ACCCBuzz

Discussing Healthcare Reform at #ACCC2014

Posted in ACCC News, Cancer Care, Healthcare Reform by ACCCBuzz on October 23, 2014

Person in information spaceACCC’s recent 31st National Oncology Conference featured 45-minute “think tanks,” supported by a grant from Genentech, on four hot topics in oncology. This is the second in a four-part ACCCBuzz blog series recapping these discussions from Think Tank facilitator, Joseph Kim, MD, MPH, of MCM Education.

By Joseph Kim, MD, MPH, Guest Blogger

At the recent 2014 ACCC National Oncology Conference, a Think Tank focused on the healthcare marketplace was held to discuss how recent changes have impacted oncology care. Since the Affordable Care Act (ACA) was signed into law on March 23, 2010, the evolving market forces have driven community cancer centers, hospitals, and oncology providers to focus more on affordability, access, quality, and accountability. The ACA has made it possible for millions of Americans to purchase health insurance through new employer requirements, the Health Insurance Marketplace, and the expansion of public programs like Medicaid.

  • In 2014, it is estimated that up to 32 million people will receive health insurance coverage through the ACA.
  • More than 8 million have selected a marketplace plan since enrollment began in October 1, 2013.
  • Adults lacking health insurance was 18% in the third quarter of 2013 and dropped to 13.4% in May of 2014.

Growing Need for Patient Navigation

The oncology community continues to face tremendous pressures and challenges as new patients enter the system. Many first-time insurance purchasers need assistance navigating the process of signing up for healthcare coverage and they remain confused about newly encountered terms like deductible, co-pay, co-insurance, and out-of-pocket maximum. As cancer patients evaluate treatment options and the total cost for treatment, some will enroll in patient assistance programs while others will lean heavily on family members for financial support. Although some cancer programs are staffed adequately to educate and counsel patients through this process, others are struggling to fill these critical positions as they anticipate a rapid influx of new patients. ACCC has developed a set of resources around cancer patient navigation and patient assistance programs, as well as the Financial Advocacy Network with resources for both clinicians and administrators.

Pharmaceutical patient assistance programs continue to be a valuable resource for cancer patients who are being treated by expensive new therapies. Medicare lists most of the programs by drug name.

The Patient Access Network Foundation (or PAN Foundation) is another helpful resource that also provides information about co-pay assistance programs.

New Patients Remain Functionally Uninsured

Although Medicaid expansion is one of the key ways that uninsured patients will gain health coverage through the ACA, not every state is participating. Currently, 28 states (including Washington, D.C.) are implementing Medicaid expansion, 2 states are in open debate, and 21 states are not expanding. As a result of the Medicaid expansion, approximately 10.5 million new patients will receive health insurance coverage. However, many of these patients will remain “functionally” uninsured because they will lack access to providers who are willing to accept new Medicaid patients. (Less than half of physicians are accepting new Medicaid patients.) Think Tank participants also emphasized the growing importance of care coordination in oncology since more patients are living longer with a cancer diagnosis and are requiring care by other specialists such as cardiologists or psychiatrists.

Value in Oncology

Think Tank participants agreed that the growing focus around the “value” of healthcare can be difficult to measure in the area of oncology. The measurement of subjective clinical endpoints can be challenging when cancer patients are dealing with severe nausea or vomiting, fatigue, rashes, or pain. Cancer programs and oncology clinicians are also noting the growing importance of focusing on patient satisfaction scores, since these metrics are directly impacting reimbursement.

Conclusion

Think Tank participants also acknowledged that other complex and intertwined issues related to healthcare reform are directly impacting cancer providers and patients. There are ongoing discussions about the 340B Drug Pricing Program, the consolidation and acquisition of oncology practices, and of creative ways for achieving patient-centered care in oncology.

Stay tuned for Think Tank #3 Discussing Personalized Medicine at #ACCC2014.

Genentech-logo

Two Tracks, One Destination: Quality Care

Posted in ACCC News, Cancer Care, Healthcare Reform by ACCCBuzz on October 13, 2014

by Amanda Patton, ACCC Communications

Java PrintingLast week hundreds of cancer care providers gathered in San Diego for the 31st ACCC National Oncology Conference. Over two days, attendees joined in a range of dynamic sessions focused around two track themes: YOUR PATIENTS and YOUR PROGRAM.

A unifying message underlying this year’s conference sessions: Regardless of care setting, oncology care providers are facing the same challenges—new payment models, declining reimbursement, increasing competition, quality demands, rapidly evolving technology, and growing emphasis on patient engagement. To achieve the triple aim of improved quality, reduced cost, and enhanced services, providers will need to work together, collaboratively, across settings and service lines.

For those of you unable to be with us in San Diego, here are some key takeaways from each track.

Takeaways from YOUR PATIENTS TRACK:

  • Truly patient-centered care requires conversations. For example, when a distress tool triggers a referral to financial assistance: Is the patient having trouble paying rent? Is the patient unable to pay for medications? Is the patient uninsured? Providers need to have conversations with patients to identify and meet these complex needs.
  • Patients and families want to be active participants in treatment decision-making. And, they want a say in how our programs provide services, whether this means ensuring access to financial counselors, developing a patient transportation program, or creating a healing garden for reflection during treatments.
  • All cancer programs have a responsibility to conduct community outreach—and we are doing this in a number of innovative ways, leveraging our community resources to reach at-risk and under-served populations.
  • Proactive patient education provided before the start of treatment can help improve care and patient adherence to treatment recommendations.
  • Patient engagement is key to patient-centered care. This requires on-going conversations between patients and their care providers. Patient portals are an emerging tool with potential to improve engagement and, under Meaningful Use, cancer programs will be required to use them.
  • Cancer programs need to find ways to make communication easier for patients—whether it’s through an innovative symptom management clinic, patient advisory councils, patient portals, or other venues.

Takeaways from YOUR PROGRAM TRACK:

  • The market place is in a state of flux—hospitals acquiring  physician practices; practices coming together to strengthen their bargaining power with payers, while remaining autonomous. No matter what the practice setting, physicians and hospitals will need to work together to meet the growing needs of our cancer patients.
  • Patient-centered care is not only a requirement for accreditation; it is the right thing to do for our patients!
  • The oncology community is exploring a number of new care models. For example, Oncology Medical Home Models that put the patient front and center. This model is accessible to practices of all sizes. Requirements: being innovative and willing to change—tools are available to help.
  • The most successful cancer programs have access to and actively mine data to identify areas for improvement and marketplace differentiators.
  • With the growing demand for services and a shrinking workforce, the oncology community will need to explore ways to partner with primary care providers to meet the needs of cancer patients.

Stay tuned for additional session highlights from the ACCC 31st National Oncology Conference.

5 Key Tips for Financial Advocates

Posted in ACCC News, Across the Nation, Advocacy, Healthcare Reform by ACCCBuzz on October 10, 2014

By Amanda Patton, ACCC Communications

cost disparitiesACCCBuzz is in San Diego this week for the ACCC 31st National Oncology Conference.

On Wednesday, at ACCC’s Financial Advocacy Network Pre-Conference, financial advocates from cancer programs around the country gathered for a one-day session focused on challenges and solutions to helping patients with issues around the costs of care.

Increasingly, the term “financial toxicity” is being used to recognize a potentially devastating side effect of cancer—the financial burden on patients and their families related to the cost of their care.

In 2012, the U.S. spent close to $3 trillion on healthcare, speaker Mark Rukavina, MBA, told attendees. Of this, $328 billion was estimated to have been paid out of pocket (for both uninsured and insured consumers). “We don’t have good cost containment strategies in place,” Rukavina said. As  a result, people face out of pocket costs beyond their budgets and are exhausting their savings.

“One of the most troubling effects of financial toxicity is its impact on patients’ care seeking behavior,” he  said.

Without question, the last challenge cancer patients need to face is the double whammy of serious health issues and serious financial issues.

Cancer care providers today are often on the front lines, helping patients and their families with financial issues surrounding the diagnosis and treatment of cancer. As ACCC’s 2014 Trends in Cancer Programs survey reveals, 90 percent of respondents report offering financial assistance services to patients, and 84 percent report having a financial specialist on staff.

Key session takeaways for oncology financial advocates include:

  • Financial advocates need to know their place in the revenue cycle—barriers can crop up anywhere along the line.
  • All patients should be screened for financial issues—coverage and financial assistance needs.
  • Conversations about costs should take place early on in the care process.
  • A lot of work needs to be done to educate newly insured patients about coverage they are purchasing through the insurance Marketplaces, including assistance in understanding health insurance terminology. For example, many newly insured consumers may not understand the meaning of terms such as “premium,” “deductible,”  “co-payment,” and “co-insurance.”
  • Metrics are key. Financial advocates should:

-Track out-of-pocket coverage metrics
-Measure results of their work and communicate results internally both to justify the position and show the value of the financial advocate services
-Practice continual learning, staying educated about changes in Medicare, state laws, ACA coverage, and more.

Stay tuned for upcoming ACCC Financial Advocacy Network regional meetings November 6 in Schaumburg, Illinois, and December 9 in Seattle, Washington. Find more resources for financial advocates at www.accc-cancer.org/financialadvocacy.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Sun is Shining. . . .Now What?

Posted in ACCC News, Advocacy, Healthcare Reform, In and Around Washington, DC by ACCCBuzz on October 6, 2014

By Matt Farber, MA, Director, Provider Economics & Public Policy, ACCC

453142595On Sept. 30, the Centers for Medicare & Medicaid Services (CMS) released the first round of Open Payments data to the public. The Open Payments program, which was mandated by a section of the Affordable Care Act (ACA) known as the Sunshine Act, requires drug and device manufacturers to report any payments or transfers of value – such as money for research activities, speaking fees, meals and travel – to physicians and teaching hospitals.

The recently released data is based on five months of payment reports, collected from August through December 2013. CMS continues to collect payment information this year and reporting on all 2014 expenditures is expected sometime next summer.

CMS provided a relatively short window (45 days) during which physicians could register and log in to the Open Payments system, check the accuracy of data reports and, if necessary, dispute any reports that they did not believe to be accurate.  Unfortunately, most physicians did not review the reports before public release of the data. In fact, technical glitches with the Open Payments system—approximately one-third of the payment reports had “intermingled data”—caused  CMS to shut the system down for several days during the physician data review window.  In the face of these technical difficulties, both the American Medical Association and PhRMA urged CMS to delay the public release of the Open Payments data but, as we’ve seen, CMS held firm on the Sept. 30 release date.

What Does This Mean for Providers?

First, ACCC recommends that all physicians log in to the Open Payments system, and ensure that all data reports are accurate. CMS is reporting that 4.4 million payments were made during the second half of 2013, totaling $3.5 billion attributable to 546,000 individual practitioners and 1,360 teaching hospitals. Of the 546,000 individuals, only 26,000 (less than 5 percent) registered in the system, the first necessary step to verifying data reports. In addition, CMS suppressed 40 percent of the Open Payments records released because the agency could not reconcile differences in provider names and numbers reported by industry. CMS expects these data to be corrected in time for the next reporting period.

A yet-to-be resolved issue is what will happen with these data. First, it is important to note, as CMS has, that these payments do not necessarily signal wrongdoing; physicians have relationships with industry for a host of reasons, some of which are critical to advancements in innovative medical therapies and patient care. This glimpse into payments is just that: a limited window into billions of dollars in industry spending. ACCC has also long stated that we do not believe that the Open Payments data will greatly impact patients’ choice of providers.  There will certainly be outliers, physicians who have a high dollar figure associated with them (not counting those with research money attributed to them) who may draw the attention of the media. This may be especially true if the same physicians appear with a high Medicare payment figure from CMS’ earlier release of data on Medicare payments to physicians. But for a majority of providers, we predict little impact.

Moreover, ACCC hopes that Open Payments data reporting will not have unintended consequences, such as a chilling effect on participation in clinical research. For example, if providers do not want their name to appear in the data reports, they may no longer participate in industry-sponsored trials, nor will they accept certain publications from industry, important activities to advancements in clinical research and cancer care. In addition, if CMS finalizes its proposed rule on the 2015 Medicare Physician Fee Schedule that included elimination of the exemption for payments made to speakers at CME events, the sunshine reporting may have a negative impact on participation in certain CME programming.

If you are a physician or if you work with physicians who have not yet registered in the system, we highly encourage registering today to ensure the accuracy of the reporting. For more information, click here.

Will 90-Day Rule Leave Providers Holding the Bag?

Posted in ACCC News, Advocacy, Healthcare Reform, In and Around Washington, DC by ACCCBuzz on May 23, 2014

By Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC

healthcareImplementation of the Affordable Care Act (ACA) is bringing many changes to the healthcare system, including the establishment of health insurance exchanges and new requirements for insurance coverage.

Health insurance exchanges (also known as health insurance marketplaces) provide an option for patients to purchase health insurance outside of employer-based plans and are a step toward the goal of universal coverage. However, because all plans offered through an exchange must meet minimum health benefits and satisfy other insurance reforms, such as a cap on annual benefits and coverage for young adults, individual plan premiums on the exchanges are often more expensive than patients expect. This could lead–and in some cases, has already led–to missed premium payments.

In the event of a lapsed premium payment for individuals enrolled in a federally facilitated exchange (FFE) plan, the ACA gives patients 90 days to become current on any past payments before insurance coverage is terminated. The ACA replaces all existing state laws with the 90 day rule. The rule applies to all consumers, in all states, who purchase subsidized coverage through the FFE health insurance marketplace.

How the 90-Day Rule Works

Here’s how the 90-day grace period works. After the first premium is made, patients have 90 days to pay the next premium. If the patient doesn’t pay the premium for the second month, the insurer can hold all claims. At the end of the third month, if the patient still has not paid, the insurer may terminate the policy.

Unfortunately, there is one wrinkle in the 90-day rule that is concerning for providers. This issue only applies to those individuals who receive tax subsidies to purchase insurance through the FFE insurance marketplace. In this instance, if a consumer still fails to make a payment after 90 days and his or her coverage is dropped, insurers are not required to pay for claims incurred during the last 60 days of the grace period. This means that if coverage for these patients is dropped for nonpayment, physicians must work directly with the patients to collect payments for the balance incurred during days 31-90 of the grace period.

While this issue only applies to individuals who receive tax subsidies to purchase insurance through the federally facilitated insurance exchanges, providers need to know that patients’ insurance cards will not include information on whether or not the patient is receiving subsidies. Claims unpaid the 31st through the 90th day may be pended by the insurer. If the enrollee never pays his or her share, the claim is not payable by the insurer.

Chilling Effect?

During a recent House Energy & Commerce Oversight and Investigations Subcommittee hearing, insurers were asked about health insurance marketplace enrollment and premium payment by enrollees. Representative Michael Burgess (R-TX) and other subcommittee members expressed concern over the 90-day grace period and the chilling effect it may have on provider participation in exchange plans.  Insurance company executives testifying at the hearing assured the subcommittee that adequate systems are in place to give physicians the ability to determine patient payment and eligibility status. Industry representatives said call centers, and in some instances online applications, are available for premium payment verification. However, premium status policies vary by company and so providers and their staff are left with a complex process for determining a patient’s status. At the conclusion of the hearing, the Oversight and Investigations Subcommittee remained concerned that this information is not readily available to healthcare providers  who might ultimately be left unreimbursed for care already provided.

ACCC agrees with the concerns expressed by House Energy and Commerce Subcommittee members and urges Congress and the Administration to work together to require more easily accessible and real-time patient status data to be available to providers. ACCC has submitted a letter to the Administration about this issue and continues to work with members of Congress to raise the volume.  We will keep members posted on any developments on the 90-day grace period.

Is Your Cancer Program Indispensable?

In April, ACCC held its 40th Annual National Meeting, with a focus on policy, economics, and business. The session on “Strategies for Growth in Cancer Care Delivery,” with Sg2 Vice President Trever Burgon, PhD, was standing room only. ACCCBuzz invited Dr. Burgon to share some key takeaways from his talk. Read on and find out why the term “indispensable” is the way you want patients and payers  to describe your cancer program.

Person in information spaceby Trever Burgon, PhD, Vice President, Sg2

Let’s start with a provocative statement: There is no service line more important to your hospital, practice or health system’s future competitive position than cancer services. Here are three areas of evidence to support this claim:

1. Growing demand – An aging population and expanding treatment options will drive strong demand for cancer services. At the recent ACCC 40th Annual National Meeting in Arlington, Va., I shared data from Sg2’s Impact of Change® forecast model, which projects demand for healthcare services over the next decade. Much of this growth will happen in the outpatient setting, in fact, Sg2 forecasts stronger outpatient growth for cancer than for any other service line. Nationally, we anticipate that demand for ambulatory cancer care will increase 15% over the next five years and 31% over the coming decade. Demand growth will be softer on the inpatient side, increasing only 3% over the next decade. There is an important nuance in these inpatient numbers. Many inpatient surgical procedures will see strong growth of +9% over the next 10 years, while non-surgical admissions are expected to fall by 5%. This expected decline will be the result of improved patient management in the ambulatory setting and expanded access to appropriate palliative and end-of-life care which will reduce avoidable hospitalizations. Meeting this demand will require hospitals and health systems to develop and expand strong systems of care that coordinate services across the care continuum, from screening and diagnosis to outpatient and inpatient treatments through survivorship and end-of-life care.
2. Changing economics – Per person, cancer is the most expensive disease to treat in the U.S. For providers and health systems, cancer care represents an important source of revenue that helps subsidize other care delivery services. At the same time, spending on cancer is increasingly coming under the scrutiny of public and private payers looking to control healthcare spending costs. As we heard multiple times at the recent ACCC meeting, various new payment reforms, including robust benefits management, bundled payments, and narrow networks, all have the potential to materially impact cancer services. Successfully navigating these changing economic structures has the potential to impact the entire enterprise.
3. Connecting with patients and families – Cancer occupies a unique and important part of our healthcare landscape. It is a terrifying disease that will impact virtually each one of your patients and prospective patients either through a personal diagnosis or that of a loved one. Meeting the needs of these patients and their families with seamlessly coordinated, patient-focused services that span the care continuum represents a powerful opportunity to engage and care for these consumers over their lifetime. Guiding a patient from initial diagnosis to treatment, providing critical but under-reimbursed psychosocial support services, or ensuring that patients’ end-of-life treatment plans are aligned with their quality of life goals, can be some of the best opportunities to establish your program as the go-to place of care for all of a family’s healthcare needs. If you can provide this level of coordinated, patient-centered care for a complex disease like cancer, you can do it for any disease.

What must cancer programs do to position themselves for success in the face of growing demand, changing economics, and unique opportunities to connect with patients? Build a differentiated program that is indispensable to both patients and payers.

There are many ways to build this type of program and no two cancer programs will establish their indispensability in the same way. One area that will be consistent across all successful programs, however, will be a robust system of care that delivers value by ensuring patients and data flow seamlessly between the many providers and sites that span the cancer care continuum. At ACCC’s Annual National Meeting in April, we discussed a number of clinical opportunities for differentiation, including protocol-driven lung screening, easy-access one-day multidisciplinary clinics, and cancer-program-embedded outpatient palliative care services. In addition, we examined a number of oncology-specific bundled payment and accountable care pilots that progressive organizations are using to differentiate themselves with payers.

There are not enough resources to build every clinical program you would like, and not all of the new payment pilots will be successful and scalable. But these types of investments and innovations will be the key to making your cancer program indispensable in your market. And it will be these indispensable programs that succeed, to the benefit of your hospital, practice, or health system and more importantly, your patients.

NCI Issues Letter Clarifying Community Clinical Trials Funding

Posted in ACCC News, Advocacy, Healthcare Reform, In and Around Washington, DC by ACCCBuzz on April 14, 2014

by Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC

healthcareNational Cancer Institute’s (NCI’s) recent announcement that two community-based research networks, the Community Clinical Oncology Program (CCOP) and the NCI Community Cancer Centers Program (NCCCP), would be combined under the NCI Community Oncology Research Program (NCORP), raised concern and confusion about future clinical trial funding for community-based programs. In a blog post last week, ACCC expressed concern about a reduction in clinical trials and a possible gap in funding.

The NCI announcement about the change states that the new NCORP will have fewer investigators and “will be comprised of some of the sites formerly funded through the CCOPs, MB-CCOPs, and NCCCP, as well as new grantee institutions….”

NCI Director Harold Varmus has now released an open letter to the oncology community clarifying how this consolidation will impact clinical trial funding. The newly formed NCORP network will center on treatment and prevention-based clinical trials, as well as population-based studies and other research.

Dr. Varmus responded to concerns about maintenance of funding between the current round of annual CCOP awards (June 2014) and the start of the newly created NCORP (estimated to be August 2014), stating:

“With Fiscal Year 2014 budgets now in place, our grantees can be assured that NCI will fund all CCOPs at their current levels during this period. While this was always our intention, this has not been clearly communicated. Furthermore, currently funded investigators should continue the active, uninterrupted accrual of patients to new or ongoing clinical trials during this interval. As in the past, full funding for all research activities required to carry out approved studies will be provided.”

In addition, the letter states that programs not selected to receive funding under the new NCORP will receive assistance to ensure the smooth closeout of operations.

ACCC continues to monitor developments and will keep members updated as additional information is released.

ICD-10-CM Delay: What Next?

Posted in ACCC News, Across the Nation, Education, Healthcare Reform by ACCCBuzz on April 11, 2014

by Amanda Patton, Manager, Communications, ACCC

time for actionThe language delaying implementation of ICD-10 that was piggy-backed on last week’s SGR “patch” legislation caught many off guard. With months—if not years—of preparation and planning for implementing the new code set—it seems we’re back to uncertainty. ACCCBuzz asked Cindy Parman, CPC, CPC-H, RCC, to share her thoughts on the delay and next steps for cancer programs. Parman is a principal at Coding Strategies, Inc., and authors the “Compliance” column for ACCC’s journal, Oncology Issues.

ACCCBuzz: What are your thoughts on this latest delay by Congress?

Parman: First, it isn’t over until it’s over. The Centers for Medicare & Medicaid Services (CMS) has not weighed in yet [at the time this post was written] on what the inclusion of ICD-10 delay language in the SGR fix legislation really means. At present, several news sources have suggested that the agency’s silence on the never-ending drama—termed by one publication as “ICD-10 Held Hostage”—could mean:

  1. There will be an official implementation delay until October 1, 2015, or
  2. CMS will establish a different mandatory/voluntary implementation scheme, or
  3. CMS will decide to allow those providers who want to voluntarily implement ICD-10 on October 1, 2014, to do so, or
  4. CMS will decide that the legislation is not valid, since there was no Federal Register announcement, no comment period, etc., and
  5. Other payers may decide to “go live” on October 1, 2014, regardless of the SGR patch legislation that affects only the Department of Health & Human Services (HHS).

ACCCBuzz: Assuming that ICD-10 implementation is delayed, what does that mean for hospitals and physician groups who have already invested in computer system upgrades, clinical documentation improvement, and coding education?

Parman: According to the American Health Information Management Association (AHIMA) in a March 31, 2014, email to its membership:

Effects of a one year delay include an estimated likely cost of $1 billion to $6.6 billion to the healthcare industry and lost opportunity costs for failing to move to a more effective code set. A cloud will also be cast over the employment prospects of more than 25,000 students who have learned to code exclusively in ICD-10 in HIM associate and baccalaureate educational programs.

ACCCBuzz: So what should oncology providers do now with respect to the ICD-10 transition?

Parman: It’s important to stay the course. Shelving the work completed so far and losing the financial investment is simply not an option! Here are some tips to help:

  • Keep working on clinical documentation improvement (CDI). This is not just a project that affects ICD-10; it affects quality reporting, value-based modifiers, responses to audits and investigations, patient portals, and almost every other aspect of healthcare. Practices and facilities who have not implemented a CDI program should get the ball rolling as soon as possible. (Find out more about why you need a CDI program here.)
  • Know the ICD-9-CM Official Guidelines for Coding and Reporting! The ICD-10-CM Official Guidelines include some changes to sequencing, mandatory assignment of additional diagnosis codes for tobacco and alcohol use, etc., but they are built on the same format and structure. As a compliance consultant that performs both radiation oncology and infusion center chart audits, I rarely see correct and complete ICD-9-CM diagnosis coding. If a facility or practice is completely documenting all primary, secondary, and tertiary medical conditions with ICD-9, the transition to ICD-10 will be so much easier.
  • For those providers who have initiated or completed training on the ICD-10 code set, it is use it or lose it. Make certain that coding staff continues to use the ICD-10-CM code set, by dual-coding a subset of medical records, performing peer review of records coded with ICD-10, etc. Do something creative, like a weekly Lunch-and-Learn to discuss unique ICD-10 coding situations.
  • For those providers who have not initiated or completed training on the ICD-10 code set, don’t wait – just do it. The whole point of any transition delay is to maximize the remaining time to complete the task. This is a larger coding classification than ICD-9-CM with variances in the verbiage and specificity of available codes. Don’t underestimate the extent of education required, and don’t wait until the last minute and assume that there will be training programs available.
  • Continue to perform end-to-end testing with those payers who are ready for this. Test often with any payer that is available for testing, and set up a process for denial management. There is a potential for an increased number of denials with the implementation of ICD-10, so make sure your denial management process is efficient and accurate. Of course, the best way to manage denials is not to have any, so use this gift of time to also improve front-end processes to minimize rejections and denials.
  • Facilities who have completed the computer system updates, clinical documentation improvement, and most or all of the coding education can consider “backtrack” diagnosis coding. This means that the medical coding staff reports ICD-10-CM diagnosis codes, but the software backtracks and bills the ICD-9-CM code. This is a much easier conversion process (to go from one detailed code back to a more general diagnosis code) and can be accomplished by many existing billing software engines. If this process is initiated during calendar year 2014, the actual transition to ICD-10, when it finally occurs, may be smooth and straight-forward.

ACCCBuzz: What about those who say, “Why not just wait for ICD-11?”

Parman: Have you seen ICD-11? It is built on ICD-10, so be careful what you wish for! Attempting to transition from the ICD-9 classification directly to ICD-11, and bypassing ICD-10, will create additional stress (economic, financial, and mental), especially for intermediate and small physician practices.

The World Health Organization (WHO) plans to release the ICD-11 classification somewhere between 2015 and 2017 (depending on which WHO document you read).  Not only will ICD-11 incorporate all the functionality of ICD-10, it will be digital only (no paper manuals) and will link with terminologies such as SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms) and support electronic health records and information systems. Remember that a WHO “release” as early as 2015 still means that various agencies and committees will have to meet and develop the Clinical Modification (CM) that will be used in the U.S.

ACCCBuzz: Any parting advice?

Parman: Use any implementation time resulting from a delay in ICD-10 transition to improve operations, documentation integrity, and coding skills. Never waste the gift of time!

Editor’s Note: ICD-11 release date in this post was updated 4/14/14 to reflect ambiguity in the current WHO timeline.

 

Strength in Numbers

Posted in ACCC News, Advocacy, Cancer Care, Healthcare Reform, In and Around Washington, DC by ACCCBuzz on April 4, 2014

By Amanda Patton, Manager, Communications, ACCC

By the time ACCC’s Annual National meeting wrapped up this week, attendees had heard plenty of numbers. Here is just a small sampling:

7.1 million     Estimated number of enrollees under the ACA’s health insurance marketplaces
70%                
  Percent of plans on insurance exchange that are considered “narrow networks”
30                    
Number of states that have now passed oral parity legislation
13.7 million  
Current number of cancer survivors in the U.S.
1.5 million    
Number of new cancer cases diagnosed annually
18%                 
Percent of U.S. population that will be Medicare eligible by 2020
17                     
Number of times Congress has passed a “doc fix” to the SGR

All these figures and more added up to some overarching themes from this year’s meeting sessions:

Attendees at the ACCC 28th National Oncology Conference in Seattle

Strength in numbers is needed to make the voice of community cancer care heard on Capitol Hill. “At the end of the day, I think we need more clinical voices in the policy setting,” said keynote speaker Kavita Patel, MD, of  the Brookings Institution. “You don’t want Medicare or Congress thinking about cancer care without [your voices being heard].”

Patient-centered care requires open communication. In Tuesday’s panel on “What Are the Costs and Where Is the Value in Cancer Care?” panelists agreed that discussion about value in cancer care is complex but must be patient-centered. “For patients, value has a number of different meanings,” said panelist Nancy Davenport-Ennis of the Patient Advocate Foundation. “Patients want to have open dialogue with physicians about what the options are and how they are going to pay for this [treatment].”

The need for good communication with patients was also part of an earlier panel discussion on Multidisciplinary Care in Oncology. Smaller hospitals and cancer programs trying to create multidisciplinary programs should first look to the relationship that needs to exist between patients and the team, said panelist Tom Kean, MPH, of C-Change. It’s important to ask: “What does the patient value?”

The future oncology care delivery structure & workforce will look different.  Given the perfect storm brewing of escalating costs, a growing demand for oncology services, and a projected future shortage of oncologists, the way we deliver cancer care will have to change. Several presenters circled around the medical home (possibly in combination with some type of pay-for-performance) as potentially a good fit for oncology—in part because many cancer centers are already providing the services encompassed by this model. And several sessions touched on how the cancer care workforce will have to change to meet the projected demand. This new “care force” will not only include more non-physician providers, but also is likely to have non-clinical care providers and make increased use of community resources.

One shift that is already underway in some cancer programs is careful assessment of skill sets. Multidisciplinary Care in Oncology panelist Marie Garcia, RN, OCN, said, for example,  her practice took a close look at the skill set needed to provide survivorship services. For their survivorship program was a nurse practitioner needed? Could the position be filled by a nurse? Or a patient navigator? “In a value-based world, you need everyone on the team performing at the top of their licenses,” said co-panelist Mark Soberman, MD, MBA, FACS.

We must be the change. Across sessions the recurrent message was that cancer providers need to be proactive. It’s fine to start small, but start now, assess ways to demonstrate value, explore new payment models, and work more collaboratively with payers, providers, and community resources.

Alternative Payment Models, Risk-Sharing Ahead, Says ACCC Keynoter

meetings-AM2014-Patel(1)by Amanda Patton, Manager, Communications, ACCC

With polarization on Capitol Hill impeding the legislative process, ACCC 40th Annual National Meeting keynote speaker Kavita Patel, MD, of the Brookings Institution told attendees: “If you are looking for change, I would point you to your own selves in the mirror, not to Washington, D.C.”

With the Senate having passed the SGR reform patch the night before, Patel noted that despite the fact that SGR reform was one of the few things with bi-cameral support in Congress, ultimately, we once again have a one-year “doc fix.” This is the 17th time Congress has enacted an SGR patch since the formula went into effect in 2002.

Still, Patel believes there is potential for Congress to act on long-term reform next year.

The current “SGR fix” legislation reflects Congress’s focus on “value” and value-based alternative payment models, she noted.

“At some point, it will be important for your community to think about what that would look like at your programs.” She believes medical oncology may be well suited to what Congress is thinking about with alternative payment models.

While cancer care has evolved so greatly over the past several decades, our reimbursement policies to pay for that care have not evolved.

Among the alternative payment models, Patel believes the medical home model may be suited to oncology, while bundling is a poor fit.

“If people think there’s going to be bundling in oncology, they are wrong,” she said.

So is fee for service gone forever? “No,” says Patel. “The answer is there is always going to be room for fee for service in certain settings.”

But, some form of risk-sharing is definitely in the cards. “In 10 to 15 years, the majority of people in this room will have some sort of risk-based contract…that will become the norm in the next several decades.”

However, she warned that if you turn to Congress for a solution, they are likely to turn it around and ask you to show them viable solutions—and this is a good thing.

At the end of the day, I think we need more clinical voices in the policy setting arena, “ she said. “You don’t want Medicare or Congress thinking about cancer care without [our] voices.”

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