American College of Cardiology

ACC Forms Workgroup To Improve Use of Disease Management for Chronic Cardiac Conditions
The ACC and the Disease Management Association of America (DMAA) have formed a consensus workgroup on the treatment of chronic cardiac conditions. The end goal of the groups’ work is a consensus report on how to improve and enhance care delivered to patients with chronic cardiac diseases using proven disease management techniques, as well as to develop steps to help physicians and health plans implement these techniques. In an ACC news release, Janet Wright, MD, chair of the ACC Disease Management Workgroup, noted that the initiative is aimed at “improving the use of clinical practice guidelines, teaching [physicians] how to better work with nonphysician members of the care team, and to do a better job of both recording and reporting our data, so we can truly assess the care we are providing.”

CMS Expands Coverage of PET, Magnetic Resonance Angiography
The Centers for Medicare and Medicaid Services (CMS) has announced two national coverage decisions strongly supported by the ACC. The CMS announced last week that Medicare will now cover N-13 ammonia positron emission tomography (PET) for the evaluation of myocardial perfusion. In 2001, ACC supported FDG PET coverage for myocardial viability that referenced Rb-82 as the tracer element. The ACC supported the request to CMS that N-13 ammonia be allowed as a tracer element as well. The CMS also announced last week that it will expand coverage of magnetic resonance angiography to include imaging of the renal arteries and the aortoiliac arteries in the absence of abdominal aortic aneurysm or aortic dissection. The ACC joined with the American College of Radiology, the Society of Cardiovascular & Interventional Radiology, and the Society for Vascular Medicine and Biology to request this expanded coverage. The effective date of both coverage decisions will be announced soon.

Caps on Noneconomic Damages Keeps Physicians’ Liability Costs Low, Report Finds
Physicians in large states that have caps on noneconomic damages have below-average medical liability loss costs, according to a report released last week. The study, conducted by Milliman USA, looked at the 15 largest U.S. states from 1990 to 2001. States with caps on noneconomic damages, including California, Colorado, Indiana, and Maryland, had medical liability losses per physician well below the country-wide average. States without caps, including, Florida, Illinois, New Jersey, New York, and Pennsylvania, were well above the average. Pennsylvania was the worst, with losses at 171 percent of the country-wide average.

Supreme Court Says Physicians Must Go Through Arbitration on Racketeering Claims
The U.S. Supreme Court has ruled that a group of physicians suing two HMOs for alleged violations of racketeering laws must take their case through arbitration and not the court system. The unanimous decision was a reversal of a federal appeals court ruling in which the court said that arbitration was not required because the arbitration agreement between the physicians and the managed care plans, United Health Group and PacifiCare, was too restrictive and did not allow for meaningful relief. The Supreme Court ruled, however, that the physicians must abide by their contracts, the Los Angeles Times reported, and that it was unclear whether arbitration could not yield the kinds of damages the physicians are seeking. Lawyers for physician groups in a larger class-action suit against managed care plans, which also includes these two HMOs, said the ruling should not weaken their case.

Requests for Returns of Medicare Overpayments Coming in July
The CMS has released a program memorandum providing instructions for Medicare carriers on requesting returns from physicians for erroneous overpayments made under the 2003 fee schedule. Many claims for services performed in January and February but processed after March 1—the effective date of the 2003 physician fee schedule—will likely be paid at the higher 2003 rate. The CMS has instructed carriers to send a “demand” letter requesting returns of the overpayments; the letter should include a listing of the specific overpayments and the amount of the overpayment. Carriers were also instructed to write off aggregate overpayments per physician of $10 or less.

CMS COO Resigns, New Deputy Chief Clinical Officer Named
Ruben King-Shaw Jr. has resigned as CMS deputy administrator and chief operating officer. King-Shaw cited family responsibilities and fulfilling his duties as the leader of President Bush’s health insurance tax-credit strategy as reasons for his departure. CMS Administrator Tom Scully told National Journal that he was sad to see King-Shaw go, adding that he expected that King-Shaw might eventually succeed him in the administrator position. Meanwhile, William K. Sullivan, MD, a veteran public health official from Maine, has been named as the new deputy chief medical officer at the CMS. Dr. Sullivan will take a leadership role in the review and implementation of all quality, clinical, and medical science issues and policies.