American College of Cardiology

House Bill Could Ban Some Physicians' Referrals to Heart Hospitals
Legislation introduced in the House of Representatives on April 1 would add new prohibitions on so-called physician "self-referrals." The bill—introduced by Reps. Pete Stark, D-Calif., and Jerry Kleczka, D-Wisc.—would allow physicians to refer patients to hospitals in which they have a financial interest, but only if that interest was obtained via terms that were also available to the public at large. Rep. Stark is the namesake of federal laws already on the books related to physician self-referrals. According to a news release issued by Rep. Stark, the new legislation is aimed at closing a "loophole" in the current self-referral laws through which physicians can legally refer their patients to "freestanding, boutique hospitals where they have a direct personal financial interest." Under the bill, physicians could be fined as much as $15,000 for individual violations and $100,000 for each "referral scheme."

HIPAA Privacy Rule Takes Effect
The regulations on the privacy of patients' medical information issued under the auspices of the Health Insurance Portability and Accountability Act of 1996, better known as HIPAA, became effective today. According to the results of a survey released by Phoenix Health Systems last week, less than 10 percent of health care providers (primarily hospitals) and payers reported having completed remediation efforts to ensure compliance with the rule (9 percent and five percent, respectively). Meanwhile, several patients' and privacy groups have filed a lawsuit to block the rule. According to a Philadelphia Inquirer report, the groups argue that the rule increases third parties' access to patients' medical records, instead of providing more protections.

A revised version of the ACC HIPAA Privacy Manual is now available for free to all ACC members. Members can get a hard copy of the manual by calling the ACC Resource Center at 800-253-4636, ext. 694. It is also available electronically via the ACC Web site.

Access Problems Worsen As Liability Crisis Grows
Nearly two-thirds of high-risk specialists have been forced to make changes to their practice that affect patient access to care because of liability concerns, according to a new American Medical Association survey. The survey involved more than 30 state and national medical specialty societies and included responses from more than 4,800 physicians. The high-risk specialties include emergency medicine, general surgery, neurosurgery, obstetrics/gynecology, orthopedic surgery, and thoracic surgery. According to the survey's findings, 24.2 percent of high-risk specialists have stopped providing certain services, including emergency and trauma care and delivering babies. The House has already passed ACC-supported liability reform legislation. As reported previously, Senate action on the reform legislation has been delayed. For more information, visit the ACC Medical Liability Reform Resource Center.

Leapfrog Group Hospital Survey Incorporates ACC-NCDR Outcomes Measure
The revised voluntary hospital-patient safety survey released last week by The Leapfrog Group relies in part on the ACC-National Cardiovascular Data Registry™ (ACC-NCDR™) risk-adjusted mortality measure for percutaneous coronary interventions. "More and more PCI procedures are being done and the ACC-NCDR can help hospitals—and health care purchasers—more accurately assess the quality of care they are providing," said Ralph G. Brindis, MD, MPH, chair of the ACC-NCDR Task Force, in an ACC news release. Previously, The Leapfrog Group has relied exclusively on volume measures to rate the quality of cardiovascular care a hospital has provided. The survey will ask hospitals if they participate in the ACC-NCDR and, if so, how they ranked against the national average on the risk-adjusted mortality rate.

Broad 'Any Willing Provider' Law Upheld by Supreme Court
A Kentucky law that requires managed care plans to allow any physician to participate in their provider network has been unanimously upheld by the U.S. Supreme Court. The Kentucky Association of Health Plans, which brought the suit against the Kentucky insurance commissioner, had argued that the law was pre-empted by federal ERISA laws and that the law regulated the relationship between patients and physicians, not physicians and insurers. The court disagreed, Modern Physician reported, with Justice Antonin Scalia writing in the opinion that the Kentucky 'Any Willing Provider' law legally imposes "conditions on the right to engage in the business of insurance" in Kentucky.

CDC Report: Hospital Stays Down, Heart Disease Leading Cause of Hospitalization
The length of patients' hospital stays has been markedly reduced since 1970, according to a report released last week by the Centers for Disease Control and Prevention. In 2001, the average hospital stay for the nearly 33 million people who entered a hospital was 4.9 days, compared to an average stay of 7.8 days in 1970. The most dramatic decrease in average length of stay was in elderly patients, which dropped from 12.6 days to 5.8 days. In 2001, as in earlier years, the most frequent reason for hospitalization was heart disease, accounting for 4.3 million discharges. While the rate of hospitalization for most conditions has decreased over the past two decades, hospitalization for congestive heart failure increased by 62 percent for those 65 and over from 1980 to 2001.

FDA Approves New Versions of LVAD, ICD
The FDA has approved Thoratec Corp.'s HeartMate XVE left ventricular assist system for "destination therapy" in end-stage heart failure patients who are not candidates for a heart transplant. The XVE system is an enhanced version of the HeartMate SNAP-VE device approved by the FDA in November 2002. The FDA has also granted marketing approval for Guidant's next-generation ICD, the Vitality AVT system. The device combines complete ventricular and atrial therapies in the world's smallest (30cc) and thinnest (11mm) dual chamber ICD, Guidant noted in a news release. Guidant also announced FDA approval of the Ventak Prizm AVT implantable cardioverter defibrillator.

The March Keeps On: Physicians Continue Drive for State-Level Liability Reform
Physicians in North Carolina and Massachusetts last week kept pressure on their state legislatures to pass legislation that would reform the states' medical liability laws. In Massachusetts, physicians held a rally at the state capital to urge legislators to support a bill that, among other things, would eliminate judges' and juries' ability to override the state's $500,000 cap on noneconomic damages. In North Carolina, more than 2,700 physicians rallied at the state's general assembly last week to support legislation that would cap noneconomic damages in liability cases at $250,000. According to The Post and Courier (Charleston), the bill would also cap lawyers' contingency fees and ensure patients receive 85 percent of awards or settlements worth more than $600,000.

Coalition Launches Physician Pay-for-Performance Initiative
A coalition of health care institutions, health plans, and large employers have launched a program that gives physician financial incentives for providing quality care. The initiative, called "Bridges to Excellence," will initially focus on three areas: diabetes care, cardiovascular care, and patient care management systems. The cardiovascular component of the initiative will not be launched until later this year. The program will also feature incentives for patients to become more involved in their own health care. Partners Community Healthcare, Inc., the Lahey Clinic, and the Cincinnati Children's Hospital Medical Center were involved in the initiative's development. Corporate partners include General Electric and Ford Motor Company, and some of the health plans include United Healthcare and several Blue Cross and Blue Shield plans.