Practice Management

Medicare will grant limited coverage for the use of positronemissiontomography (PET) for certain of its beneficiariessuffering from thyroid cancer, the Centers for Medicare andMedicaid Services (CMS) recently announced. CMS also said that ithad refused a request to provide PET coverage for soft-tissue sarcomabecause imaging techniques currently covered by Medicare providegood diagnostic results.

The American Society of Clinical Oncology (ASCO) recentlycommended US Representatives Charlie Norwood (R-Ga) and LoisCapps (D-Calif) for introducing the Quality Cancer Care PreservationAct (H.R. 1622).

The Department of Health and Human Services (HHS) has createda unified advisory committee on human immunodeficiency virus(HIV) and sexually transmitted diseases (STD) by merging twoexisting groups. The new committee brings together the AdvisoryCommittee for HIV Prevention at the Centers for Disease Control andPrevention (CDC) and the AIDS Advisory Committee at the HealthResources and Services Administration (HRSA). The two groups havemet jointly on several occasions during the last 2 years, and all currentmembers of the two bodies will serve on the new CDC/HRSA AdvisoryCommittee on HIV and STD Prevention and Treatment.

WASHINGTON-The Department of Health and Human Service (HHS) has created a unified advisory committee on HIV and sexually transmitted diseases (STD) by merging two existing groups. The new committee brings together the Advisory Committee for HIV Prevention at the Centers for Disease Control and Prevention (CDC) and the AIDS Advisory Committee at the Health Resources and Services Administration (HRSA). The two groups have met jointly on several occasions during the last 2 years, and all current members of the two bodies will serve on the new CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment.

WASHINGTON-A new federal program will help some states create high-risk pools to extend health care coverage to people whose health status makes it difficult for them to obtain medical insurance. Under the program, the Centers for Medicare & Medicade Services (CMS) will provide seed grants of up to $1 million to support creation of the programs in 27 states that currently do not have qualified high-risk pools and in the District of Columbia. Typically, such pools are state-created nonprofit associations. The new program was authorized in the Trade Law of 2002, which appropriated $20 million to fund the grants.

An advisory group to the Centers for Medicare and Medicaid Services (CMS) has delayed a decision on whether to recommend Medicare coverage for positron-emission tomography (PET) with F-18-fluorodeoxyglucose (FDG) in the

WASHINGTON-An advisory group to the Centers for Medicare and Medicaid Services (CMS) has delayed a decision on whether to recommend Med-icare coverage for positron emission tomography (PET) with the radiopharmaceutical F-18-fluorodeoxyglucose (FDG) in the management of thyroid cancer and soft tissue sarcoma.

Medicare’s proposed fee-schedule changes for calendar year 2003 would result in a 3% cut in average payments to oncologists. That reduction is due to an expected 4.4% negative "update" to all physician fees in 2003. The total relative value of the CPT codes used most often by oncologists will actually go up 1% in 2003 because of some positive changes Medicare wants to make in the "practice expense" portion of the relative value formula. However, that increase will not be nearly enough to offset the negative 4.4% update. The negative update could have been worse had Medicare not proposed to change the way it figures a "productivity" element in the Medicare Economic Index (MEI). A measure of inflation in physician inputs, the MEI is itself one of the determinants of the annual Medicare fee update-the higher the MEI, the higher the annual update, or the lower the decrease. The change being proposed by the Centers for Medicare & Medicaid Services raises the estimated 2003 MEI update from 2.3% to 3.0%. Without the productivity change, the update would have been a negative 5.1%. These figures are all preliminary. They will be finalized when Medicare releases a final 2003 fee schedule, probably in late October.

The House corrected some of the problems with the Medicare physician fee formula when it passed its Medicare reform bill at the end of June. That bill also inaugurates a Medicare outpatient drug benefit for seniors.

At the same time that the House was trying to improve physician pay, the "Centers for Medicare and Medicaid Services" (CMS) announced that barring a change in the Medicare statute, the update in calendar 2003 will again be negative.

WASHINGTON-In an effort to streamline its operations, the Centers for Medicare and Medicaid Services (CMS) will adopt a standard, unique identifier for use by employers beginning July 30, 2002.

A bipartisan group of House of Representatives members is trying to pass a medical malpractice reform bill. Medical liability reform disappeared along with the Patients’ Bill of Rights, in which it was included, when the House and Senate failed to agree on a compromise version of the bill at the end of 1999.

WASHINGTON-The Department of Health and Human Services (HHS) is moving to cut colorectal cancer mortality by urging screenings for all Americans age 50 and older. In collaboration with the American Cancer Society, HHS will established a task force to increase public awareness of the causes, symptoms, treatment, and prevention of the disease. As part of its continuing "Screen for Life" campaign, HHS will release four new public service campaigns designed to educate American about the vital need for colorectal screening.

WASHINGTON-Nearly 9 out of 10 American adults favor changing Medicare rules to cover all approved cancer drugs for its beneficiaries, including oral medications, according to a poll commissioned by the National Coalition for Cancer Survivorship (NCCS). Further, 83% said they would support increasing Medicare’s cancer budget by 1% to pay the additional costs, and 83% said that Congress should pass legislation this year requiring coverage of oral cancer agents.

WASHINGTON-Amid continuing controversy over the effectiveness of screening mammography for breast cancer, the US Preventive Services Task Force (USPSTF) has extended its recommendations to include women between the ages of 40 and 49, after concluding that the procedure reduces breast cancer deaths.

The Medicare Payment Advisory Commission (MedPAC) has agreed that Medicare’s physician-fee formula needs to be overhauled. Medicare cut physician fees this year by 5.4% because of an "update" in the formula that MedPAC agreed is seriously flawed.

Outpatient cancer clinics received a 3-month reprieve before Medicare institutes its new prospective payment system, which is expected to result in a big drop in reimbursement for some newer cancer drugs.

TARRYTOWN, New York-The American Medical Association (AMA) has approved a unique Current Procedural Terminology (CPT) code for the serum HER-2/neu oncoprotein test. The CPT code, 83950 became effective January 1, 2002, for most health insurance programs.

WASHINGTON-The Centers for Medicare and Medicaid Services (CMS) has begun using a simplified form intended to make it easier for physicians and other health care providers to become eligible for reimbursement for the care and services

Rep. Billy Tauzin (R-La), the influential chairman of the House Energy and Commerce Committee, made it clear at hearings in late September that he intends to pressure Medicare to cut reimbursements to oncologists for the chemotherapy agents

RESTON, Virginia-In a statement, the American College of Radiology (ACR) said that the proposal by the Centers for Medicare and Medicaid Services (CMS) to cut the ambulatory patient classification (APC) payment rate to hospitals for diagnostic mammography creates "serious concern about women’s future access to this life-saving technology."

Oncology groups are unhappy with the prospect that Medicare payments for chemotherapy drugs provided in outpatient settings could drop drastically in 2002. The Centers for Medicare and Medicaid Services (CMS) is considering a cut for

ROCKVILLE, Md-With HIV infections rising among American women, the Department of Health and Human Services (HHS) has published The Clinical Guide for the Care of Women With HIV. The full text is available online at http://hab.hrsa.gov/womencare.htm.

WASHINGTON-Medicare will begin or expand coverage of positron emission tomography (PET) diagnostic scans for several cancers on July 1. For the first time, Medicare will cover PET for head and neck cancers, except for central nervous system and thyroid cancers, and esophageal cancer. Coverage will apply to diagnosis, staging, and restaging.

WASHINGTON-The US Department of Health and Human Services (HHS) has awarded $845.7 million in grants to assist poor and uninsured HIV-infected persons in obtaining primary care, support, services, and anti-AIDS drugs. About two thirds of the money, $571.3 million, will pay for the purchase of medications through state-run AIDS Drug Assistance Programs.

George W. Bush’s arrival at the White House has given physicians new hope that a bill easing Medicare mistreatment of physicians will pass Congress this year and be signed by the President. The bill is called the Medicare Education and

WASHINGTON-Health and Human Services Secretary Tommy G. Thompson asserted in a speech that the Bush Administration will pursue fundamental reform of the Health Care Financing Administration (HCFA) as part of its efforts to modernize Medicare.

Congress is turning back again to managed-care reform, with Democrats and Republicans trying anew to forge a bipartisan consensus on issues such as: what options exist for a cancer patient whose health insurance company refuses to cover a quasi-

WASHINGTON-New Medicare regulations governing self-referrals by physicians will go into effect on Jan. 4, 2002. The first version of the final rule was announced early in January; a second "fine-tuned" version will be released later this year.

Medicare made an important decision in December 2000 to expand its coverage of fluorodeoxyglucose (FDG) positron-emission tomography (PET) as a cancer screening tool. The agency said it would pay for FDG-PET for diagnosis, staging, and