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June 2019 Newsletter
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Newsletter Michigan Society of Hematology and Oncology JUNE 2019 The Voice of Hematology and Oncology in Michigan FROM THE PRESIDENT PLAN TO ATTEND! Thomas Gribbin, M.D. Annual Review in Oncology & ASCO Update A Perspective Saturday, June 22, 2019, Troy Marriott - Troy, MI On the Benefits of Anxiety MSHO, the Barbara Ann Karmanos Cancer Institute, and Wayne State University School of Medicine will present the Annual Review in Oncology and ASCO Last month, I had the pleasure of Update at the Troy Marriott in Troy, MI. This conference will provide up-to- representing MSHO at a meeting date information, advances and new directions in cancer medicine to oncology at ASCO headquarters, with other providers. Participants will gain detailed information and interpretation of recent representatives of State Societies. developments in the diagnosis and treatment of common types of cancer. The subject was cancer care costs (hint: high), the impact that costs Course Director, Ulka Vaishampayan, M.D., from the Karmanos Cancer Institute, have on our patients (hint: not has brought together an outstanding faculty to present this course that good), and our profession (hint: highlights the major lectures at the American Society of Clinical Oncology’s burnout). We were awaiting the Annual Meeting in Chicago. Speakers and topics include: Christopher D. Lao, Trump proposal for management M.D., MPH, University of Michigan (Melanoma and Cutaneous Oncology), of drug costs, and the mood was, Lawrence Flaherty, M.D., Karmanos Cancer Institute (Breast Cancer), Karen well, anxious. Kelly, M.D., UC Davis Comprehensive Cancer Center (Thoracic Malignancies), This month, I participated in a Charles Schiffer, M.D., Karmanos Cancer Institute (Hematologic Malignancies), round table discussion convened Adnan Munkarah, M.D., Henry Ford Health System (Gynecologic Malignancies), by the Detroit Economic Alliance, Ulka Vaishampayan, M.D., Karmanos Cancer Institute (Genitourinary representing MSHO. The group Malignancies), Philip A. Philip, M.D., Ph.D., FRCP, Karmanos Cancer Institute included physicians from various (Gastrointestinal Malignancies). health systems, as well as representatives from Ford, GM, This meeting is always a must for those who were unable to attend the national and the UAW, with representatives conference. Those who attend ASCO find this concise recap of the important from Blue Cross and Priority presentations of value as well. Register at www.msho.org before June 14th for Health mixed in. The subject was early bird pricing. the cost of cancer care. It’s fair to say that everyone in the room felt MSHO Joins that we, as a country, are at or Health Can’t Wait Coalition near a breaking point in the care that we can afford to deliver. to Put Patients First From the President con’t on page 8 MSHO is proud to announce it has joined the Health Can’t Wait coalition, a growing partnership of patients, health care providers, and patient advocacy Board Profile Andrew Muskovitz, MD . . . . . . . pg 2 associations dedicated to putting Michigan patients first and ending delays in Reimbursement News . . . . . . . . . . . . . . . pg 3-5 patients’ access to health care. Advocacy News . . . . . . . . . . . . . . . . . . . . pg 6-7 Member Spotlight . . . . . . . . . . . . . . . . . . . pg Health can’t wait. It’s a reality that physicians understand and patients News to Know . . . . . . . . . . . . . . . . . . pg 9 Nurses’ Nook . . . . . . . . . . . . . . . . . . . . . . pg 10 experience. Tragically, insurance company bureaucracy too often stands MSHO Meeting Schedule . . . . . . . . . . . . . pg 11 12 between patients and the medicine, treatment, or testing their physicians believe they need. Prior authorization, step therapy, and fail first requirements hamstring treatment, drive up prescription nonadherence and lead to diminished health. Health Can't Wait Coalition con’t on page 7

BOARD MEMBER SPOTLIGHT BOARD OF DIRECTORS Andrew Muskovitz, M.D. President Thomas Gribbin, M.D. Dr. Andrew Muskovitz is an established and highly regarded oncologist and hematologist with the President Elect Cancer and Leukemia Center at Troy Beaumont Anas Al-Janadi, M.D. Hospital. He is known for his good humor and patient- centered approach to care, which helped secure Past President his place on Hour Detroit Magazine's annual list of Jerome Seid, M.D., FACP Top Docs in 2017 and 2018. Dr. Muskovitz is also distinguished by his interest in geriatric oncology. Treasurer Michael Stender, M.D., FACP He is one of a small number of physicians in the United States to maintain board certifications in both specialties. Board Members Paul Adams, M.D. Dr. Muskovitz is an alum of Cranbrook Schools in Bloomfield Hills, MI. Ernie Balcueva, M.D. He received a Bachelor's Degree with Great Distinction in anatomy and Timothy Cox, M.D., FACP cell biology from McGill University in Montreal, where he also served as David S. Gordon, M.D. a teaching assistant of neuroanatomy and neuroscience. He obtained his Zachary Hector-Word, M.D. medical degree from Wayne State University School of Medicine in 2005 JoAnn Hirth, M.D. and served his residency at the University of Illinois at Chicago. Philip Kuriakose, M.D. Duel fellowships in hematology/oncology and geriatrics were completed Ted Lawrence, M.D., Ph.D., FASTRO at the Karmanos Cancer Institute at Wayne State University and the Andrew Muskovitz, M.D. University of Illinois at Chicago, respectively. Dr. Muskovitz also had the Mohammed Ogaily, M.D., FACP honor of completing a foreign exchange externship in medical oncology at Carol Rapson, M.D. the Hacettepe University School of Medicine in Ankara, Turkey. He joined Oscar Signori, M.D. the faculty of Oakland University William Beaumont School of Medicine Samuel Silver, M.D., Ph.D., MACP, FASCO in 2016 and enjoys teaching medical students and residents in the clinic T. Trevor Singh, M.D., FACP and classroom. Edward Smith, M.D., FACP Joseph Uberti, M.D., Ph.D. As the MSHO Board endeavored to expand their ranks, Dr. Muskovitz became Ulka Vaishampayan, M.D. one of the first to fill the “Young Professional” position in 2014. He has Jerome Winegarden, M.D. remained an elected member of the board thereafter and enjoys serving on the Young Professional Committee and Payor Committee. He is committed Young Professionals to helping MSHO develop programs that prepare fellows for their transition Daniel Isaac, D.O. out of training. David Macari, M.D. Dr. Muskovitz was born and raised in Southeast MSHO STAFF Michigan, where he currently resides with his former high school sweetheart, now his wife, Executive Director and their three children. When he has time Mary Kay Makarewicz off, he enjoys tinkering in his vegetable garden, [email protected] playing squash, skiing and being outdoors. Membership Coordinator Kasie Blazevski [email protected] MISSION OF MSHO It is the mission of the Michigan Society of Hematology and Oncology to promote exemplary care for patients with cancer and blood disorders through advocacy, education and research. Page 2 Michigan Society of Hematology and Oncology JUNE 2019

REIMBURSEMENT NEWS Time Spent With Your Patient Can Be An necessary face-to-face time with the patient or family. Advantage - Using Time To Code The Visit This face-to-face time includes not only the time spent counseling but also the time associated with any history, By Michelle Weiss, MSHO Senior Reimbursement Consultant exam or medical decision making that you perform. The time you spend reviewing records, talking with other It often takes an extensive amount of time for an oncologist providers and documenting the encounter without the to care for a cancer patient. Taking the time to counsel patient or family present cannot be included. the patient, offer treatment options, and answer not only the patient’s questions, but also the questions of the In the inpatient setting, time is measured using the family members, can cause visits to be much longer than face-to-face time with the patient as well as other time anticipated. When time spent counseling and coordinating spent on the unit or floor related to the care of the care takes up the majority of the visit, consider choosing patient. This unit/floor time might include discussions with your level of the service for the visit, based on time. nursing staff, calls to other physicians, and/or reviewing or documenting in the medical record. Choosing the level is usually based on the extent of the history, examination, and medical decision-making Listed below are some of the visit codes and associated necessary to evaluate or treat the patient. However, when times. CPT lists the average times that must be met or counseling or coordination of care dominates the visit, exceeded to choose that code: the level of care can be selected based on the time spent. The AMA CPT states; “The three key components when selecting the appropriate level of E/M services provided are history, examination, and medical decision making. Visits that consist predominately of counseling and/or coordination of care are an exception to this rule. For these visits, time is the key or controlling factor to qualify for a particular level of E/M services.” “When counseling and/or coordination of care dominates The following example may help clarify utilizing time to (more than 50 percent of) the physician/patient and/ choose the level of service: or family encounter (face-to-face time in the office or other outpatient setting, floor/unit time in the hospital), Example: A patient returns to the office to discuss time is considered the key or controlling factor to qualify the findings of a test/scan ordered at their last visit. for a particular level of E/M services. If the level of service A comprehensive history and examination were recorded is reported based on counseling and/or coordination at that visit, so there is no need to repeat these of care, you should document the total length of time components at this visit. This visit’s focus is to discuss the of the encounter and the record should describe test results and the plan of care. This visit is dominated the counseling and/or activities to coordinate care.” by counseling and care management. The physician spent 25 minutes face-to-face with the patient and their This means that time alone can be used to select a level family. The physician has documented the discussion, of care, regardless of the extent of the history, exam or the total face-to-face time with the patient, and a summary medical decision making, as long as the majority of the of what was discussed. When choosing the code based encounter involves counseling or coordination of care. For on time, this visit could be coded as a 99214. If the E/M services, counseling may include a discussion of test physician chose the code based on the key components results, diagnostic or treatment recommendations/options, of history, exam and medical decision-making, the visit prognosis, risks and benefits of management options, would have likely been coded as a 99212. instructions, education, compliance or risk-factor reduction. CPT also states that counseling can involve a discussion With this said, keep in mind the importance of with the patient or family. CPT goes on to say that documenting all 3 of the components required to choose encounters with parties who have assumed responsibility the level based on time: for the patient can be used to calculate the face-to-face time as well. When coding on the basis of time in the out-patient setting, you (the provider) can count only your medically Page 3 Michigan Society of Hematology and Oncology JUNE 2019

6%. DAYS – so your Monday contact will be just fine! You are also required to have a face-to-face contact within 14 days (99495) QUESTION: When a patient comes in for a chemo treatment or 7 days (99496) post discharge – this time frame is based on and has a pump put on, can we bill for the disconnect of the CALENDAR DAYS. pump? We do flush the port-a-cath during this visit. Can I charge for at least a port flush 96523? QUESTION: A patient is admitted to the hospital but his condition warrants transfer to another facility, and he is ANSWER: There is no code for disconnecting the pump. discharged on the same day. How should the physician report Disconnecting the pump is included in the payment for his services? putting on the pump. Additionally, you cannot charge for a port flush because according to the AMA CPT rules, the ANSWER: Do not report discharge codes (99238-99239) 96416 (chemotherapy administration, IV infusion; initiation when the patient is admitted and discharged on the same of prolonged chemotherapy infusion [more than 8 hours] calendar date. When this occurs, the physician selects from requiring use of portable or implantable pump) is within the initial inpatient care codes (99221-99223) or observation the AMA CPT administration section and considered a service including admission and discharge on the same day “prolonged infusion”. This CPT section specifically states (99234-99236). Choose 99234-99238 when the patient stay is that you cannot separately bill for a flush at the end of any >8 hours on the same calendar day and the insurer accepts infusion. If the nurse disconnecting the pump is performing a these codes. Documentation must reflect two components \"medically necessary\" E & M service on this day and of service: the corresponding elements of both the admission documents the E & M service appropriately, then you could and discharge, and the duration of time the patient spent in bill a nurse level visit, 99211. If the nurse is ONLY removing the hospital. Alternately, if the patient stay is [email protected] The complementary a manager has additional skills and knowledge to better guard registrations will be on a first-come first-served basis the practice against risks, hire more motivated employees and for our MSHO members. very importantly, increase the practice’s revenue. The CMOM- HEMONC certification course will teach experienced staff This meeting features top experts in the field, proven strategies to lead the medical practice to increased comprehensive clinical content, the latest clinical productivity and efficiency. research, and the opportunity to interact with colleagues in an intimate, small group setting with MSHO is once again partnering with the Practice no competing sessions. Management Institute (PMI) to offer the Certified Medical Office Manager – Business of Hematology and The program content will be structured as “How I Oncology (CMOM-HEMONC) Workshop and Exam. These Treat” presentations, which showcase each speaker’s are live classroom sessions and participants must attend all evidence-based treatment approaches, present dates in person. If you already hold the CMOM certification, cutting-edge scientific >[email protected] or Jimmie Vail at [email protected] Page 11 Michigan Society of Hematology and Oncology JUNE 2019

2019 EDUCATIONAL OFFERINGS Date Name of Meeting Location Audience Monday Amway Grand Hotel Nurses, Financial Navigators, June 10, 2019 Oncology Navigator Conference Saturday Grand Rapids Social Workers, MAs June 22, 2019 Annual Review in Oncology Detroit Marriott Physicians, Fellows, Saturday and ASCO Update August 24, 2019 Troy APPs, Nurses Hematology/Oncology Somerset Inn Friday & Saturday Board Review Course Physicians, Fellows September 20-21, 2019 MSHO's Annual Meeting Troy Economic & Regulatory Update Physicians, Fellows, Saturday Administrators' Forum Mission Point APPs, Administrators September 21, 2019 Update in Hematology Mackinac Island Physicians, Fellows, and Oncology Mission Point APPs, Nurses Mackinac Island Wednesday OCN Review Course University of Michigan Oncology Nurses, APPs October 2, 2019 Live Session Ann Arbor Friday OCN Review Course Live - Traverse City Oncology Nurses, APPs October 4, 2019 Live Session w/ REMEC Connection REMEC - Grand Rapids / Detroit Friday & Saturday Certified Medical Office Manager - October 11-12, 18-19 Business of Hematology & Oncology Somerset Inn Administrators November 15-16, 2019 (CMOM-HEMONC) Review Course Troy Friday & Saturday October 11-12, 2019 Great Lakes Cancer Conference Somerset Inn Nurses, APPs Troy Thursday The Great Debate Radiation Oncologists, October 17,2019 Exact Location Medical Oncologists and 10th Annual Fall Payer Update TBD Wednesday Hematologists October 23, 2019 Legislative Update: Schoolcraft College Key Changes for 2020 Livonia Administrators, Billing Staff Wednesday December 4, 2019 Webinar Administrators, Billing Staff *APPs = Advanced Practice Providers, MAs = Medical Assistants Friday, September 20 Economic and Regulatory Update Oncology Fellows Mentoring Reception Golf Outing – The Jewel, Woods Nine Annual Meeting and Banquet Saturday, September 21 Update in Hematology and Oncology Oncology Administrators Forum Banquet Keynote Speaker: Barbara L. McAneny, MD, FASCO, MACP President, American Medical Association Connect with Us Contact Us Michigan Society @MSHO1985 Michigan Society ADDRESS: 5435 Corporate Drive, Suite 250 of Hematology of Hematology Troy, MI 48098 and Oncology and Oncology PHONE: 248-385-5464 FAX: 248-712-6857 WEBSITE: www.msho.org

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