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Practice Matters
News about health policy and practice management issues of importance to oncologists
Friday, April 18, 2014

Fasten your seatbelt, steel your courage, and promise yourself to be part of the solution.

The front-page headline on The New York Times this morning reads: “Cost of Treatment May Influence Treatment.”


The term “death panel” did not appear in the article, but look for it in the thousands of news reports that we will see in the years ahead as society comes to terms with the fact that physicians must help solve the health care cost crisis.


The article points out that new guidelines being developed by medical societies “could result in doctors choosing one drug over another for cost reasons or even deciding that a particular treatment—at the end of life, for example—is too expensive.” The next sentence uses the word “rationing.”


The Times article focuses on cost control efforts of the American Society of Clinical Oncology, the American College of Cardiology, and the American Heart Association. Among other things, the article reports that ASCO is preparing a scorecard to evaluate drugs on cost, efficacy, side effects, and value.


I hope oncologists will be inspired by this quote from Lowell Schnipper, MD, chair of ASCO’s task force on the value of cancer care: “We understand that we doctors should be and are stewards of the larger society as well as the patient in our examination room.”


Physicians did not ask for this role, but it has been thrust upon them by myriad circumstances beyond their control. Fortunately for oncologists, ASCO has been showing leadership on this issue for years. To learn more, check out this and this and this and this and this.


To hear Dr. Schnipper discuss cost-consciousness in cancer treatment, click here and scroll down to “The Thinking Behind ASCO’s Top Five List.”

Wednesday, April 09, 2014

Insurers, fraud investigators, hospital utilization reviewers, potential business partners, and maybe even patients are going to be looking at your Medicare pay data, so you may as well check it out yourself.


The data, released for the first time yesterday, details $77 million in Medicare payouts to 880,000 individual physicians and physician practices in 2012.


You have to sift through more than nine million lines of Excel spreadsheets, but you (and anyone else interested in you) will find the exact services for which you submitted Medicare bills, the average payments for each service, and the number of patients who received each service. By the end of the day, you can figure out how your practice patterns for your patients covered by Medicare compare with those of your colleagues around town, with the statewide average, and with your peers nationally.


For details about your individual Medicare pay, look for your name in the alphabetical files (scroll down to the subhead Microsoft Excel Format). For a quick peek without details, find yourself in the summary data (scroll down to the subhead Summary Tables.) Sort the data on “provider type,” and scroll to hematology/oncology, medical oncology, radiation oncology, or whatever provider type you wish to see.


Other information to be found in the data files:

·    On average, Medicare paid $366,677 to physicians who were categorized as “oncologist/hematologist” in 2012. (Click into this USA Today article and scroll down to the Medicare Billings insert.) Those in the “medical oncology” category were paid, on average, $308,702, while radiation oncologists received an average of $362,666 in Medicare pay that year.

·    At least you’re not this guy: Salomon Melgen, a Florida ophthalmologist, took top billing, literally, by receiving $21 million in Medicare pay in 2012, according to an article in today’s New York Times. If his name seems familiar, perhaps you are remembering that he is under investigation by the federal government and that his offices were raided twice last year. That said, his lawyer told the Times that his big Medicare pay does not suggest fraud -- only that he simply has a big practice.

·    Couldn’t you work a little harder? Modern Healthcare reports that a primary care doctor in Ann Arbor, Mich., was paid $7.6 million by Medicare for treating more than 207,000 Medicare patients in a year. While that is good for a gasp, MH reporter Joe Carlson says those figures probably reflect the work of multiple doctors using a single provider number.

·    The data may contain errors, according to the American Medical Association (and anyone who has used a big data file.) If your blood pressure spikes, requiring a visit to a cardiologist, you might ask if he or she received the average of $233,240 in Medicare in 2012.


Monday, March 31, 2014

A Senate vote Monday evening averted the 24 percent cut in Medicare pay to physicians that would have gone into effect April 1, but don’t expect many physicians to thank their Senators for it.


The vote follows an earlier vote by the House to patch the much maligned Sustainable Growth Rate (SGR) for one year. The action, which had been expected for several days, angers physician advocacy groups that have been rooting for a permanent fix to the SGR.


The American Society of Clinical Oncology, American Society for Radiation Oncology, and many other physician organizations were counting on bipartisan support for the SGR Repeal and Medicare Provider Payment Modernization Act of 2014  until it fell apart over discussions on how to pay for it.


“We are disappointed that this remarkable progress and hope for real change has been cast aside by partisan politics over paying for the cost of repeal,” ASCO said in a news release. “The failure of Congress to repeal SGR … is not a solution and simply means that we will face this crisis next year for an 18th time.”


In the same vote, Congress pushed back the deadline for ICD-10 diagnostic and procedure codes—again—for at least a year.

Friday, March 28, 2014

So much for my sunny optimism earlier this month.


The enthusiastic push to get Congress to repeal the much-maligned Sustainable Growth Formula (SGR) that keeps physicians guessing about if or when their Medicare pay will drastically cut slammed into a brick wall  a couple weeks ago. Now physicians are just hoping that Congress will pass another temporary fix before Monday to stave off an immediate 24% cut in Medicare pay.


The American Society of Clinical Oncology, American Society for Radiation Oncology, and other important medical societies had been campaigning for the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, but that appears dead.


The SGR patch currently on the table provides a 0.5 percent increase in physician pay through the end of 2014 with no increase in the first three months of 2015. The increase would be paid for by payment cuts for diagnostic laboratory tests, advanced imaging, and adjustments to certain codes under the physician fee schedule.


As of this morning, ASCO is urging its members to call their U.S. Senators to ask them to permanently repeal the SGR: “Another patch will add to the instability of struggling oncology practices,” ASCO said in a statement.


But ASCO’s summary of the situation acknowledges that all hope for a permanent solution is lost for the time being: “Earlier this month the House passed SGR repeal legislation, offsetting the cost with a delay to the Affordable Care Act individual mandate which is not acceptable to the Senate or the President. The Senate could vote in the days ahead on a similar bill with a provision to use war funding, the Overseas Contingency Operations fund, to cover the cost of the bill. This will not be accepted by the House.”

Thursday, March 20, 2014



A sizable minority of medical oncologists believe that palliative care and curative treatment are mutually exclusive, but the Centers for Medicare & Medicaid Services (CMS) suspects otherwise.


CMS this week announced an initiative to develop a new payment system that allows Medicare patients to receive comfort from palliative care while they are being treated with curative intent. The goal of the Medicare Care Choices Model is to test whether providing hospice services to patients in active treatment can improve their quality of life and the care they receive, increase patient satisfaction, and reduce Medicare expenditures.


The test will be conducted in about 30 hospices; CMS expects to enroll 30,000 Medicare beneficiaries who are being treated for advanced cancer, chronic obstructive pulmonary disease, congestive heart failure, or HIV/AIDS over a three-year period.


“Clinicians, family members, and caregivers in this model will no longer need to choose between hospice services and curative care,” Patrick Conway, MD, deputy administrator for innovation and quality and CMS chief medical officer, said in a fact sheet accompanying the announcement.


Currently, only 44 percent of Medicare patients use hospice at the end of life and typically for a very short period of time.


The new program comes from the Center for Medicare & Medicaid Innovation, which was created as part of the Affordable Care Act.

About the Author

Lola Butcher
LOLA BUTCHER, MPA, MA, an award-winning Contributing Writer for Oncology Times, writes about health policy and business trends. She is a frequent contributor to Hospitals & Health Networks, Modern Physician, Neurology Today, and other health care trade publications. This blog was recently recognized with an APEX Award for Publication Excellence.