FOR INFORMATION CONTACT:
Lori Gardner, Senior Director
Communications & Marketing
301.984.9496 ext. 226
For Immediate Release: March 6, 2009
Association of Community Cancer Centers Active in 2008—2009 Cancer Care Policy Activities/Agenda
ROCKVILLE, Md.—This busy election year 2008-2009 saw the Association of Community Cancer Centers continue its advocacy efforts on Capitol Hill and with the Centers for Medicare & Medicaid Services (CMS). ACCC continues to work with stakeholder groups and decision makers on a wide range of issues, including: comprehensive cancer legislation; an updated Government Accountability Office (GAO) report on CMS’ methodology in the hospital outpatient department; and an overhaul to the SGR.
Hospital Outpatient Department Issues
On October 31, 2008, the Centers for Medicare & Medicaid Services (CMS) released the final Hospital Outpatient Prospective Payment System (HOPPS) rule for 2009. The rule calls for a reduction in drug reimbursement to average sales price (ASP) +4 percent for 2009, from the previous level of ASP+5 percent in 2008. In addition, CMS reduced the number of drug administration APCs from six to five. This change will increase reimbursement for many chemotherapy administration codes; however, it will also cause a decrease to many other codes, including hydration. ACCC is aware of our members’ concerns over adequate drug reimbursement from Medicare, and the staff has been relaying their concerns to CMS via our comments and meetings.
ACCC is also continuing to encourage CMS to properly reimburse for pharmacy overhead services. This has been an ongoing effort for a few years. After receiving a positive recommendation from the APC Panel in August, we were hopeful for inclusion of the plan in the final 2009 rule. Unfortunately, CMS did not include the proposal in the final rule. In addition, they did not include a proposal to create two separate cost centers in an effort to capture overhead costs. ACCC was against this proposal and asked CMS not to implement it. Since the final rule was published, ACCC has held meetings with CMS staff, and they have encouraged ACCC to continue to push our pharmacy overhead proposal in early 2009, in the hopes of getting it included in rule making for 2010.
ACCC met with CMS representatives during the months of January and February 2009 in order to continue to educate the agency on our issues in the hopes of having them addressed in 2010 rule making. At a meeting of the Ambulatory Payment Classification (APC) Panel in February 2009 at the headquarters of the Centers for Medicare & Medicaid Services (CMS) in Baltimore, Md., ACCC testified on a range of hospital outpatient prospective payment system issues, including drug reimbursement, pharmacy overhead services, and 340B hospitals. After testimony was concluded, the APC Panel made the following recommendations to CMS for 2010 rulemaking:
- CMS should reimburse all separately paid drugs at no less than ASP+6 percent.
- CMS should package payment for all drugs that are not separately paid at ASP+6 percent, and should use the difference between those rates and CMS's costs derived from charges to create a pool that is used to fund payment for pharmacy service costs more appropriately.
- CMS should reimburse hospitals for pharmacy service costs using this pool by making payments based on a tiered approach of drug complexity.
- CMS should exclude data from hospitals that participate in the 340B program from its rate-setting calculations for drugs. CMS should not, however, adjust payments for separately paid drugs to 340B hospitals.
These recommendations are almost word for word the recommendations that ACCC and the other stakeholders requested of the panel in testimony.
ACCC has been very active on the issue of the physician supervision clarification that was included in the 2009 final HOPPS rule. In addition to identifying the clarification within the rule and educating members on its impact, ACCC has formed a coalition of like-minded advocacy groups to develop possible solutions to this issue. Although it is referred to as a clarification, the wording has left additional confusion in its wake. ACCC has held numerous meetings with CMS officials to suggest ways to lessen the impact this rule may have on patients and providers.
In July 2008 Congress passed the Medicare Improvements for Patients and Providers Act (MIPPA) that included an 18-month fix to the sustainable growth rate (SGR) formula along with a 0.5 percent increase for physicians for the remainder of 2008, and a 0.6 percent increase for 2009. It also extended the Physician Quality Reporting Initiative (PQRI) program to 2011 and raised the bonus payment; and introduced incentives and penalties for e-prescribing over the next several years.
The final Physician Fee Schedule for 2009, published on October 31, 2008, included all of these aspects from MIPPA and others as well. After adjustments to the work value units and the conversion factor, medical oncologists will see a roughly 1 percent decrease on payments for 2009 and radiation oncologists will see a roughly 3 percent reduction. These rates are accurate even with the overall 1.1 percent increase to the conversion factor from MIPPA. However, if a physician office were to properly report for both PQRI and e-prescribing, then the office may be eligible for up to a 4 percent bonus payment.
ACCC would like to begin looking into more of the issues the membership face in regard to private payer reimbursement policies and problems. The Governmental Affairs Committee is planning on holding meetings on this issue early in 2009 in the hopes of identifying common problems and addressing potential solutions.
ACCC has also been active in an attempt to pass legislation regarding prompt pay discounts in the calculation for ASP. ACCC worked with other advocacy groups in the oncology community in drafting a letter and attending Congressional meetings and will keep its membership updated on this issue as well as provide details of ongoing healthcare reform and policy changes.
CMS issued a Change Request (CR) in October in regard to the new drug compendia and detailed what indications are required to be covered by Medicare contractors. CMS also announced that it will continue its compendia application process again in January 2009.
ACCC is analyzing the newly recognized Medicare drug compendia. The goal is to update ACCC’s Compendia-Based Drug Bulletin in 2009 so it reflects indications within the newly recognized compendia. The three newly recognized compendia include: the National Comprehensive Cancer Network’s (NCCN’s) Drugs & Biologics Compendium™, Thomson Micromedex’s DrugDex®, and Elsevier Gold Standard’s Clinical Pharmacology. The American Hospital Formulary Service Drug Information (AHFS-DI) published by the American Society of Health-System Pharmacists remains a Medicare-recognized compendium.