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California Oncology Weekly
"Where California Oncologists Go For Answers!"
A collaborative publication of the
Medical Oncology Association of Southern California, Inc.
and the
Association of Northern California Oncologists, Inc.
October 6, 2015
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- For more than 15 years MOASC & ANCO worked tirelessly to keep the onerous legislation at bay, fraught with liability to the physician with no protection, California Gov. Jerry Brown (D) signed ABX2-15 Assemblymember Susan Talamantes Eggman (D-Stockton) End of Life. This bill allows terminally ill patients to be prescribed life-ending drugs. California is the fifth state to adopt "right to die" legislation. A signing message can be found here. Also signed yesterday were bills affecting healthcare in California: AB 192 by Assemblymember Travis Allen (R-Huntington Beach) Specialized license plates of which the California Breast Cancer Awareness Pink Ribbon specialty license plate is included. AB 941 by Assemblymember Jim Wood (D-Healdsburg) Clinics: licensure and regulation - exemption; and SB 19 by Senator Lois Wolk (D-Davis) Physician Orders for Life Sustaining Treatment form: electronic registry pilot. Governor Brown also announced that he has vetoed AB 1060 by Assemblymember Susan Bonilla (D-Concord) - Cancer clinical trials. A veto message can be found here. - The open enrollment period for the third year of Covered California, California's health benefit exchange, begins November 1, 2015, and continues through January 31, 2016. All 10 health insurance companies that offered coverage in 2015 will continue to offer coverage in 2016, with two new health insurance companies, United Healthcare (UHC) and Oscar, entering into the marketplace for 2016 in select regions. - The next Cal/OSHA Antineoplastic Drugs Advisory Meeting will be on Wednesday, October 28, 2015. The meeting will be in Oakland at the Elihu Harris State Building on 1515 Clay Street in Room 1304 on the 13th floor, from 10:00AM to 3PM. The purpose of the meeting is to seek advice on a new discussion draft that is intended to meet the requirements of AB 1202 and is in response to the advice provided during the first meeting earlier. This bill would require the California Occupational Safety and Health Standards Board within the Department of Industrial Relations to adopt a standard for the handling of antineoplastic drugs, as defined, in health care facilities regardless of the setting. The bill would require the standard to be consistent with and not exceed specific recommendations adopted by the National Institute for Occupational Safety and Health for preventing occupational exposures to those drugs in health care settings. By creating a new crime, this bill would impose a state-mandated local program. If you have questions regarding this meeting, please contact Grace V. Delizo Senior Safety Engineer, DOSH Research and Standards Health Unit, at 619-278-3770 or Bob Nakamura at 510-286-7005. Thank you for your interest in this project.
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- Join Noridian at the upcoming Ask the Contractor Teleconference (ACT), Thursday, October 15, 2015, 1:00-2:00 p.m. Pacific Time. Call 866-243-8959.Noridian representatives from various departments including Appeals, Claims Processing, Electronic Data Interchange Support Services (EDISS), Medical Review (MR), Provider Contact Center (PCC), Provider Enrollment, Provider Outreach and Education (POE), and System Support will be available to address your questions. No registration is required for this call. Please call in ten minutes prior, the call will start promptly at 1:00pm. After placing the call, you will be asked for the following:
Conference Name; Facility Name; Location; Number of people in attendance. ACTs are designed to open communication between providers and Noridian, which allows for timely identification of problems, and sharing information in an informal and interactive question and answer (Q&A) format. No Personal Health Information (PHI) is allowed. Noridian has created the "Ask the Contractor Teleconference Question Submission Form" which can be used to submit questions up to five days prior to the ACT. Questions submitted using this form will be answered first during the ACT; lines will then be opened as time allows. Do not include any PHI or claim specific inquiries on this form. If you have claim specific questions, contact the Provider Contact Center. Providers will need to have Version 7 or higher of Adobe Reader to use this form. Q&As will be posted on the Noridian website at Ask the Contractor Teleconference (ACT). Noridian looks forward to your participation.
- Noridian announced that it will offer web-based workshops focusing on provider enrollment. These webinars are intended for the Part B provider using the online Provider Enrollment, Chain and Ownership System (PECOS) to change enrollment information, track revalidation or set up a sole proprietorship. The Internet-based PECOS process can be used in lieu of the Medicare enrollment application (i.e., paper form CMS-855).
The advantages of PECOS are:
Faster than paper-based enrollment (45-day processing time in most cases, vs. 60 days for paper)
Tailored application process means you only supply information relevant to YOUR application
Gives physicians more control over their enrollment information, including reassignments
Easy to check and update your information for accuracy
Less staff time and administrative costs to complete and submit enrollment to Medicare
There is no registration or teleconference fee. The presentations will be conducted through a web-based training tool that requires an Internet connection and a telephone (number provided in confirmation email) https://med.noridianmedicare.com/web/jeb/education/training-events.
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- There has been erroneous information regarding Medi-Cal's ICD-10 preparedness and the states that are using a crosswalk solution. DHCS has made it clear that California is ready and is fully compliant with the CMS ICD-10 mandate. Medi-Cal will be accepting ICD-10 codes, adjudicating them, and returning 835's to the submitters. Therefore, you must submit ICD-10 codes on claims with dates of services on or after October 1, 2015. There are actions that providers can take to reduce the possibility of payment delays. Submit the correct ICD indicator and date of service on your claim. Review the ICD-10 manuals on the Medi-Cal website. If there are specific claim questions, call the Telephone Services Center (TSC) or the CMC helpdesk. And if there are specific ICD-10 questions or if you are hearing of trends that you want to talk to DHCS about you can contact the ICD-10 mailbox. DHCS is going to be increasing the frequency of these calls so that as a community, they can monitor the success of ICD-10 and where/how they can monitor that success.
- The next DHCS Stakeholder Advisory Committee (SAC) meeting will be held on Wednesday, October 14, 2015, from 9:30 a.m. to 3:30 p.m. at the Sacramento Convention Center. There is also a listen-only conference line to hear the meeting: 888-968-3517, passcode 8245294. The agenda for the October 14, 2015, SAC meeting and the summary of the July 22, 2015, meeting can be found at the link below. Additional materials will be available on the DHCS website by October 9. All meeting materials can be found on the SAC website: http://www.dhcs.ca.gov/Pages/DHCSStakeholderAdvisoryCommittee.aspx.
There will be public comment at the end of the meeting.
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- In preparation for discussion with Noridian at the next CAC meeting on October 21st, MOASC seeks input from membership regarding the impact of ICD-10 on your practice. As we have the ear of Noridian, and a few weeks of ICD-10 coding completed, MOASC wishes to represent you on this timely issue. Please send your ICD-10 concerns to moasc@moasc.org for MOASC President, Warren Fong, M.D., to take on your behalf. Thank you! - You are invited to the MOASC Administrator Meeting, November 5, 2015, 8:00am to 3:00pm at The Mission Inn, Riverside. At this final meeting of the year, you'll hear from key industry stakeholders how the industry is faring with implementation of the new code sets. Take this unique opportunity to learn from industry experts, what they know to keep your practice current and trending toward success. Discuss with colleagues what the initial impact of ICD-10 has had on operations. Some of the topics include: Key data points for a practice's health, patient surveys, embezzlement and COPA; Current Trends in Oncology, USP 797/800, Patient Support, Medi-Cal and Medicare Updates. DON'T MISS THIS VALUABLE EVENT! If you wish to reserve a hotel room at a discounted rate, please contact the MOASC Office at moasc@moasc.org - MOASC has openings on the Board of Directors. Physician Members who are interested in providing direction and assistance to your state oncology organization are encouraged to contact the MOASC Office at moasc@moasc.org . - MOASC is also soliciting Administrators and Non-Physician Clinical Staff to fill the two positions on the board of Directors that represent your interests in the oncology practice. MOASC believes that the administrator and clinical staff bring fresh ideas and new points of view. Thank you for your participation & SUPPORT! - California Partnership for Access and Treatment has notified MOASC of a great resource on the cost and value of prescription medicines. The link below is full of infographics that explain the role new medicines play in the overall reduction of health care costs. Please take a moment to review the document and please share with your patients. - Effective January 1, 2015, AB219 (the Health Care Coverage: Cancer Treatment Act) limits a patient's total co-payment and coinsurance for an oral cancer medication to $200 per 30-day supply. Some private payor pharmacy benefit plans may be in violation of the provision of AB219. If you are finding this to be the case with any payor or their PBM, please let the MOASC office know the name of the health plan and PBM company at moasc@moasc.org. Thank you.
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- Prepare for ICD-10! Listen to Bobbi Buell's 2015 series of ICD-10 webcasts at www.anco-online.org.
- Here is Bobbi Buell's ICD-10 To Do List:
1. Contact Vendors to verify that they are ready for October 1.
2. Blitz Your Receivables--you should be working diligently to get the accounts receivable down and getting all the ICD-9 cases billed and adjudicated.
3. Prep the Clinical Staff--test them on the match between clinical documentation and changing coding descriptors.
4. Make Sure You Have Cash and have your lines of credit in place to get through the first 60-90 days of this transition.
5. Establish a War Room and team in place on October 1 to meet daily to review any successes or failures in the transition.
6. Measure, Measure, Measure your financials on September 30 and monitor these closely during the transition to see how your claims are doing.
7. Get Your Tools (Superbills, Chargemasters, EHRs, ICD-10-CM 2016 book) Together
8. Be in Your Network by staying in touch with other clinic managers and associations.
9. Ask for Help If You Need It
- ANCO's last Hematologic Malignancies Update for 2015 takes place on November 7, 2015. Join Brian A. Jonas, M.D., Ph.D., UC Davis, Michaela Liedtke, M.D., Stanford University, and Gregory P. Kaufman, M.D., Stanford University, to learn the latest about treatment modalities for acute leukemias, myelodysplastic syndromes, and myeloma and discuss case studies for each diagnosis. The program takes place at the Stanford Park Hotel in Menlo Park. Go to www.anco-online.org/4Q2015HemeMalig.pdf for more information.
- ANCO's Molecular Diagnostics & Clinical Decision Making takes place at The Claremont Resort on October 24. Faculty from industry, payers, and local institutions will discuss the science of molecular diagnostics, reimbursement for molecular diagnostics, and the use of molecular diagnostics in clinical decision making using case studies. For more information, visit www.anco-online.org/MolDx.pdf.
- ANCO is pleased to be a sponsor of the 16th Multidisciplinary Management of Cancers: A Case-based Approach which returns to the Silverado Resort and Spa, Napa, on March 18-20, 2016. The meeting is presented in collaboration by the Stanford Cancer Institute, UC Davis Comprehensive Cancer Center, and UCSF Helen Diller Family Comprehensive Cancer Center. For more information, visit http://cme.stanford.edu/multicancers.
- DEADLINE EXTENDED--ANCO launched its 2015 Staff Salary Survey the week of April 20. Visit www.anco-online.org/salsrvy.html to download, complete, and return the survey no later than September 30, 2015.
- Effective January 1, 2015, AB219 (the Health Care Coverage: Cancer Treatment Act) limits a patient's total co-paym,went and coinsurance for an oral cancer medication to $200 per 30-day supply. It has been brought to ANCO's attention that some private payor pharmacy benefit plans may be in violation of the provision of AB219. Read more about and take ANCO's AB219 survey at www.anco-online.org/AB219Survey.pdf.
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- The Community Oncology Alliance (COA) President, Bruce Gould, M. D. testified, last Thursday, on Capitol Hill. Asking for COA's attendance, the Energy & Commerce Committee held a legislative hearing on 3 Medicare bills, with one being the CMR/Israel bill (HR 1934) addressing oncology payment reform. This hearing signifies that the bill is moving.
Dr. Gould answered questions on the bill and related areas in a thorough, professional manner. During his testimony Dr. Gould stated that, "...Community oncology practices like mine want to be part of the alternative payment reform path that the Energy and Commerce committee developed in the SGR legislation; however, we need a Medicare alternative payment model in oncology for that to happen. H.R. 1934 is a critical bridge to getting us to that point. I ask Congress to pass this important legislation that will lower the costs of cancer care while enhancing the quality of care for patients." Energy and Commerce Chairman, Fred Upton (R-MI), added that, "...Sponsored by Representatives McMorris Rodgers and Steve Israel, the bipartisan legislation [H.R. 1934] would build off of the promise in the SGR repeal legislation by promoting innovative payment reforms designed to increase the quality of care delivered to Medicare seniors and reduce costs to the program. We will continue our work to keep the promise to seniors and improve the Medicare program..."
This was not just about H.R. 1934; it was about the CMMI OCM model. With this bill advancing, it puts pressure on CMMI to modify the OCM model in such a way that it will actually work. More on this can be found on the COA website www.CommunityOncology.org. COA PAC is the only independent PAC dedicated solely to community oncology.
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If you have any questions about Physician Compare, public reporting, or the 2014 quality measure preview period, please contact us at PhysicianCompare@Westat.com.
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Affiliate Association News
- You're invited! Please consider joining NCCN in San Francisco, CA for the NCCN 10th Annual Congress: Hematologic Malignancies™, October 16 - 17, 2015.
This year's agenda includes 13 educational sessions featuring the latest advances in hematologic malignancies, plus interactive Patient Case Studies & Panel Discussions where panelists will review and discuss interesting and challenging cases with the audience. Additionally, there is the addition of a Lunch Satellite Session titled, The NCCN Value Initiative: Using NCCN Evidence Blocks™ in Clinical Decisions. This session will feature the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Chronic Myelogenous Leukemia with NCCN Evidence Blocks™ and will take place October 17th, from 11:45 am to 1:00 pm. This session is open to all registered congress attendees. View the agenda for additional details on session topics and faculty. Reserve your spot today and save!
- Research to Practice for the Year in Review (YIR) Los Angeles meeting is on Saturday, November 21. Please click on the link for more information.
- Don't wait to register now to ensure the best available housing for the premier event in hematology! ASH invites you to attend the 57th ASH Annual Meeting and Exposition from December 5-8, 2015, at the Orange County Convention Center in Orlando, FL. This year's meeting will debut some new offerings and continue to showcase the full spectrum of hematology, from discoveries to new therapies to outcomes analyses. Register as an individual.
- ASCO has announced a new study which provides compelling evidence that a simple tool can help predict which patients with cancer may be in their final year of life. The tool, known as the Surprise Question, was found to predict the risk of cancer death within one year better than factors such as cancer type or stage alone. This study will be presented at the upcoming 2015 Palliative Care in Oncology Symposium in Boston. read press release
ASCO's Administrator's Workgroup prepared the following "to do" list with regard to ICD-10:
1) Modifying documentation templates to capture needed components.
2) Making crosswalk software available on the internal intranet (and some key desktops).
3) Developing quick crosswalk tools for staff that order DME.
4) Reviewing every EMR chart to confirm the appropriate ICD-9 code and its corresponding ICD-10 code.
5) Coding staff will be meeting one on one with the providers over the next three months to review their charting and confirm their understanding of the new requirements.
6) Begin requesting prior authorizations for chemotherapy, imaging, and radiation therapy with ICD-10 coding. Some payers have stated that they will not honor authorizations approved prior to 10/1/15 with ICD-9 codes.
7. One on one education for physicians.
- Be a part of ASCO's new collaborative learning network, PracticeNET, to gain valuable insights into your practice's business operations and quality of care. This new initiative, from ASCO's newly formed Clinical Affairs Department, uses existing data from your practice management system to offer customizable reports that measure practice-wide and individual performance against a national database of other PracticeNET participants. For more information, and to enroll, visit asco.org/practicenet.
- COA PAC is a political action committee (PAC) founded by community oncologists for community oncology. Funds raised within COA PAC are used to contribute to campaigns of individuals seeking elected office to the United States Senate and House of Representatives. COA PAC supports individuals who have demonstrated an interest in community cancer care and in preserving and enhancing the nation's cancer care delivery system for cancer patients.
A suggested initial contribution is at least $1,000; however, many oncologists have made an initial contribution of $2,000. Contributions cannot exceed $5,000 per year. COA PAC has a Community Oncology Leadership Club that recognizes contributions. If you want elected officials who support community oncology and the patients served, you need to support their election campaigns. COA PAC is the only independent PAC dedicated solely to community oncology. Community oncologists need to be far more active as evidenced by the list below of the top 60 healthcare professional PACs in 2014. COA PAC ranked 51st, behind many other more specialized areas of medicine. COA PAC makes the most of the funds raised, but community oncology is lagging behind many other areas of medicine in making an impact. It is up to you and your fellow oncologists to contribute to increase support for community oncology. www.CommunityOncology.org - ASCO's Practical Tips for the Oncology Practice(6th Edition) is now available at
- ASCO has published updated guidelines for the treatment of lung cancer. Systemic Therapy for Stage IV Non-Small Lung Cancer was posted ahead of print on August 31. Treatment of Small-Call Lung Cancer: ASCO Endorsement of the American College of Chest Physicians Guideline was posted ahead of print on September 8. Both are available online at www.instituteforquality.org/practice-guidelines > Lung Cancer.
- ACCC's 2015 Trends in Cancer Programs survey results are now available at http://www.accc-cancer.org/surveys/CancerProgramTrends-2015-Overview.asp. Lack of reimbursement for supportive care services tops the list of challenges facing cancer programs. Other key findings include while patient-centered services increase, cancer programs are still challenged in meeting new CoC patient-centered standards; more cancer programs are implementing quality and compliance initiatives related to oral drugs; and, reimbursement challenges continue despite a larger number of insured patients.
- The National Comprehensive Cancer Network (NCCN) is making available the NCCN Scale in October. The NCCN Scale is a tool to aid cancer patients make more informed choices by helping to assess the costs of medical treatments juxtaposed against their benefits. The NCCN Scale will make use of the so-called evidence blocks that "assign a score of up to five points for each of five measures--price, effectiveness, safety, quality and consistency of clinical data." In its October launch, the NCCN Scale will provide ratings for drugs used to treat multiple myeloma and chronic myeloid leukemia. Before 2016, the Scale is expected to have also included ratings for other types of cancer.
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Industry News
- Eisai invites you to attend a live presentation of, "Treatment of Locally Recurring or Metastatic, Progressive Radio-active Iodine Refractory Differentiated Thyroid Cancer." October 22, 2015 at 6:00pm. Presented by Ezra Cohen, MD, Moores Cancer Center,University of California, San Diego. Please open this link for further information. Invitation - Merck informs MOASC & ANCO that KEYTRUDA has received a second approval from the US Food and Drug Administration (FDA). The approved recommended dose of KEYTRUDA is 2 mg/kg administered as an intravenous infusion over 30 minutes every 3 weeks until disease progression or unacceptable toxicity. Select patients for second-line or greater treatment of metastatic NSCLC with KEYTRUDA based on the presence of positive programmed death ligand 1 (PD-L1) expression. Prescribing Information Medication Guide. If you have any questions, please contact Mike Nicolucci, Account Manager, Reimbursement (C) 913 522-6508, (F) 215 616-5889, E-Mail: mike.nicolucci@merck.com directly. - As part of Astellas' continued focus to improve business processes and better service their suppliers, Astellas is proud to launch an easy-to-use Supplier Portal in the coming months. At no cost to you, this new set of self-service capabilities will enable you to: Monitor invoice status and payment information; Receive and view your company purchase orders; Submit early payment offers; Update supplier profile information. Thank you for your participation. If you have any questions, please contact SupplierPortal@astellas.com. - Pfizer Oncology informs MOASC & ANCO that the U.S. Food and Drug Administration (FDA) has approved a supplemental New Drug Application (sNDA) to update the XALKORI® (crizotinib) prescribing information (PI) with efficacy and safety data from the Phase 3 PROFILE 1014 trial. For a copy of the updated PI and more information about XALKORI, please visit http://xalkorihcp.com. - Bristol-Myers Squibb received approval from the U.S. Food and Drug Administration for the Opdivo (nivolumab) + Yervoy (ipilimumab) Regimen in BRAF V600 Wild-Type Unresectable or Metastatic Melanoma. This is the first, and only, FDA-approved combination of two Immuno-Oncology agents; Pivotal study CheckMate -069 demonstrates significantly superior responses and progression-free survival with the Opdivo + Yervoy Regimen vs. Yervoy alone, and approval of the regimen marks a new development, demonstrating the potential of targeting distinct and complementary immune system pathways, offering patients a novel combination treatment. For more information contact Dean Marcoccia, State Government Affairs & Alliance Development, Dean.Marcoccia@bms.com . - During Breast Cancer Awareness Month last year, Pfizer released the results of a survey that showed the majority of Americans reported they know little to nothing about metastatic breast cancer (MBC), the most advanced stage of the disease which impacts 150,000-250,000 people in the U.S. alone. This year, Pfizer is launching a candid and inspiring social media campaign highlighting the stories and images of five women living with MBC. Visit the @StoryHalfTold Instagram account, www.StoryHalfTold.com, Facebook and Twitter, and SHARE using the hashtag #StoryHalfTold, #breastcancerawareness.
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The Medical Oncology Association of Southern California(MOASC) is a leading oncology society that advances and protects the ability of cancer patients to obtain, and the ability of the oncology physicians to provide, optimal cancer care. The Association of Northern California Oncologists (ANCO) is an association of hematologists/oncologists dedicated to promoting high professional standards of cancer care by providing a forum for the exchange of ideas, data, and knowledge. The material contained in the California Oncology Weekly is intended as general information for ANCO and MOASC members. Because diagnostic, treatment, contracting, coding, and billing decisions should be made on a case-by-case basis, any such information contained in the California Oncology Weekly may not apply in any given situation. Members are encouraged to contact their own consultants or advisors to obtain specific advice on matters relating to contracting, coding, and billing. The information contained in California Oncology Weekly should not be used as a substitute for such advice. This publication provides a summary of regulations affecting oncology and its business practices. Reading this newsletter does not substitute for understanding regulations and verifying the validity of every claim. This information is time-sensitive and is subject to change. MOASC or ANCO accepts no liability for any statements or articles herein.CPT codes are owned and trademarked by the American Medical Association. All Rights Reserved.
MOASC: P.O. Box 161, Upland, CA 91785 | P (909) 985-9061 | F (909) 804-5006| www.moasc.org
ANCO: P.O. Box 151109, San Rafael, CA 94915 | P (415) 472-3960 | F (415) 472-3961 | www.anco-online.org |
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