ECN Blog

Changes to the Medicare physician 2015 fee schedule

The Centers for Medicare and Medicaid Services (CMS) issued proposed changes to the Medicare physician fee schedule, which include payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2015.


“The proposed rule also proposes changes to several of the quality reporting initiatives that are associated with PFS payments – the Physician Quality Reporting System (PQRS), Medicare Shared Savings Program, and Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare tool on the website,” the agency noted in a fact sheet published on its site.


Additional highlights from the list of proposed changes include:

• The transformation of all 10- and 90-day global codes to 0-day global codes beginning in 2017.
• Annual wellness visits, psychoanalysis, psychotherapy and prolonged evaluation and management services will be added to the existing list of services that can be furnished to Medicare beneficiaries under the telehealth benefit.
• The collection of data on services furnished in off-campus provider-based departments beginning in 2015.
• The addition of 80 codes to the existing list of potentially misvalued codes.

CS Transition Group provides timely update to cancer surveillance community

In the June edition of the Collaborative Stage Transition Newsletter, the CS Transition Group set out to lessen the confusion within the surveillance community with respect to the imminent transition from Collaborative Stage. Even though the transition remains a work in progress, members of the CS Transition Group remain committed to working with stakeholders to develop appropriate implementation plans and processes. “As answers become available,” the authors write, “they will be shared and communicated to the surveillance community, and opportunities will be provided for members to identify issues and concerns.”


According to the newsletter, the initial change in 2016 for CDC and NCI registries “will be focused on the transition to directly assigned AJCC stage, but will not eliminate all CS variables.” For example, most of the Site Specific Factors (SSFs) will be required for the following reasons:

a)  SSFs are a crucial component to the staging process

b)  SSFs lend themselves to understanding the cancer (predictive or prognostic factors)


The initial transition, the authors continue, “will be focused on assignment of T, N, M and the AJCC stage group.”


To learn more about the transition from the Collaborative Staging v2 system to the AJCC staging standard, please read the June edition of the Collaborative Stage Transition Newsletter.


Think twice about mammography screening programs: The Swiss Medical Board

In a perspective published in The New England Journal of Medicine, members of the Swiss Medical Board – an independent health technology assessment initiative – presented a thorough review of mammography screening programs. The board, which included a clinical epidemiologist, a medical ethicist, a pharmacologist, a nurse scientist, an oncologic surgeon, a health economist and a lawyer, agreed that the downsides of mammography for breast screening in asymptomatic populations now outweigh any associated benefits. The following factors led to the board’s unanimous decision:


1.  Outdated clinical trials
According to the authors of the perspective, the ongoing debate surrounding mammography screening is “based on a series of reanalyses of the same, predominantly outdated trials.” The first trial, which started more than 50 years ago in New York City, and the most recent trial, which occurred nearly 25 years ago in the United Kingdom, did not take place “in the era of modern breast cancer treatment, which has dramatically improved the prognosis of women with breast cancer.”


2.  The benefits of mammography screening do not outweigh the harms
The authors were struck by how “nonobvious it was that that the benefits of mammography screening outweighed the harms.” In an effort to substantiate their claim, the authors added: “The relative risk reduction of approximately 20% in breast cancer mortality associated with mammography that is currently described by most expert panels came at the price of a considerable diagnostic cascade, with repeat mammography, subsequent biopsies and overdiagnosis of breast cancers.”


3.  Skewed perceptions
The authors referred to a survey about U.S. women’s perceptions of the benefits of mammography screening, and of the 1,003 participants questioned, 717 (71.5%) said they believed mammography reduced the risk of breast cancer by half. Seventy-two per cent of women believed “at least 80 deaths would be prevented per 1,000 women who were invited for screening.” However, the authors note, mammography may offer a relative risk of 20% and prevent only one breast cancer death per 1,000 women.

ECN at NCRA in Nashville

It was great to see so many friends at NCRA’s 40th Annual Educational Conference in Nashville. Many of you showed a lot of interest in receiving free NCRA CEUs for participating in upcoming ECN webinars. Did you know you can even receive credit for viewing previous webinars, too? All previous webinars, which include speaker’s slides and notes, are posted in the Meeting Archives section beneath the Libraries tab on the ECN website. If you choose to view a previous webinar, just print out the agenda and let me, Gayle Clutter, ECN Coordinator, know and I will send you a Certificate of Completion for that particular webinar. This is all you will need for your records.


Also, about 35 people attended the ECN Meet & Mingle Luncheon, which was held during the conference. The primary goal of this event was to bring together members of the cancer registry community to discuss how we, ECN, can continue supporting you, and we did just that. Their presence and enthusiasm made this event a great success, and everyone provided us with a lot of suggestions for topics for upcoming webinars.


Finally, we had a draw for three $25 Amazon gift cards, and on behalf of ECN I would like to congratulate the following winners:

1.  Lori Lucente, Provincial Health & Services
2.  Michael Castera, South Carolina Central Cancer Registry
3.  Laurie Hebert, Care Communications Inc.


Gayle Clutter
ECN Coordinator

Important biomarker update

The imminent transition from the Collaborative Stage v2 system to the AJCC TNM staging standard has spurred a lot of discussion among the cancer registry standard-setting organizations regarding the collection of biomarker information.


Once the decision was made to transition from Collaborative Stage, which begins with cases diagnosed on January 1, 2016 and beyond, the CS Transition Group (CSTG) was formed as an information sharing and planning forum. According to a recent newsletter published by the CSTG, this group “will provide a collaborative opportunity to identify the issues involved in the transition and to share the tasks involved in developing best practices for both the overall cancer surveillance community and the individual agencies/organizations in addressing this change.”


Members of the CSTG include:

•  Statistics Canada /Canadian Council of Cancer Registries
•  CoC


In an effort to facilitate a seamless transition to TNM staging, NAACCR is assisting in the coordination of a number of activities tied to this change. For example, NAACCR assembled a short-term working group to consider how tumor markers and prognostic factors, which are currently transmitted as Collaborative Staging (CS) Site Specific Factors (SSF’s), will be transmitted once CS is no longer supported. According to the CSTG, the NAACCR working group met this past February “to review the data transmission layout structure to assess the pros and cons of maintaining the current structure of collecting stage-related items — including SSFs — within schemas, or whether the collection of these data items would be more efficient outside of a schema structure.”


All of this activity is summarized in the CSTG’s 2016 Collaborative Stage Transition Newsletter. This edition, dated March 18, 2014, lists all of the associated activities of the participating organizations. Finally, this newsletter, along with all future editions, will be available on many of the cancer registry organization’s websites, including the Commission on Cancer (CoC) and NCRA.


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