C a l i f o r n i a O n c o l o g y W e e k l y
"Where California Oncologists Go For Answers!"
A collaborative publication of the
Medical Oncology Association of Southern California, Inc.
and the
Association of Northern California Oncologists, Inc.
October 3, 2017
This W eekly's Hot Topics
    In honor of Breast Cancer Awareness Month, we acknowledge those physicians, clinicians and people who give hope and push forward on behalf of those women and men battling the disease. 
California News 
CalPERS Open Enrollment is September 11th through October 6th You are encouraged to assist your CalPERS patients as to what to keep in mind when changing their health plan. They have the right to: Continuity of care, determine health benefits, compare plans and change plans during open enrollment. If your patient's treatment is interrupted, they can contact the California Department of Managed Health Care at 888-466-2219.
CMA's Center for Economic Services (CES) has published updated payer profiles on each of the major payers in California at www.cmanet.org/resources/reimbursement-assistance/payor-profiles/.
Noridian News  
Noridian/JEMAC has posted more updates to its website: 
* MLN Connects
Announcements--Medicare Clinical Laboratory Fee Schedule;: Preliminary CY2018 Payment Rates; 2016 PQRS Feedback Reports and Annual QRURs Updates; Quality Payment Program: New Resources Available; Quality Payment Program: View Recordings of Recent Webinars; MIPS Eligible Measure Applicability: New Resources Available
Claims, Pricers & Codes --
Events--2016 Annual QRURs Webcast-October 19
Publications-- Transition to New Medicare Numbers and Cards Fact Sheet-New; SNF Consolidated Billing Web-Based Training Course-Reminder; Remittance Advance Resources and FAQs Fact Sheet-Reminder
* Updated Editing of Always Therapy Services-MCS-Revised CR10176
* October Webinars-Register Now
* HCPCS Drug/Biological Code Changes-October 2017 Update CR10234  
  MOASC News
In MOASC's continued campaign to advocate for modernizing the 340B program and advance access to oncology care for all, please read MOASC President, Warren Fong, M.D.'s op-ed in Fox & Hounds. http://www.foxandhoundsdaily.com/2017/09/congress-must-fix-broken-340b-drug-pricing-program-benefits-hospitals-starves-poor/. Fox & Hounds is a publication for local, state and federal policy makers. The publication combines the news of business and politics and links them in such a way to inform politically-interested business-people and professionals. In a notice posted last Friday by HHS, there is, again, a delay of planned tweaks to the 340B program. CMS further delays 340B drug program changes
The 2018 ICD-10-CM code changes went into effect Sunday, Oct. 1, 2017! Going forward, you're required to master the hundreds of new, deleted, and revised diagnosis codes. With the implementation of MACRA this year, utilizing the right diagnosis code is more important to your revenue than ever before. If you don't correctly incorporate each of these new, modified and deleted ICD-10-CM 2018 diagnosis codes, get ready for denied claims, delayed payments and one huge headache. Not to mention future reductions in reimbursement due to poor MACRA quality reporting scores, and missing a bonus in the Merit-Based Incentive Payment System (MIPS) in 2019. You don't have to go through this changeover alone. ATTEND the 2017 Clinical Staff, Oncology Billing & Administrator Programs!  Clinical Staff Program (Nurses, pharmacists, NPP's) AND Administrator's Program on Wednesday, November 8, and the Billers Program on November 9, in Anaheim from 8:30am to 12:30pm. Some of the topics to be presented and discussed are: MACRA/MIPS; Pharmacy Standards/USP Regulations; Immunotherapy and Targeted Therapy; Pain Management; A/R & Billing Updates, Change Management and more.  For more information contact the MOASC office at moasc@moasc.org  or 909-985-9061 x1.
ADMINISTRATOR'S! Please note the change of date for your program is Wednesday, November 8th. We apologize for any inconvenience this may cause
Please join MOASC Member institution, City of Hope, for their Neoplastic Hematopathology Update on November 2nd - 4th in Huntington Beach. At the end of this continuing medical education activity, participants should be able to: Describe recent developments in the diagnosis, classification, and molecular biology of lymphoid and myeloid neoplasms and related disorders. Recognize the impact of new developments on targeted and precision therapy. Implement current best practices for diagnosis, classification, and detection of diagnostic, prognostic, and therapeutic markers. Early Bird Registration has been extended to October 5th.To Register, go to: https://cme.cityofhope.org/login.html.
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ANCO News  

Four seats on the ANCO Board of Directors are up for election in 2017. ANCO seeks nominations for candidates for these seats. This year's election will be conducted via mail ballot in December. Candidates with the top four vote totals will serve for three years (i.e., 2018-2020, inclusive). Nominate an ANCO member (including yourself) to stand for election to the Board via e-mail/FAX to the ANCO office at execdir@anco-online.org/(415) 472-3961.
ANCO is pleased to announce that several members--Daniel Mirda, M.D., ANCO President; Bradley Ekstrand, M.D., ANCO Vice President; Minggui Pan, M.D., ANCO Board member; Thomas Marsland, M.D., Piyush Srivastava, M.D., and Harvey Bichkoff, M.P.H.--have been named ASCO Advocacy Champions. These are ASCO volunteers who have been exceptionally active in ASCO's advocacy activities throughout the year meeting with Federal lawmakers and agencies, sending personalized letters to Members of Congress through ASCO's ACT Network, engaging with State lawmakers on policy priorities at the State level, and holding site visits during Congressional recesses. ANCO thanks these members for their efforts!    
Bobbi Buell's latest E-Reimbursement News (9/18/17) discusses biosimilars, private payers acting out, new ICD-10-CM codes effective on October 1 and is available at http://www.anco-online.org/EReimbursement News09182017.pdf.
Stanford Cancer Center's MDS Center is co-sponsoring the MDS Foundation's Educational Patient-Caregiver Forum on Saturday, October 28. The Forum takes place at 875 Blake Wilbur Drive, Room 2103, Stanford CA 94305 from 9:30AM through 2PM.
ASCO member, David Gandara, MD, UC Davis, is chairing the one-day CME conference Best of WCLC 2017-San Francisco on November 11 following the 18th WCLC held in Yokohama Japan, October 15-18. The Eventbrite registration URL is https://www.eventbrite.com/e/best-of-the-18th-wclc-san-francisco-tickets-37865231928. ANCO members will receive complimentary registration when they register for an "Early Bird ANCO Member " ticket by October 20. For more information, please visit the Eventbrite website above.
ANCO will host the 4Q2017 Hematologic Malignancies Update on November 4 at the San Francisco Hyatt Regency with Mehrdad Abedi, M.D., University of California, Davis, Sandy W. Wong, M.D., University of California, San Francisco, and Leena T. Rahman, M.D., University of California, San Francisco. The latest research on novel treatment modalities for hematologic malignancies, myeloma, and amyloidosis along with case studies for these diagnoses will be presented. This update is supported by Janssen Biotech, Merck, Pfizer Oncology, and Pharmacyclics. Download the meeting announcement and registration form at www.anco-online.org/4Q2017HemeMaligUpdate.pdf.
The 18th Multidisciplinary Management of Cancers: A Case-based Approach returnsto the Silverado Resort and Spa in Napa on March 16-18, 2018. The meeting is sponsored by the Association of Northern California Oncologists, Stanford Cancer Institute, UC Davis Comprehensive Cancer Center, and UCSF Helen Diller Family Comprehensive Cancer Center. Go to www.multicancers.org to register your interest in receiving registration and housing information when it becomes available in the Fall.
UC San Francisco informs ANCO members that Benioff Children's Hospital San Francisco is one of the few centers in the country that is certified to provide CAR-T cell therapy  for pediatric and young adult patients (less than 25 years of age) who have B-cell precursor acute lymphoblastic leukemia (ALL) that is refractor or in second or later relapse. To refer a patient to their pediatric or adult cancer programs, call UCSF Pediatric Immunotherapy Program at (415) 476-3831, UCSF Helen Diller Family Comprehensive Cancer Center at (415) 353-2051, or UCSF HDFCCC Clinical Trials at (877) 827-3222. 
National  News

Bowing to immense pressure over his use of private jets, HHS Secretary Dr. Tom Price resigned late Friday afternoon.
The Institute for Clinical and Economic Review (ICER) issued a final evidence report confirming that there is inadequate evidence to compare outcomes of PARP inhibitors for ovarian cancer. Advantages of oral treatment and lower side effects noted, but evidence judged inadequate to determine which patients stand to benefit from maintenance therapy. Key policy recommendations call for lower prices and provider payment mechanisms that favor oral treatment Read the report at  https://icer-review.org/material/ovarian-cancer-final-report/.
The American Board of Medical Specialties and its 24 member organizations are collaborating to re-evaluate how physicians are certified for continued practice. The initiative, called Continuing Board Certification: Vision for the Future, will bring together multiple stakeholders to create "a system of continuing board certification that is meaningful, relevant and of value," according to a  news release announcing the collaboration.  The effort to revamp the re-certification process comes amid controversy over specialty boards and their practices. Doctors have long complained that the continued certification process is too time-consuming, expensive and lacks value. 
Security firm McAfee reported that the health care sector and social media sites were popular cyberattack targets in the second quarter of 2017, and the health, education and public sectors accounting for more than half of total cybersecurity incidents globally in 2016 and 2017. Whether physical or digital, data breaches in health care highlight the value of the sensitive personal information organizations in the sector possess. Researchers from the University of Phoenix College of Health Professions surveyed 2,201 adults and found that the top five health care technology services used by patients in the past year were text message appointment reminders, electronic prescription filling services, online health record access, online appointment booking services and online chat capabilities. Online access to health records was ranked as the top service respondents are most interested in using in the future.
CMS News

Yesterday, October 2nd was the deadline to begin reporting one or more quality measures, improvement activities, or Advancing Care Information measures for the minimum 90 consecutive days for group practices and eligible clinicians (ECs) to earn a bonus in the Merit-Based Incentive Payment System (MIPS) in 2019. Conversely, group practices and ECs have through the end of the calendar year to avoid a 4% MIPS penalty in 2019 by reporting at least one quality measure on one patient. For resources to help your practice successfully participate in MIPS, visit MGMA.org/MACRA. 
Register for Medicare Learning Network event on the 2016 Annual Quality and Resource Use Reports (QRURs). On September 18, 2017, CMS made the report available to all group practices and solo practitioners nationwide. This event provides an overview of the report and explains how to interpret and use the information. 2016 Annual QRURs show how groups and solo practitioners performed in 2016 on the quality and cost measures used to calculate the 2018 Value-Based Payment Modifier (Value Modifier) and how the Value Modifier will be applied to payments for physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. Learn more on the 2016 QRUR and 2018 Value Modifier webpage. This event will be more meaningful if you have your report in front of you to follow along. Visit How to Obtain a QRUR to access your report prior to the event.
Affiliate Association News 

For the past few years PBM's (pharmacy benefit managers) have allowed many in-office pharmacy dispensing to be in-network to dispense drugs to patients, but have only allowed the initial script to be filled. All subsequent scripts are to be filled by a specialty pharmacy of the PBM's choosing. COPA (COA) has retained the law firm of Frier Levitt to address the legality of this practice and are willing to challenge the PBM's on this issue. In the link below are sample engagement letter and submission form to fill out and submit to Frier Levitt if you would like to challenge PBM's on this issue. This is a major issue that goes on with all oncology practices. We hope you take advantage of having Frier Levitt represent you on changing the tide of this practice of taking patient care away from the physician practice and moving it to others. This is wrong and needs to be stopped. Frier Levitt will provide the following for practice pharmacies not being able to fill subsequent refills after the initial:
-          Frier Levitt will prepare and submit a Demand Letter on YOUR behalf, challenging a PBM's denial of you filling more than the initial prescription for a flat fee of $500;
The Demand Letter will include reference to State and Federal "any willing provider" laws, contract and manual provisions, and other applicable laws. 
-          Frier Levitt will also participate in a telephone conference call with the PBM's representatives, aimed at resolving the denial.
This Flat Fee is intended to not only provide an avenue to challenge PBMs' exclusionary conduct in numbers in an efficient manner, but allow any practice to begin the process of challenging PBM's from restricting initial prescriptions from being re-filled within physician dispensing/retail pharmacies. These are on the COA/COPA website under the Member's Only section under PBM Tools with the other template letters that Frier Levitt has provided.
ACCC's  Patient Assistance and Reimbursement Guide was updated in September 2017. The updated edition is available online at 

Visit the  2017 ASH Meeting on Hematologic Malignancies Webcast for more than 11 hours of exclusive content at http://ashondemand.org/Meeting/117851630.
A new study entitled  The Value of Community Oncology: Site of Care Cost Analysis conducted by the Florida Cancer Specialists & Research Institute and Excenda and released by the Community Oncology Alliance (COA) finds that the total cost of care for cancer patients receiving chemotherapy delivered in the hospital outpatient setting is nearly 60% more expensive than the same treatment delivered in independent, community oncology practicesRead the full study at www.communityoncology.org//wp-content/uploads/2017/09/Site-of-Care-Cost-Analysis-White-Paper_9.25.17.pdf.
Year In Review , moderated by Neil Love, M.D.,  is a multi-tumor regional symposia series focused on the application of emerging research information to the care of patients with common cancers, is scheduled for Saturday, November 18, 2017 at the Fairmont Miramar Hotel in Santa Monica, CA. To register go to www.ResearchToPractice.com/Meetings/YIR2017/CA .
For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, the NCCN Biomarkers Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org. Recent updates include:
* B-cell lymphoma (V5.2018)   * basal cell skin cancer (V1.2018)   * Burkitt lymphoma (V4.2017)   * central nervous system cancers (V1.2018)   * dermatofibrosarcoma protuberans (V1.2018)   * esophageal and esophagogastric cancer (V3.2017) * gastric cancer (V4.2017)   * hairy cell leukemia (V2.2018)   * Merkel cell carcinoma (V1.2018)   * non-melanoma skin cancers (V1.2018)   * small cell lung cancer (V1.2018)   * squamous cell skin cancer (V1.2018)
NCCN has announced that it has instituted Categories of Preference for recommendations within the NCCN Clinical Practice Guidelines in Oncology. Initially, Categories of Preference will be published for drugs and biologics within the NCCN Guidelines for Multiple Myeloma. Additional cancer types are forthcoming. The Categories of Preference are preferred intervention, other recommended intervention, and useful in certain circumstances. Learn more about Categories of Preference at 
Industry News 
Lilly Oncology informs ANCO and MOASC that the United States Food and Drug Administration has approved Verzenio in combination with fulvestrant for the treatment of women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer with disease progression following endocrine therapy and as mono therapy for the treatment of adult patients with HR-positive, HER2-negative advanced or metastatic breast cancer with disease progression following endocrine therapy and prior chemotherapy in the metastatic setting.

Merck informs ANCO and MOASC that the United States Food and Drug Administration has approved Keytruda for patients with recurrent locally advanced or metastatic gastric or gastroesophageal junction adenocarcinoma whose tumors express PD-L1 as determined by an FDA-approved test. Patients must have had disease progression on or after two or more prior systemic therapies, including fluoropyrimidine- and platinum-containing chemotherapy and, if appropriate, HER2/neu-targeted therapy.
Pfizer Oncology is launching This is Living with CancerTM, a program that provides tools and resources to support and inspire those who have been affected by cancer, including a mobile app, LivingWith™. The app is now available in the Apple App store and you can find out more about the campaign at www.thisislivingwithcancer.com.
As part of the This is Living with CancerTM program, Pfizer has the opportunity to be part of an event called Jump, Jive & Thrive*. The event is described as a star-studded evening combining thoughtful discussion with the best of music, gymnastics and dance, in celebration of cancer survivorship. The show will then air nationally on CBS on Saturday, October 21 at 10:00 pm Pacific Time. You can find more information on the event by visiting JumpJiveandThrive.com.
Bristol-Myers Squibb Oncology informs ANCO and MOASC that the United States Food and Drug Administration has approved Opdivo for the treatment of hepatocellular carcinoma (HCC) in patients who have been previously rated with sorafenib.
AmerisourceBergen Specialty Group, pled guilty to illegally distributing misbranded drugs and agreed to pay $260 million to resolve criminal liability for skirting regulatory oversight.
Between 2001 and 2014, according to court records unsealed last week, the group's now-defunct subsidiary Medical Initiatives prepared millions of syringes that had been filled with cancer drugs and shipped them to providers in all 50 states. There are no allegations.
In This Issue
Professional Educational Series 
 November 8-9

The  Medical Oncology Association of Southern California (MOASC) is a leading oncology society that advances and protects the ability of cancer patients to obtain, and the ability of the oncology physicians to provide, optimal cancer care. The  Association of Northern California Oncologists (ANCO) is an association of hematologists/oncologists dedicated to promoting high professional standards of cancer care by providing a forum for the exchange of ideas, data, and knowledge. The material contained in the California Oncology Weekly is intended as general information for ANCO and MOASC members. Because diagnostic, treatment, contracting, coding, and billing decisions should be made on a case-by-case basis, any such information contained in the California Oncology Weekly may not apply in any given situation. Members are encouraged to contact their own consultants or advisors to obtain specific advice on matters relating to contracting, coding, and billing. The information contained in California Oncology Weekly should not be used as a substitute for such advice. This publication provides a summary of regulations affecting oncology and its business practices. Reading this newsletter does not substitute for understanding regulations and verifying the validity of every claim. This information is time-sensitive and is subject to change. MOASC or ANCO accepts no liability for any statements or articles herein. CPT codes are owned and trademarked by the American Medical Association.  All Rights Reserved.



MOASC: P.O. Box 161, Upland, CA 91785 | P (909) 985-9061 | F (909) 804-5006| www.moasc.org

ANCO: P.O. Box 151109, San Rafael, CA 94915 |  P (415) 472-3960 | F (415) 472-3961 | www.anco-online.org