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 31, 2017
This W eekly's Hot Topics

  • 4Q2017 Hematologic Malignancies Update on November 4 (ANCO News)
  • U.S. House of Rep. voting, Thursday, to repeal Medicare IPAB. (National News)
  • Physicians need to report 1 quality measure for 1 patient during 2017 to avoid a 4% payment penalty in 2019.(CMS News)
California News 
- SB 189, was signed by Governor Brown, and will take effect July 1, 2018, where all owners of medical corporations will be able to exempt themselves from workers' compensation coverage, regardless of percentage ownership, as long as they submit a waiver and have health insurance coverage. This will result in premium savings ranging from hundreds to hundreds of thousands of dollars for practices impacted by the previous law change. Last year, the California Legislature passed a bill (AB 2883) that changed the definition of "employee" for the purposes of workers' compensation coverage, setting an arbitrary 15 percent ownership threshold to be able to exempt owner/employees from such coverage. Unfortunately, the bill required many owners of medical corporations to pay drastically increased workers' compensation insurance premiums for coverage they neither needed nor wanted. This year, the California Medical Association (CMA) sponsored, MOASC & ANCO supported, SB 189 to fix these unintended consequences.
- The California Medical Association installed San Diego otolaryngologist Theodore M. Mazer, M.D., as its 150th president during the organization's annual House of Delegates meeting in Anaheim.
- California was well represented at the ASCO Fall State Affiliate Council Meeting and Leadership Conference. Photos of MOASC & ANCO Officers, as MOASC President, Warren Fong, M.D., ANCO Executive Director, Jose Gonzales and MOASC Executive Administrator, Nichole East, along with some familiar faces, can be spotted here:
Noridian News  
Noridian/JEMAC has posted more updates to its website: 
* MLN Connects
Announcements--MIPS Virtual Group Election Period Ends December 1; New Medicare Numbers/Cards: Coordination of Benefits; MIPS: Participate in Field Testing of Episode-Based Cost Measures by November 15; Physician Compare Preview Period Closes November 17; Reporting Changes in Ownership-Reminder
Claims, Prices & Codes --
Events --SNC Value-Based Purchasing Program FY2018 Final Rule Call-November 16
Publications-- Medicare FFS Response to 2017 California Wildfires MLN Matters Article-New; Quality Payment Program for 2017: MIPS APMs Web-Based Training Course-New; Medicare Fraud & Abuse: Prevention, Detection, and Reporting Web-Based Training Course-Reminder
* Medicare FFS Response to the 2017 California Wildfires SE17035
* MPS Payment Calculator Now Offers Enhanced Details
* MolDX: Bladder Tumor Marker FISH Billing and Coding Guidelines-R2
* MolDX: AlloSure Donor-Derived Cell-Free DNA Test Final LCD-Effective December 11, 2017.
  DHCS/Medi-Cal News
- The Department of Health Care Services has taken steps toward improving interpretation serviced for Med-Cal patients, and hired a lead employee to carry out an evaluation of interpretation services for Medi-Cal patients. Director Jennifer Kent said the new addition will spearhead the project, which was mandated by an assembly bill that passed last year. The Department of Health Care Services will oversee a consultant-led study to look into what other states have done, financing options and other issues.
  MOASC News
DO NOT MISS the 2017 Administrator & Oncology Billing Programs, November 8th & 9th, from 8:30am to 12:30pm, at the  DoubleTree Suites by Hilton Anaheim Resort - Convention Center. The program will highlight MACRA quality reporting scores and how not to miss your bonus through MIPS in 2019.
On Wednesday, November 8th The Administrator's will hear Bobbi Buell discuss Benchmarking and Revenue Cycles, t he Impact of Rising Healthcare Costs with Dawn Holcombe and Systems Thinking Approach® to Strategic Management with Loren Tarantino, Global Partner, Haines Centre for Strategic Management, LLC, President, Loren Tarantino Consulting, Inc.
On Thursday, November 9th the Biller's will be presented A/R Billing Updates by Elaine Towle and Medi-Cal Updates. For more information, contact the MOASC office at moasc@moasc.org or 909-985-9061 x1. 
MOASC Member, City of Hope will present The Fourth Annual Gayle Brinkenhoff Breast Cancer Symposium on Tuesday, November 14, 8 am to 4pm. Objectives are to: Describe recent developments in the diagnosis, classification and molecular biology of breast cancer; articulate the impact & role of targeted and personalized therapy in the treatment of breast cancer, and manage challenging diagnoses with the implementation of new technology and testing modalities. For more information: cme@coh.org or (626)218-5622.
- CMS is now requiring facilities to adequately prepare and plan for the natural and man-made disasters of fires, hurricane, tornado, earthquakes, broken pipe, etc. These natural disasters and structural damages will never cease to impact your practice and your patient's ability to get care, and now adherence to CMS' final regulations which have been set and an implementation date needs to be met. MOASC's OPEN Program is an addition and a link in the continuity of care continuum for patients and practices affected by such disasters. Whether local, regional, state, country or world-wide, assuring access to continuous care for the oncology patient is the goal of MOASC and their membership. Contact the MOASC Office at moasc@moasc.org for more information on participating and enrolling your patients in this program.
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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 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.
- 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 .  For more information, please visit the Eventbrite website above.
- The 18th Multidisciplinary Management of Cancers: A Case-based Approach returns to 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  for more information, to register, and arrange for housing.
National  News

- We need your help now, ONE LAST PUSH! Please contact members of Congress in the U.S. House and urge them to vote YES on H.R. 849. Last week, California Congressman and Majority Leader Kevin McCarthy (R-Bakersfield) announced that the U.S. House of Representatives plans to vote THIS WEEK, Thursday, November 2, 2017, on a bill that would finally repeal the Medicare Independent Payment Advisory Board (IPAB).For quite some time, MOASC & ANCO have been encouraging you to write to your Congressperson to repeal the Medicare Independent Payment Advisory Board (IPAB).
The bill-HR 849, "Protecting Seniors' Access to Medicare Act of 2017"- is a bipartisan bill co-authored by two physician Congressmen, Phil Roe, M.D., (R-TN) and our own California Congressman, Raul Ruiz, M.D., (D-Palm Springs). IPAB was established by the Affordable Care Act and up until now has not been implemented. It was to be a 15-member federal agency charged with making recommendations to reduce per capita spending in Medicare if spending growth exceeds a specified target.
Here are some points to note in your letter to your Representative:
*IPAB threatens beneficiaries' quality of care. Quality of care improvements are mostly scored by the Congressional Budget Office or the Office of Management and Budget as taking several years to yield savings. IPAB is tasked with meeting an arbitrary savings target within a single year. Because of this tight timeline once IPAB is triggered, which is projected to happen this year, cuts will be made to Medicare that hurt the quality of care beneficiaries receive.
*IPAB lacks transparency and accountability. The recommendations for potentially sweeping cuts to Medicare made by the Board or the HHS Secretary cannot be challenged in court or subject to administrative review. In addition, there is no opportunity for public input or comment on the proposals because of this unprecedented transfer of Medicare payment policymaking away from Congress to IPAB.
*Implement other ACA cost containment methods instead of IPAB. Promising ACA provisions for containing increases in healthcare costs while also improving quality of care include patient centered medical homes, accountable care organizations, value-based purchasing and payment bundling are ongoing. Further cost containment methods that are being implemented under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) could be adversely impacted by IPAB cuts overlapping with the law's provisions.
*IPAB repeal does not require corresponding budget cuts. Suggestions that repeal of IPAB must be offset by federal budget cuts elsewhere are greatly mistaken. A board that does not yet exist (in terms of having appointed members), has not been triggered, and has made no recommendations has not achieved any concrete dollar savings. Congress does not need to determine budget offsets to repeal an entity whose actions are, to this point, entirely theoretical.
The United States Food and Drug Administration has created a series of educational materials to help health care professionals better understand biosimilars and interchangeable drugs. Access these materials at 
The United States Food and Drug Administration is easing restrictions on its compassionate-use program, also known as expanded access, which gives seriously ill patients access to experimental drugs under FDA review. Learn more at  https://www.ashclinicalnews.org/online-exclusive/fda-eases-restrictions-compassionate-use-program/.
- President Donald Trump signed an executive order designed to make it easier for small businesses to band together to purchase health insurance through association plans. The order will also relax restrictions on short-term health plans and allow consumers to pay premiums using health reimbursement arrangements.   The Hill
Oncologists often feel pressure by breast cancer patients to provide longer and more costly treatments even when the patient is eligible for less aggressive options, a new study revealed. Read More
- Seventy-two percent of patients with advanced cancer preferred interactions with doctors who did not use a computer during office visits, and many associated doctors' computer use with a lack of compassion and professionalism and poor communication skills, a study at the University of Texas MD Anderson Cancer Center found. "Perhaps doctors seeing a patient for the first time and trying to build a relationship should try to focus more on face-to-face communication," lead author Dr. Ali Haider said.

CMS News 
- This is the first year physicians need to report on quality measures under the new Quality Payment Program (QPP) from the Centers for Medicare and Medicaid Services (CMS). Eligible professionals who fail to report in 2017 face a 4 percent payment penalty in 2019. Physicians only need to report on one quality measure for one patient during 2017 in order to avoid a payment penalty in 2019. During the 2017 transition year, CMS will allow physicians to select one of three "pick your pace" participation options. Participating at any level in 2017 will ensure that you will not be hit with the 4 percent pay cut in 2019. The most lenient participation option-reporting on one measure for one patient-allows physicians to avoid a penalty by "testing" the program to ensure that their systems are working and that they are prepared for broader implementation in 2018 and beyond.
- The Administrative Simplification Enforcement and Testing Tool (ASETT) has a new address! You can now visit https://asett.cms.gov/ to: Test electronic transactions for compliance and file complaints about noncompliant transactions. CMS has also updated the  ASETT Quick Start User Guide and FAQs. These resources can help you get the most out of the ASETT tool. Visit the Administrative Simplification website for more information.
- CMS has also released a report on complaints submitted through the ASETT tool from January to September of 2017. The report includes information about the number, type, and status of complaints submitted to ASETT. Individuals and organizations can file complaints against a HIPAA-covered entity for non-compliance with standards for transaction formats, code sets, unique identifiers, and operating rules.
Get the latest news about Administrative Simplification. Sign up for Administrative Simplification Email Updates.
- CMS issued revised technical release notes (TRNs) for the addendum to the electronic clinical quality measure (eCQM) annual update specifications for 4th Quarter 2017 reporting and 2018 reporting periods. Revisions were made to TRNs for the following measures for 4th Quarter 2017 reporting:
Eligible Hospital and Critical Access Hospital (CAH) measures : CMS71v6, CMS72v5, CMS104v5, and CMS108v5
Revisions were made to TRNs for the following measures for 2018 reporting:
Eligible Hospital and CAH measure : CMS108v6
Eligible Clinician and Eligible Professional (EP) measures : CMS90v7, CMS117v6, CMS136v7, CMS137v6, CMS146v6, CMS147v7, CMS156v6, CMS164v6, and CMS166v7
The revised TRN files were updated to reflect:
The inclusion of additional TRNs to accurately document all applicable coding changes for each measure, the removal of TRNs that were irrelevant to a specific measure, and/or the numbers of codes indicated in the TRNs.
Please note: Only the TRNs have been updated. The value set content recently published in September as part of the addenda have not changed.
For More Information: Revised TRN files are now available for download on the EP/Eligible Clinician eCQMs and Eligible Hospital/CAH eCQMs webpages of the eCQI Resource Center.
- CMS has launched an initiative to help it determine what provider regulations it should junk or revamp, citing growing concerns that its regulations are reducing the time providers spend with patients. As part of the Patient over Paperwork initiative, CMS officials will travel the country to gather information on the impact their regulations have on physicians. Those conversations have been taking place informally for weeks. The outreach effort comes at a time that primary-care physicians are spending 27% of their time on clinical activities and 49% on administrative activities, according to a 2016 Annals of Internal Medicine study. The CMS now releases around 58 rules, or 11,000 pages of regulation, each year.
Affiliate Association News 
 - Eligible ASCO members will be able to vote for their chosen leaders from November 1 to December 4. Go to https://www.asco.org/about-asco/asco-overview/asco-election? to learn more about this year's candidates and VOTE!
The American Society for Blood and Marrow Transplantation (ASBMT) is hosting a webinar on CAR-T coding and reimbursement on November 2 at 8AM PT. Learn more and register at https://www.signmeup.com/site/reg/register.aspx?fid=PX2V7H7.
Registration is open for the ASCO QOPI Fall Round that ends on November 7. For more information, visit http://www.asco.org/advocacy-policy/asco-in-action/2017-qopi-fall-round-closes-november-07.
ASH invites you to attend their presentation of, Improving MDS Outcomes from Diagnosis to Treatment: A Multidisciplinary Approach, November 8, 2017 at the Westin Bonaventure Hotel & Suites, Los Angeles. This comprehensive, MDS-focused summit is a unique learning experience that encourages attendee interaction. Spread the word about this chance to improve MDS outcomes in your community through active learning for the entire care team! Learn More.
ASH will host a webinar on MIPS and Reporting for MIPS on November 13 at 10AM. The webinar will provide a specialized MIPS reporting plan for hematologists. If you are interested in attending this webinar, then please e-mail Leslie Brady at lbrady@hematology.org.
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
- ACCC's Optimizing Your EHR highlights key findings from real-world experiences with EHR implementation and use across community cancer programs and practices. It will help your practice overcome common challenges and barriers to efficient EHR use. Read the report at www.informz.net/ACCC/data/images/Attachments/EHR-Publication.PDF.
ASCO has issued an endorsement of the American Society for Radiation Oncology (ASTRO) clinical practice guideline on radiation therapy for oropharyngeal squamous cell carcinoma. Read the full endorsement at https://www.asco.org/practice-guidelines/quality-guidelines/guidelines/head-and-neck-cancer.
- Save the Date for #COA2018. The 2018 Community Oncology Conference is April 12-13  at the Gaylord National Hotel & Convention Center, just outside of Washington DC. To learn more about the Community Oncology Conference, visit:  http://www.coaconference.org/.
The 2018 ASCO Annual Meeting, is scheduled for June 1-5, in Chicago, Illinois. This year's Presidential theme developed by Dr. Bruce Johnson is Delivering Discoveries: Expanding the Reach of Precision Medicine. Precision medicine is transforming cancer care in profound ways by driving the most exciting and powerful advances to improve how providers care for their patients. Bookmark am.asco.org and check back often for updates.
NCCN has published updates to the below. For the complete updated versions, please visit NCCN.org. Recent updates include: adolescent and young adult cancers (V2.2018), adult cancer pain (V2.2017), central nervous system cancers (V1.2017), cervical cancer (V1.2018), chronic lymphocytic leukemia/small lymphocytic lymphoma (V2.2018), esophageal and esophagogastric cancer (V4.2017), gastric cancer (V5.2017), genetic/familial high-risk assessment: breast and ovarian (V1.2018), hairy cell leukemia (V2.2018), hepatobiliary cancers (V4.2017), kidney cancer (V1.2018), melanoma (V1.2018), myeloid growth factors (V2.2017), myeloma (V2.2018), non-small cell skin cancer (V2.2018), uterine neoplasms (V1.2018).
Industry News 
CANCELLED Janssen Oncology program "MACRA and the Quality Payment Program-What Does This Mean for Oncology?" with Thomas Marsland, M.D., St. Joseph Health System, on November 7 at 12:30PM. For more information, please visit www.anco-online.org/MACRAWebcast.pdf.
Genentech invites MOASC and ANCO members to their upcoming Webinar Presentation about Helping Patients Evaluate Health Insurance Options on Friday, November 03, 2017 at 8:00 AM Pacific Time to register go to http://www.medforcereg.net/SGEN9059 
or contact Barbara Cruz at (509) 869-8006 or cruz.barbara@gene.comGenentech also has their
On-Demand Webcast about TECENTRIQ™ (atezolizumab) The First FDA-approved Anti-PDL1 Cancer Immunotherapy in Previously Treated, Metastatic Non-small Cell Lung Cancer, for more information click HERE.  
Pfizer Oncology's RxPathways, a service that connects patients to the Pfizer assistance programs that may be right to them like the Pfizer Oncology Together program, has implemented emergency relief protocols for patients that have been impacted by the devastating wildfires in northern California, including:
* arranging for new early refills and/or new shipping addresses if a medicine provided through a Pfizer patient assistance program has been destroyed or lost or if patients who are enrolled are unable to reach their doctors' offices and need their medicine shipped to an alternate location;
* waiver of income documentation if new patients urgently need a Pfizer medicine but have been displaced and are unable to access income documentation and other paperwork needs for enrollment in the program so that patients can receive their medication as quickly as possible;
* early replenishment of Pfizer medicines upon request by facilities that participate in the bulk replenishment Patient Assistant Program.
Patients can contact Pfizer for oncology medicines at Pfizer Oncology Together (877) 744-5675; for other medicines at Pfizer Rx Pathways (844) 989-PATH (7284). 
In This Issue
Professional Educational Series 
 November 8-9

(San Francisco, Nov. 4)

(San Francisco, February 8-10) 

(San Francisco, January 25-27) 

(San Francisco, February 8-10) 

(Napa, March 16-18) 
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