Practice Manager Insider

Medicare Reimbursement for Community Oncology Care Out of Date

A new video made available by the Community Oncology Alliance tells the story of community oncology care through firsthand accounts of patients, caregivers, nurses, staff, and oncologists at Northwest Georgia Oncology Centers, PC. Hospitals treat cancer patients only in acute stages of care, with community oncology centers left to fill the important role of providing continuous extended cancer care. Most importantly, community oncology centers allow patients and their families to develop extended supportive relationships with doctors and staff, while battling this devastating disease. However, the 2005 changes to the Medicare Modernization Act have reduced the level of reimbursement for cancer and cancer-related drugs. Previously, cancer drugs were reimbursed at a high enough rate to offset the often below-cost reimbursement for oncology treatment services. At the time the changes were enacted, it was predicted the imbalance of reimbursement would cause dramatic access-to-care issues. The video concludes, “This is a critical time when the Congress, CMS, and cancer community need to work together to protect the community cancer care delivery system.”

How have the 2005 changes affected your oncology practice’s financial “bottom line,” and how will they affect access to care for patients?

COA Endorses Community Cancer Care Preservation Act of 2005

The Community Oncology Alliance (COA) has endorsed the Community Cancer Preservation Act of 2005 which was recently introduced in the House of Representatives by Congressman Jim Ramstad (R-Minnesota). The proposed legislation will:

• Fix reimbursement problems caused by Medicare’s average sales price method of reimbursement

• Continue the existing chemotherapy demonstration project

• Direct the secretary of Health and Human Services to work with community oncologists to help define measures of quality care

• Instruct the director of the National Cancer Institute to work with community oncologists to help increase enrollment in clinical trials

• Require the Congressional Budget Office to analyze the impact of the Medicare Modernization Act of 2003 (MMA) on oncologists and others involved in cancer care

"Congressman Ramstad, along with many other members of Congress, understands our concerns about patient access and quality care. This bill makes great headway in resolving these concerns," said Leonard Kalman, MD President of COA. A summary of the Community Cancer Care Preservation Act of 2005 can be found on the COA website under “Immediate Action Needed.”

CMS Provides Online Help for Choosing Medicare Part D Plans

The Centers for Medicare & Medicaid Services (CMS) has announced the launch of the Prescription Drug Plan Finder, an online resource to aid beneficiaries in choosing a Medicare Part D plan based on cost, coverage, and convenience. In addition, CMS is working with 140 community-based networks and nearly10,000 Medicare partners, including senior centers and State Health Insurance Assistance Programs, to aid in educating seniors about the ground-breaking and often controversial drug plan. “People do not need to make a decision now—they can’t sign up for a plan for another month and they can get coverage on January 1 as long as they enroll by December 31, 2005.  As we get closer to the time to enroll, the new tools will help people make those decisions,” said Mark B. McClellan, MD, PhD, CMS administrator.

Medicare Internet Search Techniques

The groundbreaking, controversial Medicare Part D Prescription Drug Plan takes effect January 1, 2006, and will require physicians and patients to understand complicated new policies. Adding to the confusion, the Centers for Medicare & Medicaid Services (CMS) and other Medicare-related sites can prove daunting to navigate. However, Wisconsin Physicians Service (WPS), one of the largest Medicare Part B carriers in the nation, is offering a 90-minute web-based seminar to help physicians and practice managers learn new search techniques for both the CMS Medicare website and their CMS sponsored site – WPS Medicare. If you want to register, act soon—the web conference dates are October 20 and 27, 2005. See: iLinc Sessions: Internet Search Techniques on the Provider Education Seminar Schedule page.

MedPage Today Runs 5-Part Medicare Part D Drug Plan Series

The groundbreaking and controversial Medicare Part D prescription drug plan that will provide prescription drug coverage for seniors will be available January 1, 2006. The Centers for Medicare & Medicaid Services (CMS) has released the individual plans that will be available in each state. With the November 15th enrollment date fast approaching, MedPage Today has published a 5-part series to educate physicians so they may guide patients in the selection of a plan that will suit their individual needs.

•    Medicare Prescription Drug Organizations Release Marketing Blitz
•    Medicare Stumbles in Efforts to Explain Drug-Coverage Plan
•    Medicare Part D: Who Should Join?
•    Medicare Part D: What Drugs Are Covered?
•    Medicare Part D Drug Coverage: A Little Something for Everyone

Beneficiaries who wait until after May 15, 2006, to enroll will pay more for a drug program.

Medicare Part D: Still “a Lot of ’Splaining to Do”

Fred and Ethel Mertz, of “I Love Lucy” fame, have been resurrected as TV spokespersons to market Medicare’s groundbreaking prescription drug plan for seniors. However, a special report on Medpage Today regarding the Medicare Part D plan chides that these characters are “a good choice because, as Ricky would say, Medicare has ‘a lot of ’splaining to do.’” In a recently distributed handbook, the Centers for Medicare & Medicaid Services (CMS) misstated the enrollment eligibility for the Medicare-approved regional prescription drug plans (PDPs) for low-income seniors—the very group the plan was designed to serve. According to CMS, the correct information is posted on the Medicare website; however, the website is reported to contain other inaccuracies. Medpage Today states, “This single case may be an exception, but critics of the Medicare prescription drug plan say they suspect otherwise.”

Electronic Medical Records Could Save Billions

Using a statistical model, Rand Research Corporation determined that if electronic health records systems were adopted by 90% of hospitals and doctors the potential savings would be $81 billion a year.  Rand also reports that < 25% of hospitals and 20% of private practices have begun using electronic medical records. However, the study cautioned the immediate savings would not be realized by the doctors and hospitals making the investment, but rather would go to Medicare and private insurers. In addition, experts caution that most of the projected advances pertaining to electronic medical records are hypothetical and often based on unproven assumptions. Other difficulties include:

•    Each practice or hospital will recoup its investment costs at a different rate
•    To be fully effective, record networks will have to be able to share records
•    There is still doubt as to which computer systems to purchase.

For information on available electronic medical record systems you can consult Electronic Medical Record Comparisons By Physicians for Physicians.

Medicare Pay-for-Performance Proposed

On July 27, 2005, before the US Senate Committee of Finance, the Medicare Payment Advisory Commission (MedPac) recommended Medicare adopt a pay-for- performance physician reimbursement system. MedPac concluded, “… Medicare is ready to implement pay-for-performance as a national program and that differentiating among providers based on quality is an important first step towards purchasing the best care for beneficiaries and assuring the future of the program.” Under MedPac’s plan, 1% to 2% higher reimbursements would be awarded to healthcare providers who improved quality of care, with lower-performing physicians receiving a lower percent. However, there is concern that reducing reimbursement of hospitals and physicians who don’t perform well may negatively affect their resources to improve. Professional associations such as the American Medical Association and the Medical Group Management Association are moving to ensure pay-for-performance can be designed to be fair to all physicians.