SCHUMER, KATKO: FEDS WRONGLY ATTEMPT TO TAKE $250K FROM SYRACUSE-BASED HEMATOLOGY-ONCOLOGY ASSOCIATES OVER SIMPLE CLERICAL ERROR; AFTER SCHUMER & KATKO INTERVETION, FEDS FORCED TO REVERSE NEGATIVE & UNFAIR DECISION
A Simple CMS Data-Entry Error Left Hematology-Oncology Associates of CNY On The Hook For A $250K Loss For No Real Reason – Putting Health Of Practice At Risk
Schumer & Katko Successfully Pushed CMS To Reverse Course – Touting Hematology-Oncology Associates As The ‘High Quality’ Provider It is & Protected Reimbursements That Will Be Used For Vital Care
Schumer, Katko: Return Of Fed Funds To HOA Will Keep Staff In Place & Care Top-Notch For Countless Patients
U.S. Senate Minority Leader Charles E. Schumer and Congressman John Katko today announced that, following their push, the federal government has reversed a decision that sought to take over $250,000 in Medicare Reimbursements from Hematology-Oncology Associates of CNY (HOACNY).
“Simply put, HOA saves lives each and every day and guides so many families through what is often a scary and challenging time. This practice provides high-quality and top-notch care for their patients in Central New York. Congressman Katko and I know how important Hematology-Oncology Associates of CNY’s work is to this community and those suffering from severe medical conditions. This decision lacked common sense and we knew that we had to push CMS to reconsider,” said U.S. Senator Charles Schumer. “Thankfully the Congressman and I were able to fight off the bureaucratic wolves and recover this $250,000 loss, ensuring Hematology-Oncology Associates of CNY will be able to continue providing outstanding, passionate care to patients during difficult times.”
"Hematology-Oncology Associates of CNY provides a tremendous service to our community, working with our local hospitals to provide patients with quality care and effective treatment during one of the most trying times of their lives. A drastic cut to the Medicare reimbursement for Hematology-Oncology Associates of CNY would not only have hurt their business but also the thousands of patients they provide care for. I was proud to work with Senator Schumer on this effort to correct a technical error and restore funding to this important organization," said Congressman John Katko.
“We are so grateful that CMS was pushed to be reasonable by Senator Schumer and Congressman Katko. A simple clerical error resulted in a devastating loss of revenue, and possibly staff. HOACNY has been committed to quality and excellence for over 35 years. We are the only Oncology practice in CNY certified for quality with the American Society of Clinical Oncology and the only American College of Surgeons, Commission on Cancer Accredited Oncology Medical Home in New York State. We take great pride in who we are and what our practice stands for – the designation and loss of revenue from CMS as a result of a clerical error was unconscionable, and to say we are all grateful for this correction is an understatement,” said HOACNY’s CEO, Maryann Roefaro.
This victory comes after Schumer and Katko pressed the Centers for Medicare & Medicaid Services (CMS) to revisit a simple data-entry error that wrongfully changed Hematology-Oncology Associates of CNY’s performance, quality and reimbursement total. The representatives said that when submitting annual performance data to CMS, HOACNY staff accidently inputted the letter “I” instead of the number “1.” This simple error—one that CMS would not initially correct—reduced HOA’s Medicare reimbursement by $250,000.
The Senator and Congressman explained that HOACNY is a participant in Medicare’s Oncology Care Model and the only Certified Oncology Medical Home in New York State. The federally administered program requires participants to submit annual performance data which known as ‘Value Modifier.’ Instead of reporting 1P to identify patient cases, IP was accidentally inputted into the modifier. This simple error triggered a negative reimbursement of $250,000 and would have unfairly cost the practice. Hematology-Oncology Associates of CNY appealed to revise this determination, but CMS ruled against a revision citing agency rules and regulations.
In response, Schumer and Katko intervened on behalf of HOACNY. The appealed directly to CMS Administrator Seema Verma and asked her to reconsider the clerical error and to take into account the important, high-quality work Hematology-Oncology Associates of CNY does in the community. Schumer and Katko argued that reducing their Medicare reimbursement by over $250,000 due to a data entry error was overly punitive and lacked common sense. Moreover, they pointed out that it does nothing to advance the interests of the Medicare and Medicaid programs nor reflect congressional intent regarding the Value Modifier Program. CMS ultimately reversed their decision and saw the light.
Hematology-Oncology Associates treats about 4,600 new patients per year, providing over 115,000 patient visits at multiple locations across Central New York. They are a participant in the CMS Innovation Center’s Oncology Care Model (OCM), which aims to improve the effectiveness and efficiency of specialty care. According to CMS, under the OCM, physician practices enter into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients. The practices participating in OCM have committed to providing enhanced services to Medicare beneficiaries such as care coordination, navigation, and national treatment guidelines for care.
A copy of Schumer and Katko’s letter appears below:
We write to request the Centers for Medicare & Medicaid Services (CMS) revisit Hematology-Oncology Associates of CNY, P.C.’s 2017 Value Modifier. Due to a clerical error, Hematology-Oncology Associates of CNY, PC is scheduled to receive a negative two percent adjustment for 2017, reducing their Medicare reimbursement by $250,000 or more this year. This reduction will have a disastrous impact on Hematology-Oncology Associates of CNY, P.C. and the Central New York community it serves.
The negative adjustment exists because of a data entry error when uploading to CECity. Instead of reporting 1P to identify patient cases, IP was accidentally inputted into the modifier. This simple error tanked their quality score, setting their performance, quality, and cost measures outside of the required parameters and consequently, triggered a negative adjustment. Hematology-Oncology Associates of CNY appealed to revise this determination, but CMS ruled against a revision citing agency rules and regulations. However we believe reducing their Medicare reimbursement by over $250,000 due to a data entry error seems overly punitive. It does nothing to advance the interests of the Medicare and Medicaid programs, and it does not reflect congressional intent regarding the Value Modifier Program.
Hematology-Oncology Associates of CNY, P.C. is the only Certified Oncology Medical Home in New York State. As a participant in Medicare’s Oncology Care Model, Hematology-Oncology Associates of CNY, P.C. has been providing high-quality care to patients throughout Central New York and New York State. It is inconceivable that their Value Modifier cannot be recalculated to reflect the true quality of care they provide.
We urge you to revisit this matter, as well as the review rules and regulations that may punish participants in the Oncology Care Model for simple data entry errors. If you have any further questions, feel free to reach out to us or our staffs.
Charles E. Schumer
United States Senator
House of Representatives