Prior authorization is harming individuals with cancer according to new survey results from the Association for Clinical Oncology (ASCO). The survey found that prior authorization delays necessary care, worsens cancer care outcomes, and diverts clinicians from caring for their patients.
ASCO in Action provides the latest news and analysis related to critical policy issues affecting the cancer community, updates on the Association for Clinical Oncology’s ongoing advocacy efforts, and opportunities for members and others in the cancer care community to take action.
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Without congressional action before the end of the year, Medicare providers are set to face up to a 10% reimbursement cut. The Association for Clinical Oncology (ASCO) encourages its members to contact their lawmakers and urge them to address the cuts now.
On November 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released its final rule for the calendar year (CY) 2023 Medicare Physician Fee Schedule and updates to the Quality Payment Program. CMS also released its final rule for the CY 2023 Hospital Outpatient Prospective Payment System the same day. The Association for Clinical Oncology (ASCO) is still assessing the rules, but based on a preliminary analysis, key provisions for the cancer care community are included here.
In comments to the Centers for Medicare & Medicaid Services (CMS) on the 2023 Hospital Outpatient Prospective Payment System (OPPS) proposed rule, the Association for Clinical Oncology (ASCO) continues to call for a final rule that supports patient access to high-quality, equitable cancer care and support for oncology providers. Highlights from ASCO’s comments are includeded here.
In a step towards addressing one of multiple pending Medicare physician payment cuts, Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) introduced the Supporting Medicare Providers Act (H.R. 8800), which would increase the conversion factor to 4.42%, effectively putting the Medicare physician fee schedule cut on hold for a year. The new legislation also includes language that says lawmakers and the Department of Health and Human Services should work to promote and reward value-based care, as well as safeguard timely access to high-quality care by advancing health equity and reducing disparities. The Association for Clinical Oncology supports this effort to provide short-term stability and urges Congress to pass the bill before the end of the year.
UPDATE: On September 14, 2022, the House of Representatives passed the Improving Seniors’ Timely Access to Care Act (H.R. 3173) by voice vote on the House floor. The bill now moves to the Senate. This remains a critical moment when your Senators need to hear your support for this legislation. Please ask them to pass this bill into law—it takes seconds using the ACT Network.
The American Society of Clinical Oncology (ASCO) issued a new position statement on Medicare billing for split or shared (split/shared) evaluation and management (E/M) services. The statement summarizes ASCO’s concerns about changes to split/shared E/M services and makes recommendations to better align Medicare coding for E/M services with the care that beneficiaries with cancer need.
Medicare providers are facing significant reimbursement cuts starting January 1. The 2023 Medicare Physician Fee Schedule proposal jeopardizes the financial stability of many oncology practices by proposing a cut to the Medicare conversion factor of approximately 4.5%. Urge Congress to pass important changes that will provide practices with short-term fiscal stability, while simultaneously laying the foundation for long-term payment reforms.
On August 25, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule indefinitely delaying the start of the Radiation Oncology Model. CMS will establish new start and end dates for the model through future rulemaking, which may also modify the model’s design. CMS will propose a new start date for the model at least six months prior to the proposed date.
The Inflation Reduction Act extends Affordable Care Act (ACA) tax credit subsidies, allows Medicare to negotiate prescription drug prices, places inflationary caps on price increases for Medicare Part B and Part D drugs, and limits Medicare beneficiaries’ out-of-pocket spending on Part D prescription drugs.
The American Medical Association (AMA) recently released new guidelines for reporting Evaluation and Management (E/M) services, which are to go into effect on January 1, 2023.
UPDATE: On August 7, 2022, the Senate passed the Inflation Reduction Act (IRA), a broad climate, tax, and healthcare reconciliation bill, 51 to 50. Healthcare provisions in IRA will extend Affordable Care Act (ACA) premium tax credits, allow Medicare to negotiate prescription drug prices, place inflationary caps on Medicare Part B and Part D drugs, and cap out-of-pocket spending on prescription drugs for Medicare beneficiaries. The House of Representatives will reconvene on August 12 to consider and vote on the legislation--which is expected to pass--after which President Biden will sign the bill into law.
On July 27, 2022, the House of Representatives passed the Advancing Telehealth Beyond COVID–19 Act of 2021 (H.R.4040). The bill—which was introduced by Representatives Liz Cheney (R-WY-AL) and Debbie Dingell (D-MI-12)—would extend telehealth flexibilities for two years, through the end of 2024.
Specifically, the legislation would:
On August 1, 2022, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule. In addition to updating Medicare payment rates and policies for inpatient hospital services in FY 2023, the final rule aims to improve beneficiary access, improve the quality of maternity care, and advance health equity.