Practice Manager Insider

Gap in Satisfaction and Care Between Urban and Rural Oncologists

A recent survey released by the Oncology World Congress showed that oncologists practicing in suburban and rural areas are less satisfied with their access to drugs, technologies, and trials as compared with oncologists who practice in urban/metropolitan areas. Dr. Waun Ki Hong, Oncology World Congress chair, said, “With an estimated 90% of US oncology care performed outside of academic cancer centers, community oncologists are in crucial need of timely information on
research advances and emerging technologies, as well as greater access to clinical trials and new therapies.” According to the survey, 41% of the physicians polled in both urban and rural settings say that issues with standard health coverage and Medicare present the greatest limitations to effective treatment. The gap in satisfaction and care between urban and rural oncologists will be one of the issues addressed by Dr. Hong and more than 170 colleagues at the Oncology World Congress Meeting, scheduled to take place November 16–19, 2005 in New York City.

Medicare Part D Prescription Drug Plans Announced

Medicare has formally approved the individual prescription drug coverage plans that will be available through the new Medicare Part D Prescription Drug Plan, which is set to begin January 1, 2006. The approvals will allow for prescription drug plans in every state, with between 11 and 20 organizations offering drug coverage in each region. Ten organizations will offer nationwide coverage. There will be at least one prescription drug plan with a monthly premium of less than $20 in all states but Alaska. Five or more prescription plans in each state will provide coverage with no premium for qualified beneficiaries. “Thanks to the range of options available, everyone in Medicare will be able to choose a prescription drug plan that addresses their individual concerns about cost, coverage, and convenience,” said Health and Human Services Secretary Mike Leavitt. The Centers for Medicare & Medicaid Services has published a map listing the prescription drug plans available in each state. Coverage providers may begin marketing their plans on October 1st, in anticipation of the November 15th start of patient enrollment.

Community Oncology Alliance Supports Chemotherapy Demonstration Project

The Community Oncology Alliance (COA) announced its support for the 2005 Chemotherapy Demonstration Project and requested the project be extended to run through 2006. In the 2005 Chemotherapy Demonstration Project, initiated by the Centers for Medicare & Medicaid Services (CMS), practitioners assessed three issues associated with chemotherapy: controlling pain, minimizing nausea, and reducing fatigue. From these assessments, CMS will be able to modify treatment options and enhance symptom management. COA president Leonard Kalman, MD, states, “The Chemotherapy Demonstration Project is the necessary bridge created by CMS while the Congress and CMS work towards a permanent solution for oncology reimbursement.”  Under the 2005 project, practices qualify for an additional payment of $130 per encounter if they report to Medicare on all three factors. Practitioners self enroll in the project by billing with CMS designated codes.

New Medicare Appeals Process

The Centers for Medicare & Medicaid Services (CMS) will be implementing a new Medicare claims appeals process effective January 1, 2006.  The current Medicare claims appeals process can take over 1000 days, and the new statutes must reduce that time frame to 300.  In addition, the new rules will establish a uniform appeals process for both Medicare Part A and Part B. The statute will provide new requirements for improved notice of decisions and implement a four-level appeals process. In some cases a party can have their claim escalated to the next level of review if a decision is overly delayed.

The first level of Medicare appeals is now called “redetermination”; CMS has published a Medicare Claims Manual (see R687CP) containing forms for processing this new step of the appeals process.

Helping Cancer Patients Understand Clinical Trials

The largest radiation oncology society in the world, The American Society for Therapeutic Radiology and Oncology (ASTRO), has published a new patient information brochure entitled Understanding Clinical Trials: Facts to Help Patients Make an Informed Decision. Louis Harrison, MD, chair of the ASTRO Communications Committee and a radiation oncologist at Beth Israel Medical Center, said, “Unfortunately, many patients do not participate in these vital trials because they don’t know enough about these studies or how to participate. With this brochure, we hope to give patients the facts they need to decide whether a clinical trial is right for them.” Clinical trials are important for patients looking for improved treatment and new ways to prevent and detect cancer. 

CMS Actions to Help Katrina-Stricken Areas

The Centers for Medicare & Medicaid Services (CMS) is relaxing normal operating procedures in order to meet the emergency health care needs of beneficiaries and providers in states severely impacted by Hurricane Katrina. A primary goal of CMS is to ease the burden of documentation on beneficiaries without healthcare records or proof of status as Medicare or Medicaid beneficiaries. Healthcare providers who cannot comply with normal Medicare and Medicaid requirements due to the hurricane, but who furnish medical services in good faith, will be paid and exempt from sanctions for noncompliance.

Medicare Prescription Drug Coverage: Helping Patients Choose

The enrollment process of Medicare recipients in the new Medicare Part D prescription drug plan, which becomes available January 1, 2006, is expected to place increased demands on healthcare professionals. PENN CME is offering a free online 1-credit continuing medical education (CME) course entitled Medicare Prescription Drug Coverage: Helping Patients Choose. This CME activity is designed for physicians, nurses, pharmacists, and other healthcare workers who will interact with Medicare beneficiaries in order to explain choices and benefits of the prescription plan. Topics will include reviewing the extra help that is available for those with limited income and resources, assisting patients in determining which plans are available in their area, and counseling patients on how to join a Medicare prescription drug program.

Newt Gingrich Suggests Medicaid and Medicare Overhaul

On August 22, 2005, former Speaker of the House Newt Gingrich delivered comments to the National Press Club regarding Medicaid and Medicare reform. In his speech, Gingrich addressed the skyrocketing costs of Medicaid and Medicare. In addition, he stressed that this is not a partisan issue, but rather a result of the inefficiencies embedded within this overwhelming government bureaucracy. Gingrich asserts that Medicaid and Medicare need a major overhaul to revise a system that is “…trapped in a box of 19th and 20th century institutions.” Gingrich’s suggested reforms include more aggressive pursuit of fraud and making use of current technologies such as electronic billing and the Internet.

Welcome to the September 1, 2005 launch of Practice Manager Insider

Welcome to the September 1, 2005 launch of Practice Manager Insider, an exciting new resource designed to help you increase the business efficiency of your oncology practice. Practice Manager Insider is regularly updated with the latest articles and news related to your field, with links to relevant sites, and allows you, the insider, to exchange individual expertise through comments and queries posted on each entry. Over the past month, we have begun posting, so you’ll already find the following topics for discussion: 

•    How the Medicare CAP Interim Final Rule will change the
      process through which physicians will acquire and bill for
      Medicare Part B drugs
•    Strong reaction to the Interim Final Rule and its temporary
      suspension for further evaluation
•    The January 1, 2006 initiative of the Medicare Part D
      prescription plan
•    Free software offered by Medicare to create a
      computerized patient filing system
•    Physician concerns regarding the effects of cuts to
      physician payments from Medicare
•    Recent release of practice management book

We look forward to your active participation on the Practice Manager Insider blog, and hope you find sharing the collective information and insights with fellow insiders rewarding.  A goal of Practice Manager Insider is to create a community forum, so please contribute—every comment is a valuable addition to each discussion.