Oncology News - November 2015

VBCC - November 2015, Vol 6, No 10 - Oncology News

In This Article

Medicare Will Now Reimburse Physicians for End-of-Life Discussions with Patients

The Centers for Medicare & Medicaid Services (CMS) approved what was a controversial issue until now—paying for end-of-life or “advance care planning” discussions of physicians with their patients as part of the 2016 Medicare Physician Fee Schedule. What was a while back labeled as “death panels” is now part of the official federal reimbursement policy for Medicare beneficiaries.

“Consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress, CMS is finalizing its proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers,” noted a news release from CMS (

Until now, healthcare providers who conducted such conversations with their Medicare beneficiaries were doing so on their own time and were not able to submit claims to Medicare for these discussions, whether they had a long-term or a short-term perspective, depending on the specific case.

“Consistent with recommendations from the American Medical Association (AMA) and a wide array of stakeholders, CMS is establishing separate payment and a payment rate for two advance care planning services provided to Medicare beneficiaries by physicians and other practitioners. The Medicare statute currently provides coverage for advance care planning under the ‘Welcome to Medicare’ visit available to all Medicare beneficiaries, but they may not need these services when they first enroll. Establishing separate payment for advance care planning codes to recognize additional practitioner time to conduct these conversations provides beneficiaries and practitioners greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families. CMS is also finalizing payment for advance care planning when it is included as an optional element of the ‘Annual Wellness Visit,’” CMS says in its news release.

There are 2 billing codes for advance care planning—Current Procedural Terminology (CPT) code 99497 covers a discussion of advance directives with the patient, a family member, or another designated person for up to 30 minutes. A second CPT code, 99498, is used if an additional 30 minutes of discussion is necessary. For more information, see CMS; October 30, 2015

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New Scoring System Can Improve Lung Cancer Diagnosis

Lung cancer is a leading cause of cancer-related death and is often diagnosed at a late stage. A team of researchers from the University of Missouri have developed a new scoring system for the minimally invasive procedure—endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TBFNA). This common test is used in the diagnosis of lung cancer, because it is a noninvasive procedure that can quickly diagnose lung cancer.

“The EBUS-TBFNA procedure is a diagnostic tool for lung cancer that yields proven results,” said Lester Layfield, MD, Professor and Chair, Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, and lead author of a new study discussing this new scoring system. “The test categorizes the results as ‘benign,’ ‘non-­diagnostic,’ ‘atypical,’ ‘suspicious for malignancy’ or ‘malignant.’ Our goal with this study was to understand the risk of cancer associated with each category.”

The new scoring system of the EBUS-TBFNA showed an 84% accuracy of positive diagnosis of lung cancer and a 68% accuracy rate for negative diagnosis of lung cancer. The new technique also provides an accurate estimation of malignancy risks for each of the testing categories. Missouri School of Medicine; October 14, 2015

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First Consensus Statement on High-Quality Palliative Care Issued by ASCO/AAHPM

At the 2015 Palliative Care in Oncology Symposium, the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine (AAHPM) issued the first guidance on the delivery of high-quality palliative care services.

“For the first time, we’ve set some reasonable and achievable goals for high-quality primary palliative care delivery for oncology practices in the everyday care of patients, which we hope will improve patient comfort and quality of life,” said Kathleen E. Bickel, MD, MPhil, Assistant Professor, White River Junction Veterans Affairs Medical Center, and Geisel School of Medicine, Dartmouth, Hanover, NH. Dr Bickel participated in the panel that developed the combined statement and presented the main goals at the meeting.

The guidance statement was developed by a 31-member panel of physicians, patient advocates, social workers, and nurses. The goal was to “define what constitutes high-quality primary palliative care as delivered by medical oncology practices,” as stated in the meeting abstract. The panel reviewed 966 palliative care services and selected the list of services that met their definition above if they ranked high on the 3 areas of importance, feasibility, and scope (whether they are part of oncology practice). The main domain included in the statement is symptom assessment and management. Other key domains relate to end-of-life care, communication and shared decision-making, and advance care planning.

“The full publication will be coming soon with more details about the specific service items included in this definition project,” said Dr Bickel at a press discussion. “It is still an early-stage definition project, but this is necessary, because in order to improve palliative care delivery and access for patients with cancer, we must first define and agree on what oncology practices should be providing.” 2015 Palliative Care in Oncology Symposium; Boston, MA; October 5, 2015

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Last modified: November 16, 2015
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