American College of Cardiology

April 11, 2005

IMAGING

Physicians Brief Congress, Media on Imaging
A study released at a recent Coalition for Patient-Centered Imaging (CPCI) briefing shows that the growth in imaging utilization matches the overall rise in Medicare Part B expenditures. The study, conducted by The Lewin Group, also reports that financial incentives are not the primary driver of imaging growth. Instead, the clinical benefits of timely imaging tests performed by qualified physicians are prompting many providers to offer these services in their offices.

Patients support this trend according to a poll conducted by Fabrizio, McLaughlin & Associates. A survey of patients who have had imaging tests showed that 85 percent believed consumers should have the option of having their tests performed at their specialist’s office. The polling data was released at an April 5 briefing for congressional staff and media representatives on the importance of imaging to delivering high-quality care. More than 30 congressional staff from key committees attended the briefing and several media outlets covered the event. Click here to view materials from the briefing.

REIMBURSEMENT

CMS Paves Way for Broader Coverage of New Services
As part of its ongoing review of the national coverage determination process, the Centers for Medicare and Medicaid Services (CMS) released the fourth in a series of draft guidance documents on proposed changes to the current coverage system. Last week’s announcement pertains to coverage of new procedures when outcomes data is limited, referred to as coverage with evidence development or CED. A recent example of this type of coverage would be the decision to cover implantable cardioverter defibrillators (ICDs). The final decision implemented extended coverage, but called for a registry to determine which specific patient populations benefit most from ICDs. The recent decision on carotid stenting also meets CED coverage criteria. The ACC is developing comments on the draft guidance document.

Important Information Regarding ICD Claims
As of April 1, Medicare providers must submit patient data to a registry and use the QR modifier for ICD claims. The QR modifier was created for use on Part B claims to identify protocol covered services. The appropriate use of the QR modifier, in defibrillator claims, is to identify patients whose data is being submitted to a registry and to document meeting the coverage requirement for devices implanted for prevention of sudden cardiac arrest. This modifier is not required when ICD-9-CM codes appear on the claim that identify a patient receiving the device as secondary, not primary, prevention of sudden cardiac arrest. Click here to view a summary of this policy.

MEDICAL LIABILITY REFORM

South Carolina Celebrates New Liability Law
Surrounded by physicians at a Charleston hospital, Gov. Mark Sanford signed legislation last week that caps noneconomic damages awarded in medical liability cases at $350,000. The legislation would also create additional qualifications for expert witnesses. The South Carolina Chapter of the ACC worked hard to persuade state legislators that immediate reform was necessary to offset skyrocketing liability insurance rates. To view a state-by-state analysis of medical liability reform efforts, visit www.protectpatientsnow.org.

FDA Cracks Down on NSAIDs
Following the worldwide withdrawal of the popular arthritis drug Vioxx in September 2004, the Food and Drug Administration (FDA) revisited the cardiovascular risks associated with all non-steroidal anti-inflammatory drugs (NSAIDs) and recently announced a series of important changes for this class of drugs. On April 7, the FDA asked Pfizer, Inc. to withdraw its painkiller Bextra from the market because the overall cardiovascular risks of the drug outweighed its clinical benefits. The FDA also asked manufacturers of prescription NSAIDs to include a boxed warning and a Medication Guide highlighting the increased risk of cardiovascular events and gastrointestinal bleeding associated with their use. Manufacturers will also need to modify labeling for over-the-counter NSAIDs to reflect the potential for cardiovascular or gastrointestinal adverse events. Click here for more information.