There's been a lot of fuss about these Medicare reimbursement rules. MOGN has been hit by them, although to my mind the net effect on Aloxi sales will be close to zero.
There's been virtually no discussion about this interesting new estimated $300m offsetting program, which should benefit MOGN, AMGN and perhaps some of the cancer pain drug companies:
For Immediate Release: Contact:
Monday, November 01, 2004 CMS Office of Public Affairs
202-690-6145
For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov.
DEMONSTRATION OF IMPROVED QUALITY OF CARE FOR CANCER PATIENTS UNDERGOING CHEMOTHERAPY
In order to assess and provide new support for the quality of care for cancer patients undergoing chemotherapy, Medicare will initiate a one-year demonstration project during CY 2005.
Quality cancer treatment includes determining patient status and preferences; outlining appropriate chemotherapy regimens; assessing patient symptoms, complaints, and quality of life; and supporting and educating caregivers. In addition to reducing cancer burden or providing cures, effective cancer care also results in managing pain, minimizing nausea and vomiting, and limiting fatigue. These steps may also help reduce the overall costs of cancer care, by avoiding hospitalizations with complications. In particular, clinicians armed with appropriate assessments can intervene to reduce some of the unpleasant and frequent side-effects that often accompany cancer and chemotherapy treatment.
While CMS seeks to encourage quality care in all facets of cancer treatment, the demonstration will focus on measuring patient outcomes in three areas of concern often cited by patients undergoing chemotherapy: controlling pain, minimizing nausea and vomiting, and reducing fatigue. Standardized assessment scales will be used to measure the condition of chemotherapy patients, and CMS will collect data based on these assessments and on subsequent treatments to trace improvement in outcomes, such as trends and variations in these measures of patient function as well as reduced hospitalizations or emergency department visits.
To facilitate the collection of information on these areas, we have established new billing codes to be reported by practitioners in the demonstration. The codes correspond to four patient assessment levels for each of the patient status factors: nausea and/or vomiting; pain; and fatigue. These levels, based on the Rotterdam scale, have already proved effective in cancer care, are easily understood by patients, and have been in widespread use.
Any office-based physician or nonphysician practitioner operating within the State scope-of-practice laws who takes care of oncology patients and administers chemotherapy to them in an office setting is eligible to participate in this demonstration.
Receiving payment in the demonstration requires entering three new codes in conjunction with each chemotherapy encounter (i.e., one code for each patient status factor). For this purpose, a patient encounter is defined as a day when chemotherapy is administered through intravenous infusion or push. The severity scale for each of these three aspects of patient status has four levels, ranging from no impairment to severe impairment.
A participating practitioner will determine the patient's status by directly asking the patient about each of the three factors, preferably at the start of each chemotherapy session. The resulting data will be used by the oncology practice to appropriately tailor treatment of the factors.
Practices reporting data on all three factors to Medicare will qualify for an additional payment of $130 per encounter. By billing the designated codes, the practitioner will self-enroll in the project.
Practitioners participating in the project must provide and document specified services related to pain control management and minimization of nausea and vomiting, and the reduction of fatigue. To facilitate the collection of this information, we have established 12 new G-codes to be reported by program participants.
G-codes for Assessment of Nausea and/or Vomiting
G9021: Chemotherapy assessment for nausea and/or vomiting, patient reported, performed at the time of chemotherapy administration; assessment level one: not at all (for use in a Medicare-approved demonstration project)
G9022: Chemotherapy assessment for nausea and/or vomiting, patient reported, performed at the time of chemotherapy administration; assessment level two: a little (for use in a Medicare-approved demonstration project)
G9023: Chemotherapy assessment for nausea and/or vomiting, patient reported, performed at the time of chemotherapy administration; assessment level three: quite a bit (for use in a Medicare-approved demonstration project)
G9024: Chemotherapy assessment for nausea and/or vomiting, patient reported, performed at the time of chemotherapy administration; assessment level four: very much (for use in a Medicare-approved demonstration project)
G-Codes for Assessment for Pain
G9025: Chemotherapy assessment for pain, patient reported, performed at the time of chemotherapy administration, assessment level one: not at all (for use in a Medicare-approved demonstration project)
G9026: Chemotherapy assessment for pain, patient reported, performed at the time of chemotherapy administration, assessment level two: a little (for use in a Medicare-approved demonstration project)
G9027: Chemotherapy assessment for pain, patient reported, performed at the time of chemotherapy administration assessment level three: quite a bit (for use in a Medicare-approved demonstration project)
G9028: Chemotherapy assessment for pain, patient reported, performed at the time of chemotherapy administration, assessment level four: very much (for use in a Medicare-approved demonstration project)
G-Codes for Assessment for Lack of Energy (Fatigue)
G9029: Chemotherapy assessment for lack of energy (fatigue), patient reported, performed at the time of chemotherapy administration, assessment level one: not at all. (for use in a Medicare approved demonstration project)
G9030: Chemotherapy assessment for lack of energy (fatigue), patient reported, performed at the time of chemotherapy administration, assessment level two: a little. (for use in a Medicare approved demonstration project)
G9031: Chemotherapy assessment for lack of energy (fatigue), patient reported, performed at the time of chemotherapy administration, assessment level three: quite a bit. (for use in a Medicare approved demonstration project)
G9032: Chemotherapy assessment for lack of energy (fatigue), patient reported, performed at the time of chemotherapy administration, assessment level four: very much. (for use in a Medicare - approved demonstration project)
The codes correspond to four patient assessment levels ('not at all', 'a little', 'quite a bit', or 'very much') for each of the following patient status factors: nausea and/or vomiting; pain; and lack of energy (fatigue). These levels, based on the Rotterdam scale, have already proved effective in cancer care, are easily understood by patients, and have been in widespread use. |
