Health Policy Report – April 16, 2024

Texas Oncology – San Antonio Hosts Site Visit with Representative Greg Casar 

On Wednesday, April 3, Texas Oncology – San Antonio, hosted Representative Greg Casar (D-TX) for a site visit at their downtown practice. During the one-hour tour led by Dr. Allyson Harroff, Regional Medical Director, Brenda Elmendorf, Practice Administrator, Natasha Pacilio-Kidder, Nurse Manager, Becky Jorgensen, Director Practice Operations, and Amber Castillo, Regional Nurse Manager, Representative Casar learned more about the value that community oncology offers to patients. Additionally, the practice shared insight on the issues that they’re facing, including site-of-service payment disparities that incentivize the acquisition of independent practices, and the inability to mail prescriptions to patients through their Medically Integrated Dispensing pharmacies at Texas Oncology. 

Representative Casar is in his first term and sits on the House Committee on Oversight & Accountability and House Committee on Agriculture. The Network and Texas Oncology look forward to working with Rep. Casar on issues impacting community oncology. 

To learn more, CLICK HERE.

In Podcast Interview, Dr. Moshe Chasky Highlights Need to Protect Independent Medicine 

Dr. Moshe Chasky, hematologist-oncologist at Alliance Cancer Specialists, recently appeared as a guest on the Healthcare Strategies podcast to discuss his practice’s experience with healthcare consolidation and emphasize how independent physicians provide value to their communities. 

Dr. Chasky described how, after his own practice refused an acquisition attempt by a large health system, the system revoked their inpatient privileges – leaving Dr. Chasky and his colleagues unable to continue providing continuous care for their patients in the hospital. He went on to describe how healthcare policies, including the 340B Drug Pricing Program and site-of-service payment disparities, have emboldened health systems to engage in anti-competitive practices like referral restraints. 

Despite these challenges, Dr. Chasky emphasized that independence has allowed his practice to keep the quality of care high for patients. “We wanted to remain independent,” Chasky states. “We felt that when we had skin in the game, meaning it was our practice and we were working for ourselves and really working for the community, we could deliver a higher level of care and we could deliver care that went above and beyond. Also, it’s actually a better value [in terms of] cost of care; we don’t have facility fees, so the cost of care is much less in independent practices.”

Physicians must advocate for themselves and continue to show their value to patients, Dr. Chasky stressed. “Continue to focus on the patient, and if you do that and you take your care to the next level, I think that independent practices will continue to survive,” Chasky says. 

To listen to the podcast, CLICK HERE.

To read a follow-up article, CLICK HERE.  

CMS Announces Change Request to Expand Monetary Amount Fields to Fiscal Intermediary Shared System (FISS)

Medicare recently implemented a change to the Fiscal Intermediary Shared System (FISS), its claims-processing system, that adds two extra digits to money amounts, expanding the fields from eight digits to 10. This change now allows for billing and payment totals of up to $99,999,999.99, or a penny shy of $100 million.

“With the increase of Part B procedures/treatments exceeding the $999,999.99 limitation, CMS is implementing the expansion of display screens for monetary amount fields related to billing and payment within FISS to accept and process up to 10-digits ($99,999,999.99),” CMS explained in a notice released last month. 

Medicare has previously had to explain how to charge for CAR-T cancer drugs, which have prices that don’t fit into the space in their billing code. CMS had previously asked physicians to divide the bill by either five or 10 and then bill Medicare five or 10 separate times for a single claim. The change went into implementation on April 1, 2024.

To read the notice, CLICK HERE.

To read more, CLICK HERE.

Senate Finance Committee Holds Hearing on Bolstering Chronic Care Through Medicare Physician Payment

On April 11, the Senate Committee on Finance held a hearing focused on bolstering chronic care through Medicare physician payment reforms. During the hearing, lawmakers highlighted that Medicare is no longer solely an acute care program and discussed reform efforts that can enable the program to better address chronic conditions.

Chairman Ron Wyden (D-OR) advocated for eliminating cost-sharing for care coordination and better compensating primary care physicians (PCPs) to manage chronic care more effectively. Meanwhile, Ranking Member Mike Crapo (R-ID) emphasized the urgent need to address physician payment declines and the potential of alternative payment models (APMs) to improve care for chronic conditions, while also criticizing the inadequacies of the current Merit-based Incentive Payment System (MIPS).

Witnesses during the hearing, including Steven P. Furr, MD, FAAFP, President of the American Academy of Family Physicians (AAFP), highlighted the current fragmentation in chronic disease care and administrative challenges that reduce patient access to care. Other witnesses included, Dr. Amol Navathe of the University of Pennsylvania, Dr. Patricia Turner of the American College of Surgeons (ACS), and Melanie Matthews of the Physicians of Southwest Washington (PSW).

Though exact solutions varied, the hearing signaled growing bipartisan interest in reforming Medicare payments to better support patients with chronic care needs.

To watch the hearing, CLICK HERE.

Energy & Commerce Health Subcommittee Holds Hearing on Supporting Patient Access to Telehealth

The House Energy and Commerce Health Subcommittee recently held a hearing on legislative proposals to ensure patient access to telehealth services. During the hearing, lawmakers highlighted how the COVID-19 pandemic showcased the benefits of telehealth for patients, particularly those in rural areas.

While many agree on the benefits of telehealth, lawmakers are still weighing whether to pursue a temporary or permanent extension of pandemic-era telehealth policies. The hearing included 15 telehealth bills that would extend or make permanent telehealth provisions. Throughout the hearing, lawmakers emphasized that best practices on digital billing codes, policies that prevent overuse of telehealth services and limit fraud, and CMS’ ability to capture and report telehealth data are integral for deciding whether telehealth provisions can be permanently extended.

While some members, such as Ranking Member Frank Pallone (D-NJ) expressed reservations about the cost of a permanent policy, others, including Representative Buddy Carter (R-GA) are pushing for permanent telehealth through the Telehealth Modernization Act of 2024.

It is still uncertain when these telehealth provisions will likely be passed but will likely be included within a larger legislative package at the end of the year.

To watch the hearing, CLICK HERE.

Biden Administration Releases White Paper on Preventing Drug Shortages

The Department of Health and Human Services (HHS) recently released a white paper proposing solutions for Congress and others to prevent drug shortages and mitigate supply chain vulnerabilities.

The white paper outlines various efforts across HHS divisions, including the establishment of a Supply Chain Resilience and Shortage Coordinator role and issuing guidance for supply chain transparency. It also proposes a joint HHS and Federal Trade Commission request for information (RFI) on how group purchasing organizations (GPOs) and drug wholesalers contribute to generic drug shortages.

“All across our Department, we are working to ensure that millions of Americans will have access to medication, treatment, and services that save lives and improve health outcomes,” HHS Secretary Xavier Becerra said in a department press release.

The white paper also proposes the introduction of a Hospital Resilient Supply Program (HRSP) to incentivize supply chain resilience and mitigate shortages, particularly for generic injectable drugs used in hospital care. The program would grade hospitals based on a “scorecard that would be a combination of attestations and ratings reflecting the hospitals’ achievement and progress in adopting practices that promote supply chain resilience or prevent shortages,” HHS wrote in the white paper.

HHS also proposed a concurrent program for drug manufacturers, named the Manufacturer Resiliency Assessment Program (MRAP). Together, the proposed programs aim to integrate transparency into the market, connect purchasing decisions with supply chain resilience, and encourage investments in supply diversification and domestic production.

To read the white paper, CLICK HERE.

To read more, CLICK HERE.