American College of Cardiology

House Passes Medicare Bill; Calls Still Needed
Both houses of Congress will take action this week to stop the 10.6 percent cut in Medicare physician payment before the June 30 deadline, which is now just a week away. The House on Tuesday passed the “Medicare Improvements for Patients and Providers Act of 2008” (H.R. 6331), introduced by Reps. Charlie Rangel (D-NY) and John Dingell (D-MI). The bill, which the ACC is supporting, reportedly would stop the 10.6 percent cut and provide a positive 1.1 percent update for 2009. On the Senate side, Senate Finance Committee Chair Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) continue to negotiate for a new bill to reverse the impending cuts after a previous version failed. Partisan differences in the size, scope and cost of the bill have made it difficult for the Senate to reach a compromise.

There is no question that things will move quickly this week. It is very important that every ACC Member take action NOW. It is critical that you call your senators and representative and urge them to pass legislation that would stop the cuts and provide 18 months of positive updates. If you have already contacted Congress on this issue, thank you for taking the time, and we ask that you do so again. To take action, call the ACC's toll-free grassroots hotline at (800) 210-7193, or visit the CardioAction Network. For more information, contact Molly Nichelson (800) 253-4636 x 6470. To view an ACC letter to Reps. Rangel and Dingell, click here.

ACC Comments on Proposed Changes to CMS Hospital Inpatient Rule
The ACC this month sent a letter to acting Centers for Medicare & Medicaid Services (CMS) Administrator Kerry Weems regarding proposed changes to the hospital inpatient rule, as published in the Federal Register on April 30. The proposed changes would revise the Medicare hospital inpatient prospective payment systems (IPPS) and implement certain provisions of the Deficit Reduction Act of 2005 (DRA). The changes would be applicable beginning Oct. 1.

In carrying out the provisions of the DRA, CMS has proposed adding nine additional hospital-acquired conditions as non-payable "never events." The letter outlines the ACC’s concerns with this proposal, as the conditions do not fulfill the statutory requirement of being reasonably preventable, but instead are known complications that can be minimized with proper care. The ACC recommends that CMS explore alternatives that would use a data-driven approach to establishing benchmark and best practice complication rates for selected conditions. CMS could then set payment rates based on an average complication rate. The College's comments also address proposed changes to physician-ownership disclosure rules, physician self-referral provisions and exceptions to these provisions. To read the College's comments on CMS' proposed changes in full, click here. To view CMS' proposed changes, visit its Web site here.

ACC, AHA Submit Comments to SSA on Proposed Rulemaking
On Monday, the ACC in conjunction with the American Heart Association (AHA) submitted comments on the Advance Notice of Proposed Rulemaking entitled "Revised Medical Criteria for Evaluating Cardiovascular Disorders," published in the Federal Register on April 16. Written in a letter to Social Security Administration (SSA) Commissioner Michael Astrue, the ACC/AHA comments addressed the current criteria for evaluating cardiovascular disorders for Social Security disability benefits. The comments state that the criteria do not reflect current medical practice and do not provide adequate guidance to the SSA in making disability determinations for individuals with cardiovascular impairments. The ACC and AHA strongly urge SSA to update and review its medical criteria and base future proposals on evidence-based clinical practice guidelines for cardiovascular disease. The comments include ACC/AHA guideline documents, and encourage their use during revisions. To read the College's comments in full, click here.

DEA Expected to Lift E-Rx Ban on Controlled Substances
The Drug Enforcement Administration is expected to announce a proposed rule that would allow physicians to use electronic prescriptions for medications classified as controlled substances, the Wall Street Journal reported last week. Prescriptions for controlled substances comprise about 10 to 13 percent of all prescriptions. The rule, which will require a public comment period, is expected to include some form of security requirements to verify the authenticity of e-prescriptions for controlled substances. Allowing e-prescriptions for controlled substances might increase the number of health care offices that use the technology, according to the Journal.

HHS Announces Communities for EHR Demonstration
HHS Secretary Mike Leavitt earlier this month announced the 12 states or communities that will participate in a five-year demonstration program that awards financial incentives to practices that use electronic health records (EHR) to measure and improve quality of care. The program will target smaller physician practices, between three and 10 physicians. These practices need the most assistance in purchasing EHR systems because of cost, Leavitt said. Physicians in the program will receive bonus payments based on whether they meet certain benchmarks, which include EHR utilization and meeting quality measures. The participating communities are Alabama, Delaware, Georgia, Jacksonville, Fla., Louisiana, Madison, Wis., Maine, Maryland/Washington, D.C, Oklahoma, Pittsburgh, South Dakota and Virginia.

In related news, a survey published online in the New England Journal of Medicine last week found that physicians are reticent to adopt EHR technology because of the costs associated with switching from paper-based to computerized records. The survey polled more than 2,600 physicians and found that less than 20 percent use EHRs and only four percent use software that includes decision-support tools. The College highly encourages its members to adopt e-prescribing and other health information technology (HIT) to improve clinical outcomes, reduce medical errors and increase efficiency. To learn more about the College's efforts to promote HIT, visit http://www.acc.org/HealthIT.