Part B Insider (Multispecialty) Coding Alert

Published on Thu Sep 22, 2005 PDF

Influential senator blasts chemotherapy demonstration project

Brace yourself. Next year may not be any better for cash strapped practices.

While the House of Representatives is still talking about giving your physician a small pay increase, Senate Finance Committee Chair Chuck Grassley (R-IA) is drafting a bill that would provide a pay freeze instead, according to press accounts. That's better than the 4.3 percent cut you face if Congress doesn't act, but it won't compensate for inflation.

The Senate bill would impose pay-for-performance on doctors, meaning you'd lose money if you didn't meet quality standards. Grassley wants to save $12 billion from Medicare and Medicaid over five years--more than the $10 billion the 2006 budget resolution calls for--to pay for Hurricane Katrina relief.

Grassley is also gunning for the $300 million chemotherapy demonstration project that pays oncologists to report on their patients' pain, nausea and fatigue. Grassley wrote to President Bush and other senators to say the program should be canceled or fixed, he announced Oct. 13. He unveiled preliminary findings from the HHS Office of Inspector General that the demonstration doesn't benefit patients at all.

"It appears that assessing chemotherapy patients' levels of nausea and/or vomiting, pain and fatigue was already part of the routine care of chemotherapy patients prior to the demonstration," without paying oncologists extra for the service, says the OIG. The agency adds that the demonstration's "haphazard data collection process" yielded unreliable or incomplete results.

At the recent Supportive Oncology Conference in Chicago, a consortium of cancer experts responded with a study that showed that the demonstration was improving quality of care for cancer patients. The survey found that 40 to 50 percent of cancer care providers believe the program had improved the frequency of severity assessment for pain, nausea and fatigue.

Cancer care providers can't afford to keep treating patients unless they receive the extra funding, argued the Community Oncology Alliance. The project is set to expire on Dec. 31 unless it's extended.

You can read Grassley's letters at:
http://finance.senate.gov/press/Gpress/2005/prg101305.pdf.

In other news:

The Recovery Audit Contractors (RACs) may start poking into your claims soon. Until now, the RACs have only looked at claims for hospital services, but they plan to examine Part B claims in October and November, according to an Oct. 19 Medlearn Matters article. And if the RACs are successful in California, New York and Florida, they may expand nationwide, says the article, which you can read at: www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0565.pdf.