CMS is pleased to announce that a new self-service look-up tool can be accessed on the PQRI Portal at http://www.qualitynet.org/pqri, which allows eligible professionals at the Tax Identification Number (TIN) level to see if their 2007 PQRI Feedback Report is available. Once on the site, go to "Verify TIN Report Portlet" located at the bottom left of the page. Enter the TIN and a message will appear that indicates whether or not a 2007 PQRI Feedback Report is available.

This self-service look-up tool does not allow the eligible professional to view their 2007 PQRI Feedback Report. The availability of the 2007 PQRI Feedback Report is helpful for eligible professionals to know because it enables them to decide if they need to register for an IACS account at this time so that they can log into the PQRI Portal and view their 2007 PQRI Feedback Report. Additional information can be found in the following MLN Matters Special Edition articles:

• SE0830 – “Steps for Individual Eligible Professionals to Access Their 2007 Physician Quality Reporting Initiative (PQRI) Feedback Reports Personally”
  http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0830.pdf.
• SE0831 – “Steps for Organizations to Access Their 2007 Physician Quality Reporting Initiative (PQRI) Feedback Reports”
  http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf.

In addition, the eligible professional can call the QualityNet Help Desk to determine if a 2007 PQRI Feedback Report is available. The representatives at the QualityNet Help Desk can only inform the provider if a 2007 PQRI Feedback Report is available; they are unable to disclose the information on the 2007 PQRI Feedback Report. The QualityNet Help Desk can be reached via telephone at (866) 288-8912 from 7 a.m. - 7 p.m. CT or via e-mail at Qnetsupport@ifmc.sdps.org.

Note: The TIN must be the one used by the eligible professional to submit Medicare claims and valid PQRI quality data codes for dates of service July 1 - December 31, 2007.

The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Part B Drug and Biological Average Sales Price (ASP) Payment Amounts for October 1, 2008 to December 31, 2008 on the CMS website at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a_2008aspfiles.asp

The Centers for Medicare & Medicaid Services (CMS) no longer accepts medical records containing a physician’s stamped signature. Medicare auditors will reject any document signed with a physician’s signature stamp.

For details, see MLN Matters No. SE0829 (PDF).

University of Edinburgh researchers are seeing positive results from a new approach for treating depression in cancer patients. The program, which is given by specially-trained cancer nurses, is designed to work alongside a patient's usual cancer care. It emphasizes screening for depression, antidepressant medication, and teaching patients problem-solving skills. The results of the trial were published recently in The Lancet.

Here is a summary on several developments taking place as Congress wrapped up business before the summer August recess.   Go to the Community Oncology Alliance website at http://www.communityoncology.org under Breaking News to obtain more information and copies of legislation referenced.

Get ready to hear more about comparative effectiveness.

The Chairman of the Senate Finance Committee, Max Baucus (D-MT), introduced the Comparative Effectiveness Research Act of 2008 with the Senate Budget Committee Chairman, Kent Conrad (D-ND).  This legislation would create the Health Care Comparative Effectiveness Research Institute to review evidence and produce new information on how diseases, disorders, and other health conditions can be treated to achieve the best clinical outcome for patients.   The Institute would be a private, non-profit entity and would be governed by a multi-stakeholder Board of Governors, including the Secretary of Health and Human Services (HHS), the Directors of the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH), and 18 additional members representing public and private sector expertise and interests.

Expect to hear a lot more about comparative effectiveness as the debate on how to reform Medicare heats up going into 2009.  Although the Institute will simply disseminate research findings and be prohibited from issuing practice or policy recommendations or coverage guidelines, payers will be eager to obtain research that can shape physicians' decision making — especially related to minimizing costs.

Demonstration project pays 5% fee for 5% treatment savings.

Congressman Joe Crowley (D-NY-7) and seven House colleagues introduced a bill (H.R. 6725) that would create a demonstration project to study and improve the quality and cost effectiveness of cancer care services reimbursed by Medicare.  This demonstration project would, in effect, pay a 5% fee to practices that reduced Medicare spending by 5% related to the cost of treating six prevalent cancers.  This would involve the use of clinical pathways/guidelines and electronic medical records or a similar timely data reporting mechanism.

With so little time in the congressional calendar when Congress returns after Labor Day, it may be difficult to pass this legislation.  However, in a similar theme to comparative effectiveness, expect to see more initiatives to link Medicare payment to cost savings.

Every American should have an EMR by the year 2014.

Congressman Pete Stark (D-CA-13) gave opening remarks at the Hearing on Health Information Technology proposing that he would use Medicare reimbursement as an incentive for implementation of an EMR by healthcare providers and would give individuals the right to sue for damages when their records are breached.

Medicare payment for imaging services is in the crosshairs.

The Ranking Member of the Senate Finance Committee, Charles Grassley (R-IA), introduced the Medicare Imaging Disclosure Sunshine Act of 2008 (S. 3343). The intent of this legislation is to reduce incentives for physicians to refer patients to providers of imaging services in which the referring physician has a financial stake by requiring disclosure of any arrangements.

This bill comes on the heals of the recently published report by the Government Accountability Office (GAO) that reported that Medicare spending on imaging services had increased approximately 200% from 2000 through 2006.  Clearly, there will be more attempts to rein in Medicare spending on imaging services.

Future of the CAP program is in doubt.

BioScrip, which has been the sole vendor for the Competitive Drug Acquisition Program (CAP), has announced that it has decided not to re-sign the new CAP contract with CMS for the 2009 renewal term and plans to exit the program upon expiration of the current agreement at the end of 2008. As the sole CAP provider, BioScrip was unable to make CAP work.  It will be interesting to see if any other distributors or specialty pharmacy firms submit bids for the CAP business.

This information reflects FDA’s current analysis of available data concerning these drugs. FDA intends to update this document when additional information or analyses become available.

On April 22, 2008, FDA notified the manufacturer of Epogen/Procrit and Aranesp of its decision to require additional safety-related changes to the labeling for these products.

Amgen submitted labeling supplements for Epogen/Procrit and Aranesp on May 22, 2008, following the March 13, 2008 Oncologic Advisory Committee’s recommendations to make additional safety-related changes to the labeling for these products. Amgen and FDA have agreed on many of these changes, including to replace the existing Patient Package Insert with a Medication Guide and to modify certain sections of the Boxed Warnings, Indications and Usage, and Dosage and Administration sections of package insert.

These changes are intended to clarify the FDA-approved conditions for use of ESAs in patients with cancer and revise directions for dosing to state the hemoglobin level at which treatment with an ESA should not be initiated. While agreement was reached on the general concepts, Amgen and FDA have not reached agreement on specific wording on two points, including a warning statement that ESAs are not intended for use in patients receiving myelosuppressive therapy when the expected outcome is cure and statements regarding when to initiate and to discontinue ESA dosing. Labeling discussions concluded on July 15 and FDA issued a letter ordering the additional changes on July 30, 2008.

http://www.fda.gov/cder/drug/infopage/RHE/default.htm

On May 13, 2008, the American Hospital Formulary Service (AHFS) Drug Information listed Zometa® (zoledronic acid) injection in its compendium for the treatment of aromatase-induced bone loss.Please see this document for additional details regarding this AHFS listing. 

The mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with a 0.5 percent update, retroactive to July 1, 2008. Medicare contractors are currently working to update their payment system with the new rates.

Please read the notice linked below for additional information about the payment process.
http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=12586

The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 was enacted on July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with a 0.5 percent update, retroactive to July 1, 2008.

Physicians, non-physician practitioners and other providers of services paid under the MPFS should begin to receive payment at the 0.5 percent update rates in approximately 10 business days or less. Medicare contractors are currently working to update their payment system with the new rates.

In the meantime, to avoid a disruption to the payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, Medicare contractors will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6 percent update level. After your local contractor begins to pay claims at the new 0.5 percent rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates.

Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1, 2008 – June 30, 2008 fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced non-participation amount also will need to request an adjustment.

Contractor Web sites are being updated with the new rates and these should be available shortly.

Be aware that any published MLN Matters articles affected by the new law will be revised or rescinded, as appropriate.

Finally, be on the alert for more information about other legislative provisions that may affect you. Further instructions regarding other provisions of MIPPA will be forthcoming.

The US Senate has passed HR 6331, the Medicare Improvements for Patients and Providers Act of 2008, on a veto-proof 69-30 vote.  Prior to the July 4th recess, the Senate failed to pass a motion to proceed to consideration of the same bill on a 58-40 with 60 votes needed to pass the motion.  The US House of Representatives passed HR 6331 on a veto-proof 355-59 vote on Tuesday, June 24.

The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Part B Drug and Biological Average Sales Price (ASP) Payment Amounts for July 1, 2008 to September 30, 2008 on the CMS website at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a_2008aspfiles.asp The files are located in the \\"Downloads\\" section of this web page.