CMS Proposes 51% increase on 3 CPT codes
The Hospital Outpatient Prospective Payment System (HOPPS) dramatically cut payments for stereotactic, ultrasound, and MRI-guided breast biopsy effective January 1, 2014 .These draconian reductions essentially made minimally invasive needle biopsy financially non-viable and threatened a return to open surgical breast biopsy as the standard of care.
Affected were CPT codes 19102 (breast biopsy with core needle) and 19103 (breast biopsy with vacuum-assisted or rotating device). The codes were replaced with six new ones that bundled payments for breast biopsy procedures (19081-19086) and assigned them to ambulatory payment classification (APC) codes which reduced some payment rates by more than 50%.
Breast care advocates, including leadership from NCBC, protested, and in a March meeting, CMS' Advisory Panel on Hospital Outpatient Payment recommended that payment rates for the codes be revised. Earlier this month, CMS announced that it is now proposing that payments for codes 19081, 19083, and 19085 be raised 51%, from the $702.08 set in 2014 to $1,062.28 as of Jan1, 2015. CMS will continue to package payment for add-on CPT codes 19082, 19084, and 19086 under the OPPS for 2015, consistent with its policy for add-on codes.
We are happy that CMS has reviewed its payment schedule for minimally invasive breast biopsy and responded by adjusting its payment for the new bundled codes to a level which more closely reflects the cost and complexity of these procedures. We remain concerned however that there is apparently no payment planned for biopsy of a second lesion, a scenario not uncommon in breast care.
Gary Levine, M.D.
Director Breast Imaging
Hoag Breast Care CenterNewport Beach, CA
Associate Clinical Professor
USC Keck School of MedicineLos Angeles, CA
President, National Consortium of Breast Centers
NCBC Las Vegas - Ready for Recovery's Coming-out Party
Exhibiting at the NCoBC 24th Annual Interdisciplin- ary Breast Conference and Trade Show held March 15th – 19th 2014 at Caesars Palace in Las Vegas was a big step for our small business and we couldn't be more rewarded by the outcome. We were very possibly the last of 83 companies to register for booth space, even so, we had a fantastic spot, tremendous traffic and genuine interest from many of the 846 participants. Not only that, four days of working side-by-side with Danielle Earl, the COO of Suremark Precision Skin Markers has resulted in a cooperative program between our companies that we've named MOMENTS THAT MATTER.
Before we share program details with you, I feel compelled to rave about the people attending this show. When I was diagnosed with breast cancer 2/2/11, I was cared for by a handful of generous and compassionate medical professionals, occasional visits from out-of-state family and friends and primarily by a neighbor that I hadn't known well before this experience. Attending this conference opened my eyes to the vast numbers of dedicated professionals in the industry who not only know how to care for our bodies but have big hearts, true empathy and sincere interest in finding ways to help us survive diagnosis and treatments with our minds and spirit intact.
As first time exhibitors, we recognized there was a chance that we'd have to"earn our stripes" before being accept- ed by the vendors that have been serving the industry and participating in this show for many years. We couldn't have been more wrong. We were embraced and encouraged by vendors big and small. We can't thank our neigh- boring booth buddies enough for their guidance and friendship. One morning, Julie and I slept in expecting the exhibit space to open late morning. Thankfully I was awakened by a call from Stephanie Ellis of Imaging Technolo- gy News telling me our booth was packed and to get to the hall! Thank you Stephanie and thanks to the others who stepped in in our absence. Hey, it was Vegas! As survivors, we had to have one late night, right?
As a result of this show, Ready for Recovery Cancer Treatment Planners has expanded its reach. We are now also serving newly diagnosed cancer patients in Nebraska, Pennsylvania, Kansas, Ohio and Florida and anticipate including several other hospitals and cancer centers across the country in the near future. NCBC was our coming out party and we thank all of those involved for helping us share our products with decision-makers that truly care about healing their patients' body, mind and spirit.
Now for the most amazing outcome of all. Our collaboration with Suremark Precision Skin Markers, "MOMENTS THAT MATTER".
Danielle Earl, the COO of Suremark, a remarkably empathetic woman, has generously offered the company's resources to design and manufacture inspirational stickers to be given (free of charge) to nurses distributing Ready for Recovery Cancer Treatment Planners. When going through cancer treatments it's vitally important for patients to celebrate their accomplishments. 1st Chemo, last Chemo, Surgery, Radiation, Paying that month's mortgage, first hair to grow back (even if it is on your chin?).
Oncology nurses are on the front-line of the treatment process and often are the life-line a patient holds on to. Their job goes way beyond administering medications. Any tool we can give them to aid in this process MATTERS to us. We trust our Moments that Matter program will encourage greater connection, recognition and a little more laughter.
The National Consortium of Breast Centers (NCBC) is pleased to announce a comprehensive collaboration with the Harold P. Freeman Patient Navigation Institute (HPFNI).
The collaboration of these two highly regarded professional organizations will, for the rst time, allow an individual to combine the compassionate practicality of navigation training with the validation attained through a three-hour test for accredited certication. Working separately, but in tandem, navigators may choose between training, testing, or both depending on the individual needs of the navigator and their respective facilities. The Patient Navigation Institute will oer training based on the Harold P. Freeman model of patient navigation, and the National Consortium of Breast Centers will administer the certication exam.
The National Consortium of Breast Centers
A nonprot membership organization founded in 1986, the NCBC is dedicated to excellence in breast healthcare through education and cross fertilization of knowledge and skills. It began as a small group of multidisciplinary breast health experts and has grown into an ever-increasing group of medical and allied health professionals who exchange information, network and learn from renowned clinicians and from each other. The focus continues to be on the development; implementation and expansion of breast center programs such as navigation, which promotes high quality cost ecient care, in a patient centric manner while continuing to address and promote clinical excellence in all aspects of breast health care.
With the addition of private sector businesses and corporations as part of the NCBC membership, breast health professionals are kept informed about advances in equipment, technology, drugs and services available to them to improve patient quality care. Through monthly newsletters, an annual interdisciplinary annual conference and networking throughout the year, NCBC members are kept informed of the ever-changing breast health care world both nationally and internationally.
The National Consortium of Breast Centers developed a Certication Program for breast patient navigators in 2009 so that those who would move into navigator roles would be able to do so with standardized and validated skill sets.
Harold P. Freeman Navigation Institute Patient Navigation was founded by Harold P Freeman, M.D. in 1990 when he initiated and developed the nation's rst patient navigation model in Harlem. The program was created for the purpose of reducing disparities in access to timely diagnosis and treatment of cancer, particularly among the poor and uninsured. This program initially focused on the window of opportunity to save lives from the point of abnormal nding to resolution by
timely diagnosis and treatment.
As an outgrowth of the original patient navigation program, the Harold P. Freeman Patient Navigation Institute (HPFPNI), a non-prot organization, was rst established in 2007 to provide patient navigation training in an expanded model encompassing all phases of the health care continuum including outreach, screening, diagnosis, treatment and end of life care. The Institute opened its doors to address the rapid growth in patient navigation programs and also to oer standards and best practices to meet each program's needs. Patient Navigation has been eective in improving health outcomes, reducing organizational costs, and increasing
Our Vision Together
The National Accreditation Program for Breast Centers (NAPBC) calls for the presence of a navigation program in all Breast Centers by January of 2015. With this deadline nearly here, our partnership creates a path for navigators to prepare and validate their capabilities.
The NCBC Breast Patient Navigation Certication Program oers six types of Breast Patient Navigator Certications:
CERTIFIED NAVIGATORS – BREAST (+ individual designation based on licensure)
CN-BI = Diagnostic Imaging/Treatment Techs (all technologist from diagnostics to treatments)
CN-BM = Management/Social Worker (all social workers and managers of navigators)
CN-BA = Advocate (All volunteers/lay navigators)
CN-BC = Clinical (All certied medical assistants, technicians, licensed practical/vocational nurses)
CN-BP = Provider (all breast care diagnosticians, nurse practitioners, physicians, physician assts, breast care PhDs)
CN-BN = RN (All registered nurses from breast care, diagnostic imaging, treatment, survivorship, genetics)
Our Vision is to positively impact breast care and improve the experience, satisfaction, and outcomes of the breast cancer patient. We will achieve this by combining the highest quality training in Navigation with the most respected testing and Certication program.
ASCO Guideline Update
Lyman GH, Temin S, Edge SB, et al. Sentinel Lymph Node Biopsy for Patients with Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. JCO May 1, 2014. 32:1365-1383.