SGO Issues November 20, 2014
CMS issues final rule on Medicare payments
Palliative care articles in November 2014 Gynecologic Oncology
FDA bevacizumab approval suggests openness to PFS endpoints
Grant applications deadline
Renew membership by end of month
Voices: #gyncsm a growing community
On Oct. 31, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that updates payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule on or after Jan. 1, 2015. The deadline for submitting additional comments is Dec. 30, 2014. SGO commented on the rule in a Sept. 2 letter.
CMS finalized the following issues related to gynecologic oncology. SGO had provided CMS with comments on these issues in its Sept. 2 letter:
- CMS noticed a conversion factor for the first quarter of 2015 of $35.8013. The current conversion factor is $35.8228. Congress needs to act again before March 31, 2015, or this conversion factor of $35.8013 drops about 22%.
- CMS agreed with SGO and changed the risk crosswalk for gynecologic oncology to the same risk factor as general surgery. This was important to maintain level of malpractice Relative Value Units (RVUs) for codes that gynecologic oncologists frequently bill.
- CMS is finalizing its proposal to transition all 10- and 90-day global codes to 0-day global codes. The transition for 10-day global codes would begin in CY 2017 and the transition for 90-day global codes would begin in CY 2018. CMS believes that this transition is necessary, in part, to increase the accuracy of payment for these codes. CMS has not yet developed a methodology for making this transition. SGO opposed this policy in its comment letter as did most of organized medicine and several patient organizations. SGO will continue to oppose the implementation of this policy unless CMS assures that the transition of 10- and 90-day global codes to 0-day global codes will not have a negative impact on patients and can be implemented in a way that accurately accounts for the care that surgeons provide. In the upcoming weeks and months, SGO’s Government Relations committee will work in cooperation with their surgical colleagues, taking a variety of strategic actions on this critical issue.
In the Final Rule, CMS publishes interim RVUs for any new or revalued CPT code. These RVUs are open for 60 days of comment and medical societies can review them and work with CMS regarding such values.
Laparoscopic hysterectomy codes, CPT codes 58541, 58542, 58543, 58544, 58570, 58571, 58572, and 58573, were identified in a misvalued service screen and were resurveyed and presented at the January meeting of the Resource Update Committee (RUC) of the American Medical Association. At that meeting, based on the survey results from physicians who perform the procedure, the RUC recommended a reduction in RVUs for the work assigned to these codes. These reductions will now be in effect Jan. 1, 2015.
SGO leaders are reviewing the information regarding the RVUs assigned to these codes in detail and are considering how to respond to CMS by the Dec. 30 comment deadline.
More about the 2015 Final Rule and information about the RVUs for any CPT code are available here. Addendum B in the first Zip file lists the RVUs for all CPT codes.
November is National Hospice & Palliative Care Month and the November 2014 issue of Gynecologic Oncology contains three related articles on missed opportunities, early integration and needs assessment for education in fellowships.
- Missed opportunities: Patterns of medical care and hospice utilization among ovarian cancer patients
- Early integration of palliative care facilitates the discontinuation of anticancer treatment in women with advanced breast or gynecologic cancers
- Needs assessment of palliative care education in gynecologic oncology fellowship: We’re not teaching what we think is most important
FDA’s recent approval of bevacizumab for use in combination with chemotherapy in the treatment of women with platinum-resistant, recurrent ovarian cancer is in keeping with SGO’s assertions over the past year that while overall survival is the most objective clinical trial endpoint, progression-free survival (PFS) is also clinically important.
The announcement marks the first FDA-approved treatment option for women with this type of ovarian cancer in more than 15 years. “SGO has met with the FDA to discuss the value in a robust PFS in a tough treatment population and the impact of response to patients with baseline symptoms,” said Robert L. Coleman, MD, SGO President-Elect I. He noted that the FDA decision was in line with the SGO’s report, “Ovarian cancer clinical trial endpoints: Society of Gynecologic Oncology white paper.”
“We believe our discussions helped the agency understand why PFS may be important in certain populations, particularly those with symptoms or those in whom a biomarker might help select patients for therapy,” Dr. Coleman said.
The FDA made its decision based on results of the phase 3 AURELIA study, which showed that adding bevacizumab to chemotherapy led to a statistically significant improvement in progression-free survival and objective response rate over standard chemotherapy alone, although there was no overall survival benefit.
The AURELIA study met its primary objective by demonstrating significantly better progression-free survival in the bevacizumab group than in the chemotherapy group (6.8 vs 3.4 months). The objective response rate was also significantly better in the bevacizumab group (28% vs 13%).
The application deadline for the Foundation for Gynecologic Oncology’s four research grant awards for 2015 has been extended to Friday, Dec. 5.
Please remember to renew your SGO membership by the end of November. Member benefits include discounted rates for SGO meetings, access to SGO Connect Ed, mySGO, Career Center and a full network of colleagues in gynecologic oncology.
In September 2013, I wrote about the establishment of the #gyncsm (gynecologic cancer social media) monthly tweet chat. Over the past year, #gyncsm discussed a variety of topics relevant to the gynecologic cancer community. During the hour-long online discussion we asked four to five questions on each month’s topic. At the conclusion of each chat, we posted the questions, a chat transcript and links to the resources mentioned during the chat on our blog (gyncm.blogspot.com).
This September, on our first anniversary, we welcomed the largest number of participants ever (57) to our discussion on “Advocating for Yourself and Others.” The chat topic that garnered the most impressions on Twitter (over 2.5 Million) was the June 2014 chat on Sexuality and Fertility. Roughly half of our chat participants are survivors (mostly ovarian cancer survivors) and the other half are health care providers.
In an effort to learn more about the needs of our participants (survivors, caregivers and health care providers) and to better tailor our future chats to those needs, we recently posted a 10-question survey online.
The five chat topics our participants found most important were:
- Advocating for Yourself and Others
- Ovarian Cancer Awareness
- Clinical Trials
- Fertility and Sexuality
- Caregiver Family Issues
We then presented our ideas for chat topics for 2015 and asked our respondents to choose the most important ones. The top five topics were:
- Dealing with Long- and Short-Term Side Effects
- Personalized Medicine
- Dealing with a Recurrence
- Dealing with Anxiety
- What I Wish I Knew before Treatment
In October we began a partnership with Smart Patients, an online community where patients and caregivers can learn about their disease, ask questions, and share information and experiences. This partnership will allow survivors and caregivers to join us in a private setting and use more than 140 characters to discuss our topics.
Our health care moderators and supporters Drs. Don S. Dizon (@drdonsdizon ), Merry-Jennifer Markham (@DrMarkham), Rick Boulay (@journeycancer) , Anne Becker-Shutte (@DrBeckerSchutte) Matthew Katz (@subatomicdoc) and the SGO have made our chat a reliable source of information about gynecologic cancers. For me this chat is a dream fulfilled and would never have been possible without my co-founder and co-moderator Christina Lizaso (@btrfly12).
At the end of our chats we ask our participants to complete the phrase Today I Learned (TIL). This one is one of our favorites:
#gyncsm chat is a lifesaver. Its amazing to get opportunities to talk with fellow survivors & professionals freely. Thank you for this! @cookifit
I invite you to join us on Twitter the second Wednesday of the month at 9 pm EST by following the hashtag #gyncsm. Lurkers are always welcome.
Dee Sparacio (@womenofteal)