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2021 legislative session results in 5 important healthcare bills signed into law. California News
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Congress funds government at FY 2021 levels through December 3rd. National News
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Congress Fails to address 4 important healthcare bills. National News
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MOASC has partnered with PayGround to deliver an end-to-end patient collections platform for MOASC members. With their modern patient-first approach, MOASC expects members to increase their patient collections by 12%, decrease their overall days to collect by 4 days, all while saving 26% in processing fees. Hear more at the MOASC Annual Management Series presentation on November 4th!
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MOASC Programs - Save the Dates - All Times are Pacific
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October 13, 5:30pm Breast Cancer Overview, Presented by: Adeline Wang, MD, PhD, and Chad Barnett, PharmD, BCOP. Topics include: Overview of Epidemiology; Mechanisms of Disease; Early Breast Cancer; Metastatic Breast Cancer; Clinical Trials and Endpoints; Quality of Care. Sponsored by Pfizer.
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October 19th, 7-8:30pm PDT Targeted Oncology invites MOASC Members to their upcoming virtual roundtable BCMA-Targeted Therapies for Relapsed/Refractory Multiple Myeloma. Intended for oncologists treating relapsed/refractory multiple myeloma, this session offers practicing oncologists the perfect opportunity to sharpen their skills and expertise in treatment strategies. Attendees are paid $500 of compensation, per session, by Healthcare Research Analytics®, for their attendance, participation & completion of the post-event HRA survey.
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October 21, 12:30pm Adcetris Clinical Data Update and Patient Management, presented by: Elizabeth Brem, MD, Assistant Professor, Division of Hematology/Oncology, Department of Medicine, UCI. Sponsored by Seagen.
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October 27, in recognition of Breast Cancer Awareness Month, MOASC presents a virtual conference on “Treatment of Breast Cancer,” 5:30pm to 7:00pm.
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October 29-30, the University of California San Diego invites you to their inaugural Delivering Discoveries: Updates in Oncology CME conference. This 1.5 day event will address all aspects of cancer from basic science research, advances in clinical care, to community-based approaches that optimize prevention and interception.
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November 3, in recognition of Lung Cancer Awareness Month, MOASC presents a virtual conference on “Recent Advances in Lung Cancer,” 5:30pm to 7:00pm-PDT.
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Virtually join and interact with your colleagues while learning about tools and resources to keep you successful at the MOASC Annual Management Series for Oncology Administration & Accounts Receivable Management.
Our series starts with the Administration Track 1 on November 4, 11:45am – 3:15pm with topics: Prevent Burnout & Employee Fatigue; Time Management: Finding an extra hour every day; Creating a More Productive Practice with Process Automation; Improving Patient Collections Experience, and Match Patients to Clinical Trials.
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Followed with the Oncology Accounts Receivable-Track 2, on November 10, 11:45am to 3:15pm, with topics including: 2022 Billing Updates; Overview of Medicare Regulations; Billing tips for Practicing and Advanced Practice Providers, and How to Increase Revenue.
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Thank you to the following sponsors for supporting access to oncology care: AstraZeneca, BeiGene, Bristol Myers Squibb, Grail, Inc., Oncopeptides, Pfizer Oncology, Takeda Oncology, AbbVie, Astellas, Daiichi Sakyo, Inc., Incyte, Johnson and Johnson, Merck, Novartis, ADC Therapeutics, Agios Pharmaceuticals, Exact Sciences, Foundation Medicine, Gilead, G1 Therapeutics, Guardant Health, Kite Pharma, Lilly Oncology, MorphoSys, Inc., Myovant Sciences, Pharmacyclics, Sanofi-Genzyme, Seagen, Stemline Therapeutics.
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December 4, 8:30am The University of California San Diego cordially invites you to their Great Debates in Advanced Cutaneous Squamous Cell Carcinoma (CSCC). This virtual meeting will provide a multidisciplinary management approach for patients with advanced CSCC. Topics will focus on updates in risk assessment, pathology, radiation therapy medical & surgical management, featuring case presentations alongside plenary sessions followed by a question and answer opportunity. Target audiences include: dermatologists; medical, radiation and surgical oncologists; otolaryngologists; plastic surgeons; pathologists, and physicians and allied health professionals caring for patients with cutaneous squamous cell carcinoma.
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2021 was a very busy legislative session, and the legislature is now on recess and will reconvene on January 3, 2022. The following bills were presented to the Governor and signed into law.
AB342 (Gipson/Rubio) Coverage of Colorectal cancer: screening and testing. This bill will eliminate cost-sharing for patients who need follow-up colonoscopies after a positive stool screening test.
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AB347(Arambula) Step Therapy. Reforms utilization management, such as step therapy and prior authorization, insurance practices that hinder access to treatments for patients with chronic conditions and cause negative health outcomes, and secures much needed protections for patients in California. With the passage of AB 347, health insurance plans will now be required to expeditiously grant requests for step therapy exceptions by establishing a set of standard exceptions to the protocol. It also builds upon previously enacted timeframes to establish a timeframe for step therapy and prior authorization requests that the insurer deemed to be “incomplete.” These and other new protections will ensure that health insurance plans operate with expediency and transparency to receive all the information they need to make determinations in a timely manner.
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SB310 (Rubio) Recycling of unused cancer medication. This will create a program that allows oncologists to accept unused, unneeded medication from their patients and redistribute that medication to other patients in need. The program will require oncologists to register to participate in the program, pay a nominal fee, and work within the parameters of the program. There is legal liability protection for those participating in the program.
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SB535 (Limon) Coverage of Biomarker testing. This law prohibits prior authorization for biomarker testing for patients with stage 3 and 4 cancer who already have coverage, eliminating delays and helping patients access appropriate therapy faster. The effective date is July 1, 2022.
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SCR11 Cancer Patients Bill of Rights. Cancer Patients Bill of Rights, establishes six rights for cancer patients to ensure access to the care they need.
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October 14-15, the Western Colorectal Cancer Consortium Conference (WC4) will be a VIRTUAL event. Many presenters will focus on health disparities and inequities, both pre- and mid-pandemic. There will also be free 13.25h AAFP CME (subject to change) available.
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Reminder that Remittance Advices (RA) are issued in either Standard Paper Remittance (SPR) or Electronic Remittance Advice (ERA). An RA provides finalized claim details and contains explanatory claim processing message codes. Effective 9/29/2021, RAs are required when contacting claims review.
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Quarterly Medicare Updates - A/B - After Hours Webinar - October 14, 2021. This event includes: CMS and Noridian Updates, October 2021 Quarterly Provider Updates, Change Requests (CR), Recurring Updates, Special Editions (SE), and Resources.
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October 20 - Live Chat with Provider Enrollment Webinar - This event includes: Provider Enrollment, Live Chat with Provider Enrollment, and Telehealth/Telemedicine
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October 26 - External Breast Prosthesis (EBP), Mammography and Physician Orders Webinar. This webinar is intended for Medicare Part B providers and DME suppliers and will include: • Mammography Screening/Diagnostic • Coverage Criteria and Coding • Orders and Documentation • Reminders and Resources.
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October 27 - The Noridian Provider Outreach and Education (POE) staff is hosting the Screening Services: Mammography, Pap Test and Pelvic Exam webinar. This webinar is intended for Medicare Part B Providers and will include: • Screening Mammography • Screening Pap Test • Screening Pelvic Examination • Screening for Cervical Cancer with Human Papilloma Virus (HPV) Test • Resources.
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October 27 - Comprehensive Error Rate Testing (CERT) Clinic Webinar. The CERT Overview will address, Part A Missing Documentation - SNF, Labs/Diagnostic Tests, TAVR, ICD, OP Therapy, Part B Missing Documentation - Policy-Based Denials, DME - NPI Billing Errors, Refill Request Errors, Error Prevention, and Website Tour.
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Medicare Open Enrollment begins October 15. If your patients need help paying for Medicare costs, they may be able to get help from the state. Learn more about Medicare Savings Programs and how to apply.
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Since the publication of the August 31st California Oncology Weekly, announcing the 2020 MIPS information was made available for review, a Government Accountability Office (GAO) report found that at least 93% of health care providers qualified for a positive payment adjustment under MIPS for the performance years 2017 to 2019. Between 72% and 84% of providers received a bonus for exceptional performance and less than 5% qualified for a negative payment adjustment.
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Liz Fowler, director of the Center for Medicare and Medicaid Innovation, said the agency plans to focus on developing more mandatory payment models, including those that address the total cost of care, and move away from narrow models that focus on a single episode of care, type of disease or specialty. The agency hopes to integrate more safety net providers and encourage closer collaboration with Medicaid.
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Congress passed a short-term continuing resolution government-funding bill at FY 2021 levels through December 3rd. The lack of a concrete FY2022 funding bill fosters an environment that makes it difficult for the medical research community, as the NIH and NCI, to plan cancer research for the following years.
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If Congress does not address cuts to Medicare reimbursement: The moratorium on the 2% Medicare sequester will expire; A 4% Medicare payment cut due to the Statutory Pay-As-You-Go (PAYGO) Act will be implemented, and the 3.75% temporary increase in physician fee schedule (PFS) created by the Consolidated Appropriations Act, supplying short-term relief from the impact of the pandemic will expire. In an effort to ensure that Congress makes this a priority, Congressmen Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) are circulating a “Dear Colleague” letter that addresses the financial uncertainty facing physicians and practices if Congress fails to act.
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The COVID-19 Public Health Emergency heightened the role that telehealth plays in increasing access to care for patients with cancer while reducing treatment burden and disruption to patients’ lives. The CONNECT for Health ACT (H.R. 2903/S. 1512), introduced by Representatives Mike Thompson (D-CA-5) and David Schweikert (R-AZ-6), and Senators Brian Schatz (D-HI) and Roger Wicker (R-MS), would expand telehealth flexibilities by removing originating and geographic site restrictions, ensuring increased access for patients.
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Ensure Timely access to Cancer Treatments. Delays in care, as prior authorizations, can severely impact patients with cancer, including increased disease activity, loss of function and potentially irreversible disease progression. The Timely Access to Cancer Treatment (TACT) Act (H.R. 3258), introduced by Representatives Terri Sewell (D-AL-07) and Gus Bilirakis (R-FL-12), would require that cancer patients be provided with their oral cancer drugs within an acceptable time frame of 72 hours.
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A spokesperson from the Association of Health Insurance Providers stated they found that hospital consolidation and acquisition of physician groups by growing health systems are driving up health care costs and health insurance premiums without improving patient outcomes. Research indicates hospital consolidation has been linked with 5% higher marketplace premiums. This dovetails with last week’s publication of the California Oncology Weekly article regarding a report that some hospitals that take part in the 340B discount program are charging insurers 3.8 times on average more than the acquisition costs for oncology drugs.
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Telemedicine has expanded access to specialized care as well as behavioral health care in low-resource areas, but broader distribution of affordable, high-quality, high-speed broadband connectivity is needed, witnesses said during a congressional hearing. Witnesses also suggested easing interstate licensing restrictions, coordinating the distribution of funds from different federal agencies and ensuring continued reimbursement of audio-only services.
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Cautionary note from the above article, is that 36% of patients surveyed in June and July said they had used a telehealth service sometime in the past year, compared with 9% in 2020 and 7% in 2019, but overall satisfaction with telehealth has declined. Patient perception of security, ease of use, trustworthiness and convenience affected decisions to use telehealth; healthier patients were more likely than those with complex health conditions to be satisfied with telehealth, more than half of respondents cited at least one factor that made telehealth difficult.
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Hospitals and health care providers are owed billions of dollars from Anthem Blue Cross, and the number of claims for emergency care denied by UnitedHealthcare has risen. Anthem apologized and attributed delays to a new claims management system and "a new set of dynamics," while providers say new documentation requirements and prior authorization rules for routine care have caused payment delays and denials.
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Information from a recently released FDA database suggests that numbers of new technologies employing medical artificial intelligence have increased significantly and are aimed at reducing costs and increasing quality of diagnostics and care. The vast majority of AI and machine learning medical devices approved since 1997 have been in the area of radiology.
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According to HealthSprocket, as a result of the pandemic the percent of physicians who have experienced: Reduction in income is 49% ; Reduced staff is 32% ; Switched to a primary telemedicine practice is 18% ; Moving to new employment situation/practice is 9% ; Increased staff is 6% ; Moving from direct clinical to non-clinical is 3% ; Retirement is 2% ; Closing their practice is 2% ; Moving from permanent practice to locum tenens is 1% ; Other is 5% ; None of the above is 22%.
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Dr. Francis S. Collins, director of the National Institutes of Health for 12 years, said he is stepping down, capping a career in which he directed crucial research into the human genome and the fight against serious diseases like cancer, Alzheimer's, diabetes and COVID-19.
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Affiliate Association News |
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In honor of breast cancer awareness month, ANCO will be having Dr. Pamela Munster participate in the October 21st ANCO Connections. Dr. Munster recently authored Twisting Fate, about her experience as an oncologist and a cancer patient. The first 20 registered health care providers will receive a copy of her book.
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ANCO's 2021 Professional Education Meeting is taking place virtually on October 27th.
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ANCO's Hematologic Malignancies Updates (part III of III), will be November 6, 2021- Hyatt Regency San Francisco Embarcadero. The faculty will present the latest research on treatment modalities for hematologic malignancies—leukemias, lymphomas, and myeloma—along with case studies for these diagnoses. Registration deadline is Thursday, November 4th.
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Through this Thursday, October 14, 11am PDT, practices can post their job openings daily to ASCO’s temporary online job board. Ending this Friday, October 15th, trainees can view the list of available jobs and seek out more information on the temporary online job board to help connect oncology trainees with positions of employment, in lieu of the in-person networking received at the ASCO Annual Meeting. If you are recruiting trainees for open positions at your organization, please fill out the form or forward it to your hiring department.
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Seagen invites MOASC members to their upcoming virtual event “It is Time to Shine a Light on the Importance of Awareness and Funding for Metastatic Breast Cancer.” The virtual benefit will feature musical entertainment and inspiring Metastatic Breast Cancer. Stories heard from #LightUpMBC patient ambassadors at landmark lightings in their cities to help raise funds for metastatic breast cancer research. If you have any questions or would like materials contact Katie Adams at 310-433-1680 or kaadams@seagen.com.
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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 material contained in the California Oncology Weekly is intended as general information for 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 accepts no liability for any statements or articles herein. CPT codes are owned and trademarked by the American Medical Association. All Rights Reserved.
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