Letter From the President

by Tim McMahon
Tim.Mcmahon@baycare.org

The presents have long since been unwrapped, the incessant line-up of Holiday television favorites are over (for another year) and the BCS has left us with co-national champions in college football (something that wasn’t supposed to happen). Thank you notes have been sent (well most of them anyway), the ball has dropped ushering in the New Year and the Holiday “lag time” (you know, those two weeks where nothing seems to get done) is now behind us. It is back to reality time.

Reality smacked me square between the eyes in two different situations the other day that foretells how 2004 will play out for most cancer program administrators. Both reflect the ever-changing dynamics of cancer care. The technological advances, emotional component, the financial and reimbursement challenges and the impact our decisions have (or will have) on how services will be delivered in the future.

The first situation involved a conversation I had with a Medical Oncologist shortly before the Holidays. He has been practicing in our community for more than 15 years in a solo practice (an enigma in this day and age) and is highly regarded by patients for his compassion. He knocked on my office door, poking his head in to say that during a recent review of his practice that the new Medicare payments for outpatient chemotherapy will result in him probably closing his practice. After a brief conversation, he said he would make his final decision sometime during 2004. This comes on the heels of losing two other Medical Oncologists during 2003. Some people are already waiting 4-5 weeks for a new patient appointment in some offices. While that may be an acceptable wait time for some of your settings, this is a new phenomenon here, and most patients and referring physicians are having a difficult time adjusting to it.

The other situation involved me helping someone out of his car. I was walking into the Powell Cancer Center after a meeting at the hospital. A woman was struggling to help a man into a wheelchair. I stopped and helped, then stayed with this gentleman while his daughter went to park the car. During the ensuing conversation, I leaned that this gentleman, in his mid 40s, had been diagnosed with colorectal cancer 14 months ago. During that time he has had surgery twice, one course of radiation therapy and he was set to begin a third chemotherapy regimen that day.

In his voice I heard hope and optimism, in his eyes I saw fear and despair. He talked with me about the drain his illness has had on the family’s financial situation and how the fatigue has left him feeling a shell of his former self. His wife and he both had been using the counseling provided by our cancer program and he did say that it was helping, but he didn’t know how much longer he wanted to continue, in his words, “feeling crappy”. At that point his wife returned from parking the car and I walked with them to the elevator, wishing them both my best as the doors closed.

When I returned to my office, I sat at my desk feeling drained. Looking at the calendar it struck me; it’s almost time for the ACE Annual Conference. I look forward to this meeting as a time to share information with colleagues and gain new insight into what others are doing to meet the challenges we all face. This year’s conference is shaping up to be the best ever. Kay Petras and the program committee have planned a fantastic group of speakers and topics. I also enjoy reconnecting with colleagues from across the country to share and support each other especially during challenging times like these. I look forward to seeing everyone in Orlando.

Commission on Cancer Program Standards – 2004
(Part Three of Four Part Series)

Shirley Johnson, RN, MS, MBA
Director, Oncology Services
Siteman Cancer Center

With this issue of ACE Update, Standards 5 (Clinical Trial Information) and Standard 6 (Community Outreach) will be reviewed.

Standard 5.1 Clinical Trial Information

Information about the availability of cancer-related clinical trials is provided to patients through a formal mechanism.

Discussion: The Commission on Cancer expects that a formal mechanism is established and documented to provide information about cancer-related clinical trials to patients seen at the facility. It is not acceptable to advocate fulfillment of this standard to physician offices.

Documentation Required: Prior to the on-site visit, documentation of policies and procedures for providing information about cancer-related clinical trials will be reviewed. While on-site, the surveyors will review samples of written/printed information provided to patients. Information in the SAR related to this standard is updated annually.

Standard 5.2 Clinical Trial Accrual

As appropriate to the category, the required percentage of cases is accrued to cancer-related clinical trials on an annual basis.

Discussion: The standards are very well detailed concerning the definition and requirements expected in order to meet this standard.

Documentation Required: Patient accrual is monitored and results are documented in Cancer Committee minutes. The on-site surveyor will discuss the Clinical Trials Program with the Cancer Program Team during the site visit. SAR is updated annually.

Standard 6.1 Support Services

Supportive services are provided on-site or coordinated with local agencies and facilities.

Discussion: The purpose of this standard is to ensure supportive services, prevention and early detection opportunities are provided to patients and their families either in-house or by referral. It is the expectation that the Cancer Liaison Physician be the coordinator identified for community outreach initiatives pertaining to this standard.

Documentation Required: The on-site surveyor will review flyers/brochures describing service offerings, review support group meeting schedules, and other electronic media information specific to the program. The reviewer will discuss the Community Outreach Program with the designated Cancer Liaison Physician and Cancer Committee members.

Standard 6.2 Prevention and Early Detection Programs

Each year, two prevention or early detection programs are provided on-site or coordinated with other facilities or agencies.

Discussion: Programs may be held on-site or through coordination with other facilities and/or appropriate agencies.

Documentation Required: On-site surveyor will review Cancer Committee minutes or other sources of documentation for programs offered. The surveyor will discuss this program focus with the Cancer Liaison Physician and Cancer Committee members. SAR updated annually.

Standard 6.3 Monitoring Community Outreach

The cancer committee monitors the community outreach activities on an annual basis. The findings are documented.

Discussion: The Cancer Committee is expected to annually evaluate the appropriateness of services provided to patients and the community. Methods to maintain outreach activity are set by the Cancer Committee and documented in Cancer Committee minutes. The Cancer Liaison Physician is expected to play an active role in this review.

Documentation Required: Evaluation of services is documented in Cancer Committee minutes. The on-site surveyor will review this content in minutes and discuss the evaluation process with the Cancer Liaison Physician and Cancer Committee members.

Two New and Exciting Sessions at Tenth Annual Meeting in Orlando!
Your Chance To Participate As Members!!

There will be two very different, but equally exciting, sessions during this year’s annual meeting in Orlando, April 24 to April 27. The only similarity is that YOU, our members, will lead them and make them successful!

The first is entitled “ULTIMATE NETWORKING – WHEN YOU WISH UPON A STAR!”. This session will involve a panel discussion and questions/answers from the general membership about topics involving personal/professional growth and development. Too often we attend professional meetings and come back with terrific information on oncology trends, issues, and technology, but we don’t come back with many ideas that we can use for personal development. The Ultimate Networking session is intended to do just that!

Program Committee member Bill Laffey is coordinating this session and will be shortly sending out much more detail via e-mail. The intent is to have a small panel of members discuss topics of general interest in the areas of personal development, such as managing change, becoming a better leader, job change strategies, managing stress or any topic of interest as decided by our membership. Please think about areas you might wish to hear discussed, but also think about leading a discussion in an area in which you have experience! Look for Bill’s e-mail shortly and then PLEASE RESPOND WITH ENTHUSIASM.

The second new session for this meeting will be our Table Topic Lunch. Unlike “Ultimate Networking”, where personal development is the focus, the Table Topic Lunch is your chance to present a professional topic of interest to your peers. It might take the form of a best practice, solution to a problem, general research study, or similar topic. Eight to ten members will be selected for presentations of approximately 10 minutes. Conference attendees will get their lunch and then move throughout the luncheon area to listen to presentations of their choosing. Again, your involvement is key to a successful session.

You will be hearing much more about this session and will receive a solicitation for presenters by mid-February. Be thinking about the great things your program has done and take the opportunity to share your successes with your peers. SO, MARK THE DATES OF APRIL 24 –27 and be thinking about the best way YOU can participate in one (or both) of our exciting new sessions!

An Innovative Approach to Psychosocial Support

Suzanna Hoyler, Director
WCT Information Management
Washington Hospital Center

When the going gets tough…The tough go camping. It was 6+ years ago that a group of women from a breast cancer survivors support group raised the idea of doing something “out of the ordinary”. Several of them had watched a documentary about a group of women climbing a mountain to celebrate their cancer survivorship. This group of survivors from our health system wanted to do “something like that”! Given the geography, Florida’s highest point above sea level is 345 feet, I encouraged them to consider the alternatives.

What they proposed is now called Camp Living Springs. This 3 day retreat provides adult cancer survivors with an opportunity get away from their day-to-day obligations and let their hair down (or take their wigs and turbans off) and share experiences with other cancer survivors. Camp Living Springs’ mission is to promote camaraderie, relaxation and shared experiences while nurturing the spirit of those touched by cancer.

The camp is held at an executive retreat center, located on 100+ acres about 90 minutes south of Morton Plant Hospital. The first camp was held in 1998, with 34 “campers” (cancer survivors) and 15 “resource” buddies (members of the health system), with a $15,000 grant from the Foundation as the budget. (It was important that financial considerations not determine who did and did not attend Camp, so the entire weekend is provided at no cost to the campers.)

The sixth year of Camp Living Springs was held the first weekend in November 2003 with over 75 campers and 30 “buddies”. Since that first year, the interest and popularity of Camp has grown dramatically and so has the structure. Now the Morton Plant Hospital auxiliary (called Caring Partners) has assumed responsibility for planning, organizing and financially supporting the Camp. Each year Caring Partners raises in excess of $25,000 toward this effort. They also have subcommittees that plan evening activities, arts & crafts, canoeing, nature walks, a non-denominational spirituality service and the menu. The auxiliary members also now serve as the campers’ “buddies” and there is a long waiting list of auxiliary members wanting to participate.

Adult cancer retreats, while becoming more common, are still a unique way to provide support for cancer survivors. Including your health system’s auxiliary is a great way to insure a funding source. Here, it has also shifted the responsibility of planning, organizing and running the Camp each year. Please feel free to email me tim.mcmahon@baycare.org for more information.

ACE Launches a Subscription Email Service for Members

Members of ACE will now have access to a new subscription email service as a means to share information. ACE has created members@cancerexecutives.org—a subscription email service where members can post messages to the entire member mailing list. Here’s how the service works:

• All members will be automatically subscribed to the member mailing list through their email addresses. Members can chose to unsubscribe from the subscribers list, but we encourage everyone to remain on the list in order to maximize sharing of ideas and information.

• Pose a question, request or comment to the membership by sending an email to members@cancerexecutives.org.

• All replies to your message will be sent directly to your email address.

Before sending messages to the mailing list, remember…

• Please adhere to the guidelines whenever you post a message for the membership. Keep your postings related to the purpose of the list in which you are a member. If you want to share ideas on other topics, use personal email utilizing the online membership directory on the ACE Web site.

• Replies can also be “broadcast” to the membership if you include members@cancerexecutives.org in the “CC” or “TO” field. Contact the person individually if you would like them to fax/email you a document they have offered to the list, do not reply to the entire list. Use the individual’s email address and request or share your information. Always check the “To:” box before hitting send.

• Attachments will clog the email server, and not all recipients can receive them, creating pages of useless characters within the email. If you have an attachment to share with the group, provide your email address and ask that those interested email you directly.

• Please treat everyone with respect, and refrain from using angry or condescending tones toward individuals when posting to the list. Abusive and obscene language will not be tolerated and will result in removal from the list.

• Please do not use the email program as a marketing or sales tool. Do not post product information, pricing, or fees. ACE will monitor email exchanges for inappropriate postings. In the event that an inappropriate posting is brought to our attention, ACE shall take all appropriate and necessary action. ACE reserves the right to terminate access to this email program for any user who does not abide by these guidelines.

If you wish to unsubscribe to the list, send a blank message to members-unsubscribe@cancerexecutives.org.

News You Can Use – Legislative & Reimbursement Updates for 2004

Susan Granucci
Healthcare Reimbursement Specialist
snucci@aol.com

Keeping abreast of all of the legislative and reimbursement changes, especially at year end, is almost an impossible task, even for those who are involved on a daily basis. The following are highlights of some of the more important pieces of healthcare legislation and key 2004 Medicare reimbursement rate and policy changes for chemotherapy and radiation oncology, intended to help sidestep the minefields awaiting oncology programs in the coming year(s).

Medicare Prescription Drug, Improvement,
and Modernization Act of 2003 (DIMA)

Cost to Taxpayers of $395 Billion Over 10 Years

Title D (Medicare Part D) -
Prescription Drug Coverage Highlights

• Full coverage effective 2006, but beginning April 2004, a prescription drug discount card will be available that will cut prescription costs up to 25%

• Guaranteed to all seniors, but voluntary

• Provides extra help to low-income seniors

• If income is below $12,123 (individuals) or $16,362 (couple), there is no monthly premium, no deductible, and costs are $2 for generic or $5 for other prescription drugs

• Premiums average $35 per month, $250 annual deductible, and catastrophic coverage after $3,600 in annual out-of-pocket drug costs

• Seniors may choose service from any pharmacy
  Source: Mailing from Rep. Heather Wilson, R-NM, 12/2003

Medicare Advantage Program
Replaces Medicare + Choice

• Starting in 2004, all plans will be reimbursed no less than the rate for traditional Medicare fee-for-service amounts.

• Starting in 2010, a six year demonstration project will permit Medicare beneficiaries in six cities to choose from traditional Medicare or from at least two other private insurers.

Provider Funding

• Hospitals are to receive full marketbasket update for FY 2004 – 2007. The inpatient PPS rate increase is 3.4% for 2004.

• Quality of care data must be submitted to Medicare, or the hospital will be penalized by 0.4%.

• Physician payments will increase “not less than” 1.5% in 2004 and 2005 (over-riding the 4.5% reduction planned in the physician final rule of 11/7/2003). The new 2004 conversion factor is 37.3374.

• Areas with the geographic payment adjustment below 1.0 will be increased to 1.0 from 2004 through 2006.

• Bonuses of 5% are to be paid for 3 years to physicians in shortage areas.

• Durable Medical Equipment rates are to be frozen from 2004 through 2006, and competitive bidding for the largest metropolitan statistical areas to begin in 2007.

Deductibles

• In 2004, the Part B deductible remains $100, Part A increases to $876 from $812 for a hospital inpatient stay.

• In 2005, the Part B deductible will increase to $110, and thereafter will increase by average beneficiary spending rate increases. Beginning in 2007 (with a five-year phase in period), premiums will be determined based on income. In 2012, individuals earning over $200,000 or families over $400,000 will be required to pay 80% of the Part B premium rather than the current 25%.

Tax Deductions

• Health Savings Accounts (HSA) will permit up to $4,500 tax-deductible contributions to an HSA with a high deductible ($2,000) insurance policy.

• Employers will receive up to $1,330 tax-free for each retiree provided prescription drug coverage.

Source: HFMA Highlights 12/22/03 and
Commerce Clearing House Summary, 12/9/2003

Drugs (legislation found under heading of “combating waste, fraud, and abuse”)

Major new reimbursement methodologies for both hospitals and physicians will significantly reduce revenues.

*Exceptions to the 85% AWP rule include 29 common (and most frequently billed) OIG/GAO survey drugs, which are to be paid to physicians or free-standing clinics at generally lower rates (80%-81% of AWP, with a few higher exceptions).

Sources:  ACCC 11/21/03 release; ASCO 11/25/03 release; Community Oncology Alliance Practice Impact Analysis 12/8/03; CMS Implementation Rules for DIMA 1/10/04

Additional Information for all above:  http://www.cms.gov/medicarereform/

Medicare Final Rules – Federal Registers 11/7/03 for Hospital Outpatient and Physician Fee Schedule

Drug Administration Coding

• Major changes proposed for hospital coding were not adopted in the final rule, but one code was deleted (Q0085).

• Physician work values are increased for all administration codes, and a 32% transitional adjustment will be added for 2004. A 3% transitional increase is scheduled for 2005.

• Minimal [nursing] visit 99211 can no longer be billed with chemotherapy administration on the same patient, same day. This represents a major change for many physician office practices.

New Drug Coverage for Hospital Medicare Outpatients (Charge Master Updates Needed for the Following which were not allowed or coded differently in 2003)

• http://www.cms.gov/regulations/hopps/2004ifc

• http://www.cms.gov/regulations/pfs/2004fc/1372fc/1372fc.asp

Financial Impact Analysis of New Drug Rates

Oncology Alliance estimates Part B losses to physician or free-standing clinics at $165 million in 2004, and $1 billion in 2005. Cancer Consultants, an internet information site, has provided via a cancerrx.info newsflash, additional insight. Their estimates are $1 billion per year for 10 years in decreased revenues. The recurring theme in Medicare’s reform act (HR-1) is the impetus towards privatization. The plans for future distribution of drugs through a specialty pharmacy are designed to create market forces to drive down prices, which is good. However, many oncologists who were surveyed appear to be not inclined to use specialty pharmacies. In any event, the next two years will be transformational in the business of oncology.

Under the average sales price methodology, 50% of sales will be higher and 50% will be lower than the ASP payment rate. Those who are not prudent buyers will lose money and may opt to discontinue practice, thus causing the average sales price to ratchet down. Under this scenario, many physicians will shift care back to hospitals. Those who continue office treatments will need to be both aggressive and creative to control costs and increase revenues. Conversely, the same may be said of hospital chemotherapy programs as well.

Radiation Therapy

As most have already heard, the overall fee reductions by Medicare for radiation therapy are significant for 2004 hospital outpatients. The following is a side-by-side comparison of hospital and physician national average fees for 2004 for the most frequently billed codes.

Other changes affecting radiation policies and charge masters:

Codes G0256 and G0261 have been deleted, and prostate seed implant codes are reverting to 7777x implant + 55859 cath/needle placement + C code for seeds. Reinstated codes: C1718 per I-125 seed at $37.34 (need to bill each seed), and C1720 for Palladium 103 at $44.67.

Evaluation and Management Fee Updates

In Table 8, hospital outpatient technical payments are limited to three reimbursement rates, regardless of the CPT status of new, established or consultative visit.

Professional reimbursements reflect five code levels each for new patients, established patients, and outpatient consolations.

Note:  All fees are national averages.  Hospital payment rates are adjusted by unique wage indexes for their own localities, and physician reimbursement is adjusted by geographic practice cost indices.

Final Rule 2004 Medicare Inpatient PPS (Fed Register 8/1/2003)

Inpatient DRG 492 is to be assigned with ICD procedure code 00.15 for patients hospitalized for High Dose Interleukin 2 therapy for end stage renal cell or melanoma chemotherapy.

New Grants Web Site

For those who are interested, go to http://grants.gov/ for a new comprehensive web site by HHS, listing information to find and apply for all federal grant programs.

Ace Update Info
ACE Update is produced by the Association of Cancer Executives. ACE assumes no liability for any errors that may be contained in the source material. Opinions expressed in articles appearing in ACE Update are those of the authors and not necessarily those of the Association of Cancer Executives or the editor of ACE Update.

Editor

Barbara Mathison
E-mail: barbara.mathison@phci.org

ACE Correspondence Office

Genevieve (Gen) Hedland
Managing Director
475 S. Frontage Road, Suite 101
Burr Ridge, IL 60527-6282
Phone: (630) 323-1170
Fax: (630) 323-6989
E-mail: ghedland@cancerexecutives.org
Web site: www.cancerexecutives.org

Newsletter Design

Janet Kalbhen
Electronic Publisher

Editorial Board

Calvin Harrison
Executive Director - Cancer Services
Providence Health System

Brian McCagh
Executive Director
Washington Cancer Institute

Susan Granucci
Healthcare Reimbursement Specialist

Barbara Mathison
Executive Director
ProHealth Care, Inc.

Joseph Piccolo
Associate Administrator
Fox Chase Cancer Center

John Rieke, MD
Medical Director
Virginia Mason Cancer Center

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