The following information has been received by ANCO.
****ASCO NEWS****
The American Society of Clinical Oncology's (ASCO) Cancer Policy Today was published and is available online at http://view.exacttarget.com/?j=fe5b1579716505747210&m=ff311d707460&ls=fdf8137271640478771d727d&l=fe62157570620c7d7615&s=fe1f15797d620479731d75&jb=ffcf14&ju=fe221672706c0c75771d71. ANCO is a state/regional affiliate of ASCO. This edition features:
ASCO President Testifies at Congressional Hearing on Funding for Cancer Research
House Small Business Committee Holds Hearing on Medicare's Impact on Providers
ASCO Member Testifies at IOM Public Hearing on Comparative Effectiveness Research
Update on Status of Prompt Pay Discount Legislation
Congressmen Introduce Bills that Allow for FDA Approval of Generic Biologics
Update on Tobacco Control Legislation
****ASH NEWS***
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/policy/practice/03262009.cfm#1. This edition features:
Register Now: Webinar to Ensure Hematologists Receive PQRI and E-Prescribing Bonuses for Participation
Average Sales Price Legislation Introduced in the House of Representatives
Senators Kennedy and Hutchison to Introduce Comprehensive Cancer Legislation
Health-Care Reform Debate Continues to Take Shape in Washington
Obama Administration Names Federal Coordinating Council for Comparative Effectiveness Research
ASH Signs On to Letter Urging Medicare Physician Payment Fix
ASH Signs On to Letter Expressing Concerns about RAC Program
Medicare Releases Quarterly CCI Update
New BCBS Predetermination Procedure for Red and White Cell Growth Factors
****CMA NEWS****
The California Medical Association and the American Medical Association have joined individual physicians and other state medical groups to file a class action lawsuit against health insurance company WellPoint, Inc. The lawsuit, filed today in Los Angeles federal court, alleges that WellPoint colluded with Ingenix, a unit of United Health Group, on a price-fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care.
“Health insurers are data manipulating to set rates artificially low, forcing patients to pay more than they bargained for when they go to a doctor of their choice,” said Dr. Dev GnanaDev, CMA president. “This undermines the patient choice that insurers promise when they tout their PPO products and under-compensates doctors for the care they provide.”
WellPoint – which operates as Blue Cross in California – is legally bound to pay the usual and customary amount for care provided to their enrollees by an out of network physician. Patients pay any additional amounts over and above what WellPoint decides to pay for those services. To determine these rates, WellPoint uses a database run by Ingenix, a company owned and operated by United Health Group, another health insurance company.
A recent investigation by New York Attorney General Andrew Cuomo concluded that the Ingenix data is intentionally manipulated to allow health plans to scam physicians by shortchanging reimbursements on medical bills. A WellPoint executive acknowledged “conflicts of interest in the Ingenix database,” and the company agreed to pay $10 million to help fund a new database run by an independent non-profit organization to replace Ingenix. The company also agreed to quit feeding data into Ingenix and use the new system once it is up and running. The settlement with Cuomo did not seek redress for patients and doctors.
“As health care costs continue to rise, insurers appear to be scheming to find ways to shift resources to their bottom line rather than towards the health care of their enrollees. The CMA will continue fighting to obtain relief for patients and physicians who were harmed by the systemic flaws of the conflict ridden Ingenix database,” Dr. GnanaDev said.
The CMA and AMA have filed this litigation in partnership with the Medical Association of Connecticut, Georgia, North Carolina and the individual plaintiffs Dr. Stephen D. Henry and Dr. James G. Schwendig.
****CMS NEWS****
MM6394 – Program Overview: 2009 Physician Quality Reporting Initiative (PQRI) And The 2009 Electronic Prescribing (E-Prescribing) Incentive Program
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6394.pdf
MM6310 – Incorporation of Physician Fee Schedule Regulatory Changes into Chapter 10 of the Program Integrity Manual (PIM)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6310.pdf
CMS Provider Communications Group will host the fourth in a series national provider conference calls on the 2009 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 2:30 p.m. – 4:30 p.m., EDT, on Wednesday, April 22, 2009.
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, but only authorized incentive payments through 2010. Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period. The 2009 PQRI consists of 153 quality measures and 7 measures groups.
The topics covered on this national provider call will include:
An update on the prostate cancer measures-2008: Measure #101; 2008-2009: Measure #102, #104, and #105;
Tips for satisfactorily participating in the 2009 PQRI; and
Planning for the 2010 PQRI reporting options.
Following this presentation, the lines will be opened to allow participants to ask questions of CMS PQRI subject matter experts.
Educational products are available on the PQRI dedicated web page located at http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.
Conference call details:
Date: April 22, 2009
Conference Title: 2009 Physician Quality Reporting Initiative - National Provider Call
Time: 2:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 2:30 p.m. EDT on April 21, 2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/042209
Fill in all required data.
Verify your time zone is displayed correctly the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 3:30 p.m. EDT 4/22/2009 until 11:59 p.m. EDT 4/29/2009. The call in data for the replay is (800) 642-1687 and the passcode is 90578004.
If you require services for the hearing impaired please send an email to:Medicare.TTT@PalmettoGBA.com.
PQRI Frequently Asked Question of the Week
Q: As required by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), the Centers for Medicare & Medicaid Services (CMS) established the criteria for satisfactorily reporting through the alternative reporting method using measures groups for the Physician Quality Reporting Initiative (PQRI). When referring to these measures groups, how is “consecutive” defined?
A: For Physician Quality Reporting Initiative (PQRI) measures groups, consecutive means in order by date of service. Patients are considered consecutive without regard to gender.
****INSTITUTIONAL MEMBER NEWS****
The University of California, San Francisco is organizing The 3rd International Symposium on Cancer Metastasis and the Lymphovascular System: Basis for Rational Therapy on May 6-9, 2009 at the Intercontinental San Francisco Hotel.
Visit www.ucsfcme.com/blast2009/MSU09002.htm for more information and to register.
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