Medical Oncologists and Meaningful Data

This blog post is Part I in a series on the topic of “meaningful data”.

Any of us working in Medical Oncology know that the Evaluation and Management (E&M) guidelines are not specialty specific, and that the treatment planning of infusion therapy is considered part of a visit. We know that this “suggests” that the majority of visits in a medical oncology physician office should be a level V service.

However, if we use the Physician Quality Reporting Initiative (PQRI) as the starting point for determining meaningful value, we see we have no less than 10 meaningful data points to begin adding to the note to help confirm the value. For example, if staging and line of therapy are added to every note, each has points that add value to the complexity of the note. If this is done in less than six months, medical oncology will have the perfect level V note as well as the demand for the level VI thru IX note.

Let’s take a quick look at the current state of the oncology business.

GPOs and Sales Margins
Mergers and takeovers are everywhere, from US Oncology becoming McKesson, to P4 Healthcare being purchased by Cardinal Health. And Oncology Supply has so many layers of overhead within their GPO structure, it’s no wonder medical oncologist can’t buy drugs at ASP. Contrary to what everyone says about the market, the system was designed so that every medical oncologist should be making at least a 6% margin on its drug purchases.

Don’t be confused on drug sales margins – the sales margin actually needs to be 18% when considering the low reimbursements on the services. Do medical oncologists continue to under code? The answer in my opinion is an obvious “yes” when you look at the national bell curve.

The national bell curve is 5% at level II, 38% at level III, 48% at level IV and 9% at level V. Our audits at Neltner Billing and Consulting (based on reviewing oncology notes) show that the oncology bell curve should be 70% at level V, 20% at level IV, 10% at level III and no level II visits.

Stay tuned in my next blog post for more information on this topic. Check out our in depth Billing Brief article How the Business of Oncology Drugs Relates to Meaningful Data For the Medical Oncology Practice (Part I of III) posted on our website, www.neltnerbilling.com. Let us know your comments.