American College of Cardiology

	Legislation to Address Medicare Fee Cuts Still Priority in Congress
	Anthem Responds to Medical Societies' Complaints
	Medical Liability Reform Measure Voted Down
	Final Hospital Inpatient Rule Includes DRGs for Drug-Eluting Stents
	Nevada Legislature Passes Liability Reform Bill
	ACC Joins Other Specialty Groups at State Legislators Conference
	Wall St. Journal Report Highlights Insurer "Bundling" Practices
	Judge Clears Way for Discovery in State Medical Societies' Suit Against HMOs

Legislation to Address Medicare Fee Cuts Still Priority in Congress
With the failure of the Senate to pass Medicare prescription drug benefit legislation before the August congressional recess, the prospects for such a bill being enacted this year seem increasingly unlikely. There remains a commitment by Senate lawmakers, however, to move forward with a legislative package to prevent further cuts in physicians' Medicare fees. Sen. Charles Grassley, the ranking Republican on the Senate Finance Committee, and committee staffers have both indicated that there is a good chance such a package will be taken up in the fall, according to a Health News Daily report. The exact vehicle for a package is still unclear at this point, Sen. Grassley noted, but it could move as a stand-alone bill or could be attached to other legislation, including any additional Medicare prescription drug packages. In late June, the House approved the "Medicare Modernization and Prescription Drug Act of 2002," H.R. 4954, an ACC-endorsed bill that would provide an approximate 6 percent increase in Medicare physician payments over the next three years, as opposed to the 14 percent cut projected under current law.

Anthem Responds to Medical Societies' Complaints
Anthem has responded to a complaint from the ACC, AMA, and 18 other state and specialty societies about the insurer's practice of using contract provisions that allow it to bundle CPT codes but do not allow physicians any recourse to appeal the decisions. In its response, Anthem, which operates Blue Cross and Blue Shield plans in eight states, argued that "health care is a local activity" and that "many of the detailed questions and concerns that you raise … are thus best addressed at the local and regional level." In a July 11 letter to Anthem, the medical societies also addressed Anthem's improper bundling practices and improper recognition and payment of modifiers, such as modifier -25, which is used by cardiologists. Given Anthem's response, the ACC, through its chapters and the National Specialty Society Payer Coalition, of which the College is a member, will continue to push for changes in Anthem reimbursement practices at both the local and national levels.

Medical Liability Reform Measure Voted Down
Even before the Senate prescription drug benefit bill met its demise, an amendment to the bill introduced by Sen. Mitch McConnell, R-KY, that would have made reforms to the current medical liability system was defeated. Despite lacking what many physician groups consider to be a key component of any medical liability legislation, a cap on noneconomic damages, the amendment did not receive the support of a single Democrat. While the McConnell amendment was defeated, "The HEALTH Act of 2002," an ACC-supported medical liability bill, is likely to come up for consideration in both the House and Senate when Congress returns from its summer recess in September. The House (H.R. 4600) and Senate (S. 2793) versions of the bill are identical and include a $250,000 cap on noneconomic damages in medical malpractice cases; the payment of judgments over time rather than in a single lump sum; and allocate damages only in proportion to a party's degree of fault. President Bush has recently issued a proposed framework for medical liability reform that includes many of the same provisions as "The HEALTH Act."

Final Hospital Inpatient Rule Includes DRGs for Drug-Eluting Stents
The final 2003 hospital inpatient payment rule released on August 1 includes two new DRGs for drug-eluting stents that will pay approximately 17 percent more than CMS currently does for standard stents—or roughly $1,800 per procedure. While the final rule takes effect on October 1, the DRGs for the coated stents do not take effect until April 1, 2003. The move by the CMS is surprising because no drug-eluting stents have been approved by the FDA. The CMS noted in the final rule, however, that results from recent clinical trials presented at scientific meetings revealed "virtually no in-stent restenosis in patients treated with the drug-eluting stent," and that the agency recognized "the potentially significant impact this technology may conceivably have on the treatment of coronary artery blockages." Implementation of the new DRGs assumes that the FDA will have approved a drug-coated stent by the rule's effective date.

Nevada Legislature Passes Liability Reform Bill
The Nevada legislature last week—meeting in a special summer session called by Gov. Kenny Guinn, R—passed a medical liability reform bill. Nevada has been a microcosm of the medical liability crisis, with OB/GYNs leaving the state and trauma centers temporarily closing because physicians couldn't afford or obtain liability insurance. The bill, if signed by Gov. Guinn, will place a $350,000 cap on noneconomic damages, although with several significant exceptions, including cases in which the conduct of the defendant is determined to constitute gross malpractice. The bill also holds defendants liable only for their share of the fault in the disputed case, allows for periodic payments of economic damages, and caps civil damages at $50,000 for physicians practicing in a trauma center, with the exception of gross negligence. According to a Las Vegas Journal Review report, the bill also contains provisions modeled after a Pennsylvania law that requires mandatory reporting of medical errors to the state, but without identifying the parties involved in the errors. The Nevada Trial Lawyers Association has indicated that it will challenge the law in court, the Associated Press reported.

ACC Joins Other Specialty Groups at State Legislators Conference
For the second year in a row, the ACC joined with 11 other medical societies in a joint booth called "Physicians Advocating for Patients" at the National Conference of State Legislatures (NCSL) meeting in Denver, Colo. The exhibit offered the more than 4,000 conference attendees, many of them state legislators and their staff, a centralized source of information on state-level issues of common interest to physicians, including medical liability reform, patients' rights, medical research funding, and access to quality health care. Joint booth participants were deluged with positive comments from visitors about the unified presence of the physician groups. ACC representatives gave legislators and staff copies of the Digest of State Health Polices, information on ACC's quality initiatives, and the ACC patient brochure, Caring for Your Heart. Visitors could also receive free screenings for heart disease and breast cancer (based on family history), vision, and glaucoma.

Wall St. Journal Report Highlights Insurer "Bundling" Practices
The increasingly common HMO practice of bundling payments for multiple procedures into the payment of just one of those procedures hit the front pages of the Wall Street Journal last week. Physicians have argued that the practice is unfair and illegal and has cost them hundreds of millions in reimbursement. Several physicians and physician groups have filed lawsuits against Cigna and other insurers to recover unpaid expenses and damages related to the practice. According to the Journal report, the Florida attorney general's office is investigating the issue, and the assistant U.S. attorney in Philadelphia is also following the issue closely.

Judge Clears Way for Discovery in State Medical Societies' Suit Against HMOs
A U.S. Federal judge in Miami has given five state medical societies the go-ahead to begin "discovery" in a lawsuit they have filed against some of the nation's biggest HMOs. The ruling allows the societies and other physicians and states that have joined in the suit to obtain documents and records from the HMOs related to their reimbursement practices. Some of the HMOs in the suit include Aetna, United Healthcare, CIGNA, Humana Health Plan, Inc, and Anthem Blue Cross Blue Shield.