare ‘Flexibility’ PeriodBut, read the fine print in the clarification to the CMS guidance:◦ “As such, the recent Guidance does not change the coding specificity required
by the NCDs and LCDs. Coverage policies that currently require a specific diagnosis under ICD-9 will continue to require a specific diagnosis under ICD-10. It is important to note that these policies will require no greater specificity in ICD-10 than was required in ICD-9, with the exception of laterality, which does not exist in ICD-9. LCDs and NCDs that contain ICD-10 codes for right side, left side or bilateral do not allow for unspecified side.”
◦ So, if a Medicare policy requires specific codes, you had better have them on there
Billing With -JWEffective July 1, 2016, all drug claims for single dose vials (SDVs) must reflect the amount of drug wasted:◦ Two lines—one for the drug used; the other for the amount wasted with
Modifier –JW
◦ Exception: when the J-code unit exceeds the amount given plus wastage
◦ Wastage must be documented in the record
◦ Every effort should be made to minimize wastage
Pump “Clarification” (MLM SE1609)The memo basically states that if:◦ A patient starts a pump infusion in your office
◦ The drug is loaded into the pump in your office
◦ The patient finishes the infusion at home
◦ And, then returns after it is over
The pump then cannot be billed to the DME MAC
Furthermore, the pump is BUNDLED into the pump start code 96416 and, if you want to get paid for the pump with the start, you need to bill 96549 or another miscellaneous code
The memo states that DME suppliers will be paid by the DME MAC, whatever that means
Admin Codes (Noridian)
2016 HCPCS: Mid-YearHCPCS/MOD
Code Action Short Description Long Description Effective Date
Q9981 Add rolapitant, oral, 1mg Rolapitant, oral, 1 mg 7/1/16
S0285 Add cnslt before screen colonoscop
Colonoscopy consultation performed prior to a
screening colonoscopy procedure 7/1/16
Q9982 Add flutemetamol f18 diagnostic
Flutemetamol F18, diagnostic, per study dose,
up to 5 millicuries 7/1/16
Q9983 Add florbetaben f18 diagnostic
Florbetaben f18, diagnostic, per study dose, up
to 8.1 millicuries 7/1/16
S0311 Add Comp mgmt care coord adv ill
Comprehensive management and care
coordination for advanced illness, per calendar
month 7/1/16
Q5102 Add Inj., infliximab biosimilar Injection, Infliximab, Biosimilar, 10 mg 7/1/16
ZB Add Pfizer/hospira Pfizer/Hospira 7/1/16
S3854 Add Gene profile panel breast
Gene expression profiling panel for use in the
management of breast cancer treatment 7/1/16
More 2016 HCPCS
More 2016 HCPCS
POLITICS 101:
ADVOCATING FOR CANCER
CARE WITH YOUR MEMBER
OF CONGRESS
Why it is important & why your voice matters
COA University: Politics 101
Series Curriculum
▪ What is advocacy and why is it important
▪ How a bill becomes a law (the sausage making)
▪ More to come…
Why Are We Doing This?
What is Lobbying?
Constitutionally Protected
“Congress shall make no law … abridging … the right of the people
peaceably … to petition the Government for a redress of grievances.”
Who Do you Lobby?
Key Players in a Congressional Office
▪ Chief of Staff
▪ Legislative Director (LD)
▪ Legislative Assistant (LA)
▪ Press Secretary
▪ Scheduler
▪ Staff Assistant
▪ Caseworker
Profile of a typical Hill Staffer
Putting Staffer Age in Context
• 340B Drug Pricing Program (1992) – 24 years ago
• Medicare Modernization Act (2003) – 13 years ago
• Affordable Care Act (2010) – 6 years ago
• Sequestration (2013) – 3 years ago
Why YOUR Voice Matters
1. Politics
2. Experience
Why YOUR Voice Matters
1. Politics
2. Experience
Why YOUR Voice Matters
What You Can Do
▪ Get to know your Congressman.
▪ Follow the issues – COA emails, website, etc.
▪ Establish contact with the district office.
▪ Get involved:
• Write op-eds or letters to the editor (Contact me!)
• Call offices – district and in DC
▪ Remember: You’re the boss – they work for you.
My ASK
Remember
Remember
Thank you
Contact Information
Nicolas Ferreyros
Director of Communications
Cell: 713.377.0689
Email: [email protected]
QUESTIONS?
Next CAN Call – Thursday 6/23/16 – 2:00 pm ET
