Practice Management

Following its charge to reduce costly imaging overutilization, the Centers for Medicare and Medicaid Services (CMS) has announced more stringent prohibitions against self-referral practices.

The US Food and Drug Administration is often depicted as an obstructionist bureaucracy that inhibits the development of life-saving cancer drugs. But according to an FDA insider, the real story on drug approval has remained untold.

Over the past 2 decades, advances in cancer treatment have greatly improved survivorship statistics in the United States. As the oncology community works to ensure that this upward survival trend continues, it’s important for us to recognize the serious challenges that lie ahead.

US Oncology, Inc, is launching Oncology Reimbursement Solutions (ORS), an oncology-focused billing and reimbursement service designed to increase operational efficiency and improve the economics of independent community-based oncology practices.

Electronic medical records have been shown to reduce operating costs, increase efficiency, and improve quality of care. Why then has the adoption rate of e-technology been so sluggish?

Financial pressures from Medicare reimbursement changes may have caused physicians to switch from providing hormonal-induced castration to providing surgical castration for men with prostate cancer. That is the finding of a new study published in the May 15 issue of CANCER. The study suggests that factors other than evidence-based medicine may have a significant influence on treatment decisions.

An oncologist called me recently and said, “I am mad as heck and I am not taking this anymore.” He is not making 6% on the chemotherapy agents he administers; he is making 2%.

Justifying the huge capital investment in proton beam therapy centers requires a strategic model, in other words, a high-volume disease, such as prostate cancer.

According to recent reports, a growing number of non-cancer patients are outliving the cap on the Medicare hospice benefit, putting some hospice providers on the brink of bankruptcy.

Since the passage of the Medicare Modernization Act of 2003, community cancer centers around the country have been struggling to balance the delivery of optimum care with an ever-tightening reimbursement climate. Cancer Care & Economics (CC&E) talked with the Association of Community Cancer Centers (ACCC) Manager of Provider Economics & Public Policy, Matthew Farber, MA, about the challenges of the upcoming year.

Proposition 15, which passed by a margin of 61% to 39% last November, provides for the creation of the Cancer Prevention and Research Institute of Texas and authorizes issuance of up to $3 billion in bonds for research in Texas to find the causes of and cures for cancer.

Mounting evidence suggests that a 2007 Medicare coverage decision has severely curtailed the use of ESAs for chemotherapy-induced anemia.

federal Centers for Medicare and Medicaid Services (CMS) have increased their hospital outpatient and ambulatory surgical center reimbursement rates for cryoablation treatments for prostate cancer

The high cost of implementing new technologies has slowed the adoption rate of health information technologies, especially among smaller oncology practices. Based in Rockville, Maryland, Argole Systems, Inc. is a software and services company that recently released the beta version of Akessa Oncology, its new oncology-specific practice management and EMR system. Cancer Care & Economics spoke with Argole president, CEO, and co-founder Masoud Khorsand, MD.

The Diagnosis and Treatment of Medicare, by Andrew J. Rettenmaier, PhD, and Thomas R. Saving, PhD. Washington, DC: The AEI Press, 2007.

Oncologists have protested to the Centers for Medicare & Medicaid Services (CMS) that new rules restricting coverage of erythopoiesis-stimulating agents (ESAs) contradict Food and Drug Administration's approved labeling for the drugs and tie the hands of physicians treating cancer patients with chemotherapy-induced anemia.

The price of oncology medications is skyrocketing, and reimbursement rates for these agents are often inadequate. This situation may be hurting your medical practice more than you realize. You need to determine what you are paying for your oncology drugs, as compared to the Average Sales Price (ASP) and to the Medicare allowable for these drugs.

AMA approves CPT code for Axxent electronic brachytherapy

Medicare is the primary insurer for millions of current and future American cancer patients. The program, established in 1965, is also the reimbursement template for much of the private payer sector.

In a recent letter to Steve Phurrough, MD, of the Centers for Medicare & Medicaid Services (CMS), Joseph S. Bailes, MD, chair of ASCO's Government Relations Council, asked that CMS withdraw its proposed decision memorandum regarding coverage of erythropoiesis-stimulating agents (ESAs) in nonrenal disease indications

The Centers for Medicare & Medicaid Services (CMS) has reacted to an FDA "Black Box Warning" for erythropoiesis-stimulating agents (ESAs), manufactured by Amgen (Ara-nesp and Epogen) and Johnson & Johnson (Procrit) by proposing a national coverage decision (NCD) that would put limits on the dose and duration of therapy in patients with cancer and related neoplastic conditions.

CMS is shifting from being a passive bill payer to becoming an active purchaser of value-based care

Since the Medicare Modernization Act (MMA) of 2003 was signed, the Centers for Medicare & Medicaid (CMS) has initiated a series of fairly dramatic structural changes in reimbursement policies covering drugs and services provided in cancer care.

Over the past several decades, investment through the National Cancer Institute (NCI) has become an essential source of support for academic and clinical cancer research. The dividends paid by this investment have been discoveries that have reduced suffering and mortality due to cancer. For cancer patients and survivors, it is money well spent.

In rural areas, access to quality cancer care is especially challenging. The cumbersome process of traveling long distances for care is exacerbated by the symptoms associated with disease, leaving many rural cancer patients undertreated. However, a relatively new telecommunication technology offers one way to overcome the geographic barriers faced by rural Americans. Cancer Care & Economics (CC&E) spoke with Ryan J. Spaulding, PhD, director of the Center for Telemedicine and Telehealth at Kansas University Medical Center (KUMC), Kansas City, about how telemedicine helps serve patients in rural Kansas.

Under a proposed rule covering Medicare payments for outpatient services, hospitals would receive $32.5 billion in calendar year 2007, which includes a 3.4% inflation update over the 2006 payment rates of the Outpatient Prospective Payment System (OPPS), according to the Centers for Medicare & Medicaid Services (CMS).

Medicare has chosen BioScrip Corp., a pharmacy services company headquartered in Elmsford, New York, as the vendor for the initial 6-month phase of its new Competitive Acquisition Program (CAP), which begins July 1. CAP gives physicians the option to obtain more than 180 Part B drugs and biologicals administered in office practices from a vendor rather than acquiring them from a distributor and then seeking reimbursement. Under CAP, BioScrip will bill Medicare for the medications, collect patients' co-pays, and handle other administrative tasks.

Medicare codes for oncology services have been in transition over the past few years, and oncologists are dealing with more changes now as Medicare moves from the temporary G-codes used in 2005 to cover administration of chemotherapy and other services to the permanent Current Procedural Terminology or CPT codes, which kicked in this year.

After a rocky start with a 2005 Demonstration Project designed to assess symptoms of nausea and vomiting, pain, and fatigue in Medicare patients receiving chemotherapy, the Centers for Medicare & Medicaid Services (CMS) has shifted toward improving quality through more effective payments and evidence-based care. This will include assessing whether patients are treated according to evidence-based standards of care (typically the NCCN or ASCO guidelines) and focusing payments on patient-centered care rather than administration of chemotherapy, Christopher E. Desch, MD, national medical director of the National Comprehensive Cancer Network, said at the 11th Annual NCCN Conference.

In February 2005, Mark McClellan, MD, PhD, head of the Centers for Medicare & Medicaid Services (CMS), appointed Peter Bach, MD, MAPP, an associate attending physician at Memorial Sloan-Kettering Cancer Center, to serve as senior advisor on health care quality and cancer policy. A pulmonologist and intensivist by training, Dr. Bach has a strong reputation for research on quality cancer care, helping develop guidelines for lung cancer and chronic obstructive pulmonary disease (COPD).