Practice Manager Insider

New Medicare Drug Coverage Plan to Cost Less

The new Medicare Part D prescription drug program is likely to cost less than originally estimated. Based on favorable results from the competitive bidding process used to select providers, participants’ cost for the plan will be 14% lower, or $5 less than estimated. Medicare members can begin to sign up for the plan in October, and the benefit is to be implemented January 1, 2006. The monthly average cost is expected to be $32.20.  In addition, many Medicare beneficiaries may qualify for help, or have their full premium paid, if they choose plans that cost at or below preset levels based on region. However, some critics claim the new plan is too complicated and will deter seniors from participating. What feedback have you been getting from seniors regarding their choice to participate in the Medicare Part D drug prescription plan?

Physicians’ Concerns About Harsh Medicare Cuts

As part of its National House Call campaign, the AMA held a press conference in conjunction with the Florida Medical Association (FMA) to alert Medicare patients to the detrimental effects cuts to physician payments from Medicare will have on access to care. Payments are set to be cut by 26% over the next 6 years. In the face of consistent steep increases in healthcare costs, this is raising concerns regarding how practices will survive and whether patients will continue to have access to care. “A recent AMA survey showed that 38 percent of physicians will stop taking new Medicare patients if the first scheduled payment cut goes into effect Jan. 1,” said AMA Trustee Joseph M. Heyman, MD, at an August 8 news conference in Tampa. The AMA National House Call campaign is touring states urging patients to contact their congressional representatives to stop the Medicare cuts. What impact do you anticipate the planned Medicare cuts will have on your practice, both financially and in terms of patients’ access? Will you continue to take new Medicare patients?

"Secrets of the Best-Run Practices" by Judy Capko published August 15

“Secrets of the Best-Run Practices” by Judy Capko was published August 15, 2005. The founder of Capko & Company, Judy has specialized in medical practice operations and marketing for more than 20 years, and is a certified risk management specialist.  Her book addresses what she calls the "Not enough time, not enough money, too many demands" quandary that physicians and medical practice managers face today. Topics include: The Perfect Receptionist, Conquering Work and Patient Flow Problems, Mastering the Appointment Schedule, Common Sense Risk Management, The Dynamics of the Outpatient Academic Practice, Reshaping the Practice – A New Genre, and the Practice of The Future.

Opinions Vary on the CAP Interim Final Rule

Before the suspension of the implementation of the Competitive Acquisition Program (CAP), opinions varied as to whether the CAP would help or hurt oncology practices. From the Centers for Medicare & Medicaid Services (CMS), the issuer of the CAP program, Administrator Mark McClellan, MD, PhD, said, “The program frees physicians from the administrative work of purchasing and procuring drugs in their offices, so that they can focus more time and resources on providing the best treatments for their patients.” On the other hand, a primary concern of the Community Oncology Alliance (COA) (Click “here” under COA Reports and findings) was that CAP gives CMS and the CAP vendors too much control over the drug acquisition and billing process. In addition, COA noted that physicians will still need to purchase some drugs using the current “buy and bill” system, and must commit to a year of enrollment in order to participate in CAP. COA concluded that physicians should carefully consider how enrollment in CAP might affect their practice management needs.

What do you think of the CAP program as proposed in the CAP Interim Final Rule? How do you expect CAP, as published, could affect your practice?

Toolkit for Healthcare Professionals: Medicare Prescription Drug Coverage

Medicare will begin offering prescription drug benefits to all members starting January 1, 2006. To inform healthcare professionals and their patients about the options and mechanics of the new plan, the Centers for Medicaid & Medicare Services (CMS) has issued The Toolkit for Healthcare Professionals: Medicare Prescription Drug Coverage.

The toolkit provides healthcare professionals a free downloadable resource consisting of:

•    A Call-to-Action letter from CMS administrator Mark   
      McClellan
•    Quick facts and a newsletter article
•    Information about coverage choices
•    Important dates for office staff and patients
•    Reproducible artwork, and brochures for patient education
•    A list of additional educational resources for physicians and
      patients

Practices may add their business logo to distributed materials.

Comments on Interim Final Rule for CAP

In comments (click "here" at the bottom of ACCC news release page) submitted April 26, 2005 to Centers for Medicare and Medicaid Services (CMS), the Association of Community Cancer Centers (ACCC) questioned the practical application of the now suspended Competitive Acquisition Plan (CAP) Interim Final Rule that was planned to go into effect January 1, 2006. The implementation of the CAP program will be delayed until the vendor competitive bidding process is re-established. According to the ACCC, the program as presented in the Interim Final Rule would add an administrative burden to physicians that may discourage participation in CAP, causing access to cancer drugs through the program to diminish.  ACCC recommended CMS take steps to both reduce the administrative burden of CAP and provide increased compensation to offset the increase in administrative costs. In addition, ACCC recommended changes of policy regarding the acquisition of drugs from CAP vendors.

Medicare Offering Free Electronic Records Software

According to The New York Times, most doctors have been hesitant to file patient records electronically due to the prohibitive cost and lack of confidence in customer support. Medicare, wishing to improve quality of service, has announced it will give doctors free software to create a computerized patient filing system. Installation of the electronic filing software, called Vista, will cost $10,000 to $12,000 per practice. In contrast, commercial systems generally cost $20,000 to $25,000 per doctor in a practice, which includes the cost of the software. “An office with five doctors could save more than $100,000 by choosing the Medicare software rather than buying software from a private company . . . ,” according to The New York Times. Vista has been used to file patient records for 2 decades within the Department of Veterans Affairs.

Overview of CAP Interim Final Rule

In a news release on June 27, 2005, the Centers for Medicare & Medicaid Services (CMS) issued an Interim Final Rule that established the now delayed Competitive Acquisition Program (CAP) for the purchasing of Medicare Part B physician injectable drugs. The CAP will be a voluntary program that allows physicians to acquire drugs from vendors who are selected through a competitive bidding process, as opposed to the current “buy and bill” system. Once CMS has published a list of vendors and the drugs they will offer, physicians may then select one vendor, obtaining all available Medicare drugs though that vendor. The vendors would then be responsible for billing Medicare and beneficiaries. The aim of the program is to reduce the time and paperwork associated with direct purchase of drugs, while in the long term reducing drug costs through the competitive bidding of vendors. Physicians will be able to elect to participate in the program once a year. Once CMS has published the CAP Final Rule, physicians can voluntarily enroll.  CMS estimates the program will go into effect by July 2006.

A full copy of the CAP Interim Final is available on the Federal Register website. CMS will accept comments on the CAP Interim Final Rule as published until September 6, 2005. Nonelectronic comments regarding the program may be submitted to CMS by mail: Department of Health and Human Services, Attention: CMS-1325-IFC, PO Box 8013, Baltimore, MD 21244-8013 or by courier at: Room 445-G, Hubert Humphrey Bldg, 200 Independence Ave SW, Washington, DC 20201; or 7500 Security Blvd, Baltimore, MD 21244-1850.

CMS Competitive Acquisition Program Vendor Bidding Process Suspended

Centers for Medicare & Medicaid Services (CMS) has suspended the vendor bidding process for the Competitive Acquisition Program (CAP) established by the Medicare Final Interim Rule announced June 27, 2005, in a CMS news release. Despite the suspension, CMS will further review comments regarding the CAP, and said, “after we are able to analyze the comments and determine how we can best improve the efficiency and attractiveness of the CAP, we anticipate publishing a final rule in late 2005.” Once the final version is published and vendors have been selected, CMS will establish an election period in which doctors will have the opportunity to voluntarily enroll with a specific vendor. CMS expects physicians will be able to obtain drugs through CAP by July 2006.

Welcome to Practice Manager Insider

Practice Manager Insider caters to practice managers who are concerned with updating and increasing the business efficiency of their oncology practice, with special attention on the upcoming 2005–2006 Medicare Reform changes that will impact every practice manager in the United States. Practice Manager Insider provides a centralized resource allowing practice managers to read and comment on the recent Medicare changes and other evolving practice management issues. We encourage you to post comments on each update, discuss issues, and share information. We look forward to your active participation in this exciting new connection of resources and hope you find the exchange of information and insights with other insiders in the field of oncology practice management rewarding.