California   Oncology  Weekly
"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 .
       
April 9, 2019
  
This Weekly's Hot Topics
 
  • Noridian/JEMAC continues to deactivate provider. California News
  • ANCO Executive Director announces retirement. ANCO News
  • Senate Finance Committee held hearing today on PBM abuses. National News


California News

The California Medical Association (CMA) reports that Noridian/JEMAC continues to deactivate providers for not responding to Medicare revalidation notices. Learn more at https://www.cmadocs.org/newsroom/news/view/ArticleId/28006/Noridian-continues-to-deactivate-providers-for-not-responding-to-Medicare-revalidation-notices.
 
- Refer to the California Smokers' Helpline. Watch the video now to learn more about the California Smokers' Helpline's free, evidence-based tobacco cessation services and electronic referral options. Presented by Rina Edi, MD, Medical Director, California Smokers' Helpline. For more information on the California Smokers' Helpline, 1-800-NO BUTTS go to https://info.nobutts.org/helpline-services-and-referral-options-lp 



Noridian News  
 
- Noridian/JEMAC has the following updates on their website
Announcements: 
New Part D Policies Address Opioid Epidemic; Physician Compare: Supplemental Preview Period Open until April 27; Open Payments: Review and Dispute Data by May 15; Qualified Medicare Beneficiary Billing Requirements.
Publications: 
ASP Medicare Part B Drug Pricing Files and Revisions: July 2019; Changes to the Laboratory NCD Edit Software: July 2019; NCCI PTP Edits: Quarterly Update; Understanding the Medicare Beneficiary Identifier; Promoting Interoperability Call: Audio Recording and Transcript; SNF Value-Based Purchasing Program Call: Audio Recording and Transcript
* IVR Upgrade is Coming
* Quarterly Update to the NCCI PTP Edits, Version 25.2 Effective July 1, 2019 CR11227 
Forthcoming Noridian JEMAC meetings/webinars/workshops include: 
* Independent Diagnostic Testing Facility (IDTF) Enrollment Webinar (April 10)
* Using the Medicare Beneficiary Identifier (MBI) Webinar (April 17)
* Preventive and Screening Services Webinar (April 23)
* Modifier 59, NCCI and MUEs Webinar (April 24)
* Medicare Part A/B Revalidation Webinar (April 24)
* What's New in the Second Quarter 2019 Webinar (April 25)
* Preventive and Screening Services after Hours Webinar (April 25)
* Reopenings Webinar (April 30)
* Using the Medicare Beneficiary Identifier (MBI) Webinar (May 21)
* Submitting Your Enrollment Online-Part 1 Webinar (I&A; May 29)
* Submitting Your Enrollment Online-Part 2 Webinar (PECOS; June 26)
Educational Events - April 2019  
Providers are encouraged to attend the many educational events offered by Noridian in April. 
Read the complete update  or visit 
http://med.noridianmedicarecom/web/jeb/education/training-eents  for more information and to register. 
 
 
 
MOASC News  
 
- SAVE-THE-DATE for MOASC's Spotlight On Oncology, August 17, 2019 in Huntington Beach. Through a restricted grant from MOASC, selected oncology fellows and faculty from the University of California, Irvine (UCI), present the premier topics from their attendance at the 2019 Annual ASCO meeting. The presentations promote collegial discourse among colleagues along with networking in an informal setting.  Contact the MOASC Office for more information at moasc@moasc.org. 
 
 
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ANCO News  
 
- The ANCO  Executive Director  has announced his intention to retire effective July 1, 2020 . The ANCO Board of Directors accepted his transition plan and timeline with the goal of identifying and installing a successor by the time ANCO's annual business cycle starts in September 2019. In the meantime, ANCO will conduct a regional and national search for a successor.
 
ANCO is now on Twitter; follow @ANCO News.
 
Congratulations to ANCO members Richard Hoppe, MD, Stanford, and Margaret Tempero, MD, UCSF, on their NCCN honors. Learn more at 
 
Fellows and Young Clinicians are encouraged to submit applications for ANCO's Travel Awards to the ASCO and ASH Annual Meetings. Learn more at www.anco-online.org/ANCOTravelAwards.pdf.
 
ANCO is organizing a series of Hematologic Malignancies Updates in 2019 on May 18 in Palo Alto, September 14, in Sacramento, and November 16 in San Francisco. These Updates are supported by AstraZeneca, Celgene, Janssen Oncology, Pharmacyclics, and Takeda Oncology. Watch for the first meeting announcement in late March; register online at 
 
thesecondopinion has been serving the California cancer community for 50 years by providing free, comprehensive second opinions to cancer patients and their families. They will celebrate the anniversary with an informational and educational luncheon on Thursday, May 9, that will feature a presentation by Charles Graeber, author of The Breakthrough: Immunotherapy and the Race to Cure Cancer. For more information, visit www.thesecondopinion.org or call (415) 775-9956.
 
 
 
National News 

- The following are excerpts from a report provided by Ted Okon, Executive Director of Community Oncology Alliance. "The Community Oncology Alliance (COA) applauds the Senate Finance Committee for holding today's hearing but strongly recommends additional work be done to shine a strong light on PBM abuses in delaying and denying cancer patients critical medical care. We hope the House Energy & Commerce Committee will do the same by holding hearings focused entirely on PBMs. Today's Senate Finance Committee hearing was a reminder that pharmacy benefit managers (PBMs) refuse to acknowledge their responsibility for causing completely unnecessary pain and suffering to patients with cancer, while also fueling higher drug prices through manufacturer rebates and by extorting fees from pharmacy providers. PBMs have a financial vested interest in the highest drug list prices possible in order to maximize the rebates they demand from drug manufacturers, through spread pricing, and via so-called " DIR Fees" they extort from pharmacy providers. PBMs sit in the shadows of our health care system and do nothing for patient care while siphoning off billions of dollars in fees and dictating patient access to care.
Perhaps most shockingly to health care providers, the PBM representatives testifying today failed to acknowledge the bureaucratic and nightmarish system they have inflicted upon patients with cancer and other serious diseases. Community oncology practices have reported hundreds of  horror stories about the rogue behavior of PBMs and the torture they put patients with cancer through. The horror stories that oncologists and pharmacists report are NOT one-off or rare. PBMs frequently delay filling prescriptions for life-saving medicines, deny medicine to cancer patients that their oncologists prescribe, and have even gotten so bold as to demand treatments not backed up by medical science. 
Senator Ron Wyden (D-OR) had a great observation that PBM spread pricing is "as clear a middleman rip-off as you are going to find." PBM spread pricing is ripping off employers, state governments, and taxpayers who pay higher prices for prescriptions while PBMs pad their bottom lines. We agree that the HHS Inspector General should look into spread pricing practices and shed light on the secretive contracts and rebates that enable them. 
Senator Bill Cassidy, MD (R-LA) hits the nail on the head today describing the PBM system as "a reverse Robin Hood" with sick patients paying higher drug list prices to subsidize insurance premiums and PBM profit margins. This is the exact opposite of a normal, healthy insurance market. Sick cancer patients should not be paying more for their drugs to keep prices lower for healthy patients..."
 
- As the Senate Finance hearing on PBMs kicks off NOW - watch it here 
https://www.finance.senate.gov/hearings/drug-pricing-in-america-a-prescription-for-change-part-iii -- a major story on PBMs has just published in The Atlantic.  Read it here

- Avoid fines by protecting EHRs from curious employees. Practices could face large fines if unauthorized employees are caught viewing patient records. Training, activity audits and disciplinary action involving staff who violate privacy laws can reduce the risk. Modern Medicine/Physicians Practice.
 
- The  NIH researchers make progress toward Epstein-Barr virus vaccine. EBV is a herpes virus that causes infectious mononucleosis and is associated with certain cancers.
 
- With just days remaining before the federal tax-filing deadline, the Internal Revenue Service reminds taxpayers they have a variety of options to get help preparing and filing their tax returns on IRS.gov. Taxpayers can also find answers to their tax questions and resolve tax issues on IRS.gov, the official IRS website. As the tax deadline nears and the demand for IRS tax help by phone is higher, the IRS encourages taxpayers to make IRS.govtheir first stop when questions arise, as the website offers answers to many of the most common taxpayer questions,   
like "Where's My Refund?", how to make tax payments and how to get forms and instructions. IRS.gov offers online help for individual taxpayers as well as tax professionals and has more than 358 million page views this tax-filing season.
 
The FDA has added a new guide for companies regarding use of the Expanded Access Navigator intended to provide small and emerging biopharmaceutical companies with assistance in understanding the procedures for expanded access, developing an expanded access policy for their company, and responding to requests for single-patient expanded access. Learn more at https://www.asco.org/advocacy-policy/asco-in-action/new-fda-resource-helps-companies-manage-expanded-access-requests.
 
ASCO has highlighted the concerns surrounding the persistent lack of interoperability of EMRs and the challenges it poses to cancer care in testimony before the Senate. The Society recently submitted a letter to the Senate Health, Education, Labor & Pensions Committee in response to the March 26 hearing focused on the Implementing the 21st Century Cures Act: Making Electronic Health Information Available to Patients and Providers. Read ASCO's letter at https://www.asco.org/sites/new-www.asco.org/files/content-files/advocacy-and-policy/documents/2019-March-Letter-Senate-HELP.pdf.
 
The results of a recently released survey conducted for the American Cancer Society Cancer Action Network (ACS CAN) raises serious concerns about the negative impact that utilization management practices, including prior authorization requirements, are having on patients with cancer and their physicians. The survey results reinforce ASCO's position that payer-imposed utilization management strategies must provide people with cancer full access to the right treatment, at the right time, based on the scientific evidence on what constitutes high-quality care. Learn more at https://www.fightcancer.org/releases/new-survey-utilization-management-delays-cancer-care-leads-more-stress-and-contributes.
 
ASCO, ANCO and MOASC urge members to contact their Congressional Representatives in support of cancer oral parity legislation (HR1730/S741). Use ASCO's ACT Network at https://asco.quorum.us/campaign/12012/.
 
ASCO recently submitted comments to Congress that identified ways to improve the quality of cancer care. Learn more at https://www.asco.org/sites/new-www.asco.org/files/content-files/ASCO-Comments-Senate-HELP-RFI-Cost-of-Care.pdf.
 
MOASC is asking if you have an instance of the application of a copay accumulator, please contact the MOASC Office moasc@moasc.org with your experience. Even if the patient name is redacted, it would go a long way in helping MOASC & ANCO, the California Cancer Caucus and many other patient and provider advocacy organizations' work on legislation to limit their use. Thank you.
 
 
CMS News 
 
- Final rule allows MA plans to expand telehealth coverage. The CMS released a final rule giving Medicare Advantage plans greater flexibility to cover in-home telehealth services to seniors as part of standard benefits beginning in the 2020 plan year. "Today's policies represent a historic step in bringing innovative technology to Medicare beneficiaries," CMS Administrator Seema Verma said, adding the move will allow beneficiaries to "receive more benefits, at lower costs and better quality." Skilled Nursing News (4/5),  Home Health Care News (4/5)
 
This is the first year that Quality Payment Program performance information will be publicly reported, and many stakeholders asked CMS for additional time to review their data before it becomes available to the public. CMS is offering a supplemental Physician Compare preview period. All eligible clinicians and groups should check their performance information by logging into the Quality Payment Program website at https://qpp.cms.gov/login.  
 
 
   
Affiliate Association News 
 
- The Academy of Oncology Nurse & Patient Navigators (AONN+) application period for the Certification Exams being held at the AONN+ Midyear Conference in San Diego ends April 26.  The test date will be May 16. The AONN+ Midyear Conference takes place in San Diego from May 17-19. Learn more at https://aonnonline.org/certification
 
- Inland Empire Oncology Nursing Society is proud to announce the upcoming 5th Annual Education Fair for all medical professionals on May 18&19 at the Downtown Marriott in Riverside, CA. from 8:00am to 3:00pm. The Nursing Education agenda is geared toward oncology professionals - however the information is valuable in all aspects of nursing and care-giving.  There is not one among us who has not been impacted by the effects of cancer in a loved one, friend or colleague. Registration for ONS members is $55.00. Registration for NON-ONS members is $65.00. Your paid registration includes, breakfast, lunch, give-aways, parking and 5 CEU's.
 
The deadline for submitting a research proposal is April 30. ASCO seeks applications for research grants for projects that use data from CancerLinQ Discovery, an offering of ASCO's CancerLinQ initiative, as a source. CancerLinQ Discovery provides curated sets of de-identified data from cancer patients to academic researchers, government agencies, and others in the oncology community to generate practical knowledge that will improve care. With grants of $32,500 each, ASCO will provide early and mid-career clinical oncology and health service investigators with real-world evidence that can inform their research. Research topics may include--but are not limited to--adoption of treatment guidelines across the U.S.; development of quality measures with the highest impact for clinical care; measuring the impact of educational programs on clinical practices; supportive evidence for informing ASCO policy priorities; or novel research on other topics. For more information, visit www.conquer.org/cancerlinq-discovery-research-support-grant.
 
ASCO is pleased to invite you to their 2019 Annual Meeting being held May 31 - June 4 in Chicago.
 
Data abstraction for ASCO's QOPI Round 1 will close on June 3. Round 1 final reports will be available approximately two weeks after the round closes. Learn more at 
http://practice.asco.org/quality-improvement/quality-programs/quality-oncology-practice-initiative? In addition, The Doctor's Company, the nation's largest physician-owned medical malpractice insurer, offers up to a 10% premium discount to physicians whose practices have achieved QOPI Certification. Learn more at https://www.thedoctors.com/qcp.
 
ASCO's Oncology Practice Conference takes place in San Diego on September 6. Focused on the business of cancer care, this conference will address the needs of practice administration and operations, with timely and practice strategies for the challenges faced by all those involved in the business of cancer care. Learn more and register at https://meetings.asco.org/opc/register.
   
Join ASH on September 6-7, 2019, at the Fairmont Chicago, Millennium Park for the 2019 ASH Meeting on Hematologic Malignancies to gain knowledge that can help you make an immediate impact in your practice. The meeting will feature top experts in the field, comprehensive clinical content, the latest clinical research, and opportunities to interact with colleagues in an intimate, small-group setting with no competing sessions. The program content will be structured as "How I Treat" presentations, which will showcase each speaker's evidence-based treatment approaches, present cutting-edge scientific data that can be translated into new strategies for diagnosis and treatment, and address what to do in cases where there is no data. For more details or to register, please visit the ASH Website.
 
ASCO has published a new clinical practice guideline for multiple myeloma (under Hematologic Malignancies) at https://www.asco.org/practice-guidelines/quality-guidelines/guidelines.
 
The Society for Immunotherapy of Cancer (SITC) Cancer Immunotherapy Guidelines Head and Neck Subcommittee invites public comment on the draft consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC). Submit your comments by April 14 at www.sitcancer.org/research/cancer-immunotherapy-guidelines/comment.
 
NCCN has published the following updates at www.nccn.org: acute lymphoblastic leukemia (V1.2019), bladder cancer (V2.2019), central nervous systems cancers (V1.2019), cervical cancer (V4.2019), Kaposi sarcoma (V2.2019), malignant pleural mesothelioma (V2.2019), testicular cancer (V1.2019), thyroid carcinoma (V1.2019).
 
 
 
Industry News
 

- Janssen has published their third annual U.S. Transparency Report. The report demonstrates Janssen's commitment to responsible business practices that put patients first, including how resources are invested, medicines are priced, and help people who need Janssen medicines get access to them. The report shows that the average net price of Janssen medicines in the U.S. has decreased for two years in a row, and have maintained significant investment in discovering and developing transformational medicines for patients facing some of the world's most challenging diseases, investing 86% more in R&D than we spend on sales and marketing. Janssen also shares ideas and perspectives on policy proposals, with the goal of building on what is working in our healthcare system while fixing what is not. And detail their plan to include list price and typical patient out-of-pocket costs in their U.S. pharmaceutical advertising. Janssen issues the report because open dialogue and partnership are essential to addressing the challenges in our healthcare system. The report, executive summary and more information about the DTC announcement are available on  the Janssen U.S. website at 

Janssen.com/ustransparencyreportJanssen.com/ustransparencyreport.

 

- Pfizer Oncology is proud to announce that the indications for IBRANCEĀ® (palbociclib) now include male patients. IBRANCE is indicated for the treatment of adult patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced or metastatic breast cancer in combination with: an aromatase inhibitor as initial endocrine-based therapy in postmenopausal women or in men, or fulvestrant in patients with disease progression following endocrine therapy. Based on limited data from post-marketing reports and electronic health records, the safety profile for men treated with IBRANCE is consistent with the safety profile in women treated with IBRANCE. The recommended dosing regimen is also consistent for male and female patients. For patients requiring financial assistance, Pfizer Oncology has support programs that may be able to help. You can learn more at the product website IBRANCEhcp.com. Full updated prescribing information is available here.

 
 
 
 
 
 
In This Issue

















 
MOASC CALENDAR

Spotlight On Oncology
August 17, 2019












 
ANCO
CALENDAR
     
New Directions in the Management of Recurrent Ovarian Cancer (UC Davis, Sacramento, April 16; register via e-mail to bamathews@ucdavis.edu
)
 
American Initiative in Mast Cell Disease (AIM; Stanford, San Mateo, May 4-5)

 
 
 5th World Congress on Controversies in Breast Cancer (CoBrCa): When is Less More? 
(Use code cobrca10 for ANCO Member Discount;
San Francisco, September 4-6) 

 
(NCCN, San Francisco, September 27-28) 
 
8th International Cancer Metastatis Congress
(San Francisco, October 25-27) 
 
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