Bill Introduced to Eliminate Medicare Payment Cuts
Sen. Debbie Stabenow (D-MI) has introduced the "Save Medicare Act of 2008" (S. 2785) to eliminate the 10.6 percent Medicare physician payment cut scheduled for July 1. The legislation would replace the cut with a 0.5 percent update for the second half of 2008 and a 1.8 percent update for 2009. The 2009 update matches the Medicare Economic Index (MEI), a government measure for annual physician practice cost inflation. The Physician Quality Reporting Initiative (PQRI) would be extended until 2010, with funding remaining at 1.5 percent for participating physicians in 2009. In addition, the legislation would extend certain rural provisions through 2009. Under the bill, the payment update for the remainder of 2008 and 2009 would be fully funded and would not increase the size or duration of future cuts. The bill includes a recommendation that quality reporting measures be voluntary and nonpunitive. ACC members are urged to contact their Senators and ask them to cosponsor this bill.

Meanwhile, a separate bill introduced by Sen. John Cornyn (R-TX) and Rep. Michael Burgess (R-TX) earlier this month, would repeal the sustainable growth rate starting in 2010 and replace it with the MEI. In addition, the bill would increase the PQRI bonus payments from 1.5 percent to 3 percent. It also supports health information technology implementation by providing a 3 percent bonus in 2008 for three years to offset implementation costs and by allowing hospitals to assist physicians in setting up the technology. Both versions of the bill have been referred to committees.

ACC Releases Health Policy Statement on Public Reporting
The gaps in health care quality are coming under greater scrutiny by payers, employers, policy-makers and even patients themselves. In an effort to eliminate these gaps, public reporting of physician, health plan, and institutional performance is increasingly viewed as a solution. However, given the newness of physician performance data, particularly in the area of ambulatory care, poorly designed programs can unintentionally mislead patients about the quality of their care and create greater disparities in care delivery. To avoid these unintended consequences the American College of Cardiology Foundation (ACCF) on Monday released a “Health Policy Statement on Principles for Public Reporting of Physician Performance Data.”

Joseph Drozda, Jr., M.D., who chaired the writing committee for the health policy statement, said the six key principles outlined in the document are intended as a road map for physician performance reporting programs. For the complete document, click here.

CMS Posts New Quality, Cost Data on Hospital Compare Web Site
The Centers for Medicare and Medicaid Services (CMS) on March 28 posted information from patient satisfaction surveys to its Hospital Compare Web site, which offers information about hospital quality and cost to consumers. CMS also added information about the number of certain elective hospital procedures provided to patients between October 2005 and September 2006 and what Medicare reimbursed for those procedures. The Web site features 26 quality measures, including process of care and outcomes measures, and 10 patient experience measures based on the results of the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (HCAHPS), the first national, standardized survey on patient experience. CMS this summer will add more information on mortality measures. The Hospital Compare Web site is available here.

FDA Issues Draft Guidelines for Drug-Eluting Stents
The FDA has issued draft guidelines for the development, testing and manufacture of coronary drug-eluting stents, in an effort to collect better data to address potential safety concerns. The draft guidance document outlines the development pathway for new drug-eluting stent devices and recommends what information should be necessary to complete an agency marketing submission. It also recommends how to determine the toxicity of the drug used in the stent alone and in conjunction with the device. "This draft guidance is part of FDA's ongoing effort to provide regulated industry with recommendations on measures that can minimize the risks while preserving for patients the benefits of drug-eluting stents," said Daniel Schultz, M.D., director of FDA's Center for Devices and Radiological Health. FDA will accept public comments for 120 days from the date of issuance. For more information about, visit http://www.fda.gov/cdrh/ode/guidance/6255.html.

First Phase of Requirements for Tamper-Resistant Prescription Pads To Begin
The Centers for Medicare and Medicaid Services (CMS) on April 1 began implementing the first phase of a new requirement for the use of tamper-resistant prescription drug pads for Medicaid prescriptions. The new requirements were outlined in an August 2007 letter to state Medicaid directors. As of April 1, prescription drug pads must include at least one of three “tamper-resistant” characteristics to be used for Medicaid beneficiaries. The characteristics include:

1. One or more industry-recognized elements intended to prevent unauthorized copies of blank or completed prescription pad forms
2. One or more industry-recognized elements intended to prevent the alteration or erasure of information present on completed prescription pad forms
3. One or more industry-recognized elements intended to prevent counterfeit prescription pad forms

States may ask for additional requirements on top of the requirements above. State prescription laws and/or regulations can be obtained by contacting the state Medicaid agency. For more information about the requirement, see CMS’ Frequently Asked Questions document at http://www.cms.hhs.gov/DeficitReductionAct/Downloads/MIPTRPFAQs9122007.pdf.

CMS Committee To Discuss Clinical Issues of Importance to Elderly
CMS on April 30 will hold a public meeting of the Medicare Evidence Development & Coverage Advisory Committee (MedCAC) to discuss the “Evidentiary Priorities for the Medicare Program.” MedCAC in October 2007 held a meeting that generated a list of 105 research questions of importance to the elderly, formulated from a review of evidence from several NIH Institutes on their “most important evidentiary gaps.” At the upcoming meeting, the MedCAC will revise and score the list based on the major issues, producing a final draft of some of the research needs most significant to the elderly population. The Federal Register notice announcing the upcoming meeting may be accessed here. The MedCAC Draft Evidentiary Priorities List may be accessed here. For questions about the upcoming meeting, please contact rkelly@acc.org or ssantivi@acc.org.