Practice Manager Insider

Budget Bill Caps Payment for Office-based Imaging as of 2007

A provision of the federal Deficit Reduction Act of 2005 limits reimbursement for imaging services performed in a physician office to the lesser of the hospital outpatient or the physician office payment schedule. This means that physician offices will be reimbursed at the hospital outpatient prospective payment system rate if that is less than the physician Medicare fee schedule payment, according to the Society for Nuclear Medicine. This applies to the technical (as opposed to the professional or interpretative) component of payment.

The change applies to molecular and nuclear imaging—including positron tomography, X-rays, ultrasounds, magnetic resonance imaging, computed tomography, and fluoroscopy—but excludes diagnostic and screening mammography, according to the bill. The Society of Nuclear Medicine opposes this provision. President Bush signed the Deficit Reduction Act on February 8, 2006 and it takes effect January 1, 2007.

Why Patients Don’t Enter Clinical Trials: Lancet Oncology Publishes Meta-Analysis

Most common barriers to trial participation include concerns with the trial setting, dislike of randomization, discomfort with the research process, complexity and stringency of the protocol, presence of a placebo or no-treatment group, potential side effects, being unaware of trial opportunities, the idea that trials are inappropriate for serious diseases, fear that trial involvement would negatively affect the relationship with their physician, and their physician’s attitude to a trial.

Authors, including Dr. Edward J. Mills, department of clinical epidemiology and biostatistics at McMaster University in Ontario, Canada, conducted a meta-analysis and systematic review of 12 qualitative and 21 quantitative studies assessing patient barriers to participation in trials. The article appears in the February 2006 issue of Lancet Oncology. Knowing why patients are reluctant to participate in trials should help physicians and clinical researchers address these concerns, authors said.

CMS Approves PET Registry; Expands Medicare Coverage of PET

CMS approval opens the door to Medicare coverage of positron emission tomography (PET) scans for a much wider array of cancers and indications. Examples of newly covered indications for PET scanning include brain, cervical, ovarian, pancreatic, small cell lung, and testicular cancer. The start date for patient registration will be announced soon; CMS approval was a prerequisite for that.

The National Oncologic PET Registry (NOPR) was developed in response to a CMS proposal to expand PET coverage if the patient’s referring physician and the imaging provider submit data to a clinical registry. NOPR is that registry. The registry will assess the impact of PET with F-18 fluorodeoxyglucose (FDG-PET) on management of oncology patients. Once the project is activated, referring physicians will complete short surveys before and after the PET scans. The PET facility will electronically transmit the scans to the NOPR database. NOPR investigators will assess the effect of PET scans on referring physicians’ plans for patient management, and report findings to CMS. The American College of Radiology Imaging Network (ACRIN) Biostatistics Center at Brown University will provide data analysis support.

NOPR received input from, and is endorsed by, the American College of Radiology, the American Society of Clinical Oncology, and the Society for Nuclear Medicine. NOPR worked with CMS to develop the registry.

Final US Budget Bill Freezes Medicare Payments at 2005 Levels

The House approved the budget reconciliation conference report on February 1, by a vote of 216-214. The Senate already had approved the bill; it is now scheduled to be forwarded to President Bush for his signature.

The bill freezes 2006 Medicare payments to physicians at 2005 rates, reversing a 4.4% reduction that took effect on January 1. This decrease occurred because Congress did not pass the 2006 budget before the end of 2005.

Medicare processed January 2006 claims under the 4.4% reduction. It will instruct Medicare contractors to reprocess these claims automatically at 2005 rates, according to a letter from Herb Kuhn, Director of the Center for Medicare Management, to Representative Bill Thomas, chairman of the House Ways and Means Committee. Physicians and other providers should not need to resubmit claims. Reprocessing should be completed by July 2006, according to the letter. Medicare will reimburse physicians in one lump sum payment for the difference between the 4.4% rate reduction and the now-corrected 2006 rates, the letter said.

A 45-day physician enrollment period will begin soon, so that physicians who opted not to participate in Medicare due to the 4.4% rate cut can enroll. Participant status would then be retroactive to January 1, 2006, according to the letter.

Survey: Are Hematologic Cancer Patients Underreferred to Trials?

More than half of hematologic cancer patients seen by a hematologist or oncologist say that their specialist did not inform them about the possibility of participating in a clinical trial. This finding comes from a survey commissioned by the Leukemia & Lymphoma Society (LLS). Physicians were less likely to direct patients over age 75 to trials, with 74% of those respondents stating that their specialist did not discuss clinical trial participation. More than 60% of women, and nearly 50% of men, said they did not talk with their specialist about trial participation. About 25% of those not informed about trials said they would have wanted that information.

Brookdale Center on Aging of Hunter College and Bellevue-Hunter School of Nursing conducted the survey for LLS last fall. LLS’s goal was to determine how to improve access to, and quality of, health services for hematologic cancer patients from underserved segments such as older patients and women.

NCCN Offers Guidelines Annotated for CMS Demonstration Program; Updates Clinical Guidelines

Thirteen clinical guidelines annotated with CMS G-codes are available on the National Comprehensive Cancer Network (NCCN) website. These specially coded versions were designed to help speed determination of whether a given treatment adheres to the guidelines. The 2006 CMS Oncology Demonstration Program invites physicians to report to CMS about whether their patient management accords with either NCCN or ASCO guidelines.

The NCCN guidelines included in the 2006 CMS Oncology Demonstration Program, are for: breast cancer, chronic myelogenous leukemia, colon cancer, esophageal cancer, gastric cancer, head and neck cancers, multiple myeloma, non-Hodgkin’s lymphoma, non-small-cell lung cancer, ovarian cancer, pancreatic cancer, prostate cancer, rectal cancer, and small cell lung cancer.

Separately, the NCCN has released updates to 4 guidelines: NHL, Hodgkin’s disease/lymphoma, head and neck cancers, and gastric and esophageal cancers. These include recommendations regarding use of rituximab and thalidomide in lymphoma subtypes. A PET scan is now recommended for initial workup in the gastric and esophageal cancers guidelines.