American College of Cardiology

	Agreement on Patients' Rights Bill Still Elusive
	ACC Cosponsors AED, CPR Awareness Day
	Physicians' Compensation Grew in 2001, To Fall in 2002
	Medicare Inpatient Rule Addresses CRT, VADs
	Nevada Gov. Guinn Signs Liability Reform Bill
	Hospitals Get Payment Increase Under Proposed Medicare Outpatient Rule
	California Bill Would Disclose Physician Malpractice History
	Crestor Approval Likely Delayed Until 2003

Agreement on Patients' Rights Bill Still Elusive
Democratic leaders and Bush administration officials have reportedly ended negotiations on patients' rights legislation, the New York Times reports. Both the Senate and House passed different patients' rights bills last summer. The primary point of contention continues to be liability. Sens. Edward Kennedy, D-Mass., and John Edwards, D-NC, along with John McCain, R-Ariz., one of the few Republicans siding with Democrats, have been engaged in talks with the White House since last year trying to reach a compromise on the extent of patients' ability to sue HMOs for coverage decisions that result in injury. Both bills contain provisions long supported by the ACC, such as a ban on gag clauses and unfettered access to specialists. It is unclear at this point whether negotiations can be revived and an agreement reached before the end of the current session.

ACC Cosponsors AED, CPR Awareness Day
More than 75 federal lawmakers and staffers participated in an ACC-cosponsored CPR training day on Capitol Hill last week. The event was coordinated largely through the American Heart Association and the American Firefighters Association. During the event, legislators and staff were introduced to the importance and use of AEDs, the "Chain of Survival," and basic CPR techniques. Volunteers from Washington, DC, Virginia, and Maryland emergency services then provided participants with one-on-one instruction. Participants also received information about important ACC-endorsed legislation to fund wider availability and increased training in the use of AEDs.

Physicians' Compensation Grew in 2001, To Fall in 2002
According to the Medical Group Management Association's most recent annual Physician Compensation and Production Survey, physicians' compensation grew slightly in 2001, with a 1.21 percent increase for primary care physicians and a 2.64 percent increase for specialists. Invasive cardiologists' median income for 2001 was $410,300, a more than 12 percent increase from 2000; noninvasive cardiologists median income was $320,111, a nearly 7 percent increase from 2000. "We anticipate that that the combination of the 5.4 percent Medicare reduction and the recent industry-wide increases in medical liability premiums will lead medical groups to experience a far different compensation and production landscape for 2002," said MGMA President and CEO William F. Jessee, MD. In addition to the nearly 9 percent cut in Medicare reimbursement cardiovascular specialists experienced on average in 2002, current projections are that they will experience a cumulative decrease of nearly 20 percent for 2003 to 2005. The results of the MGMA survey will not officially be released until the end of the month.

Medicare Inpatient Rule Addresses CRT, VADs
As was reported last week, Medicare's proposed inpatient payment rule for 2003 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. The inpatient rule also addresses several other cardiovascular treatments. While the CMS is currently considering developing a national coverage policy on cardiac resynchronization therapy (CRT), the CMS rejected professional societies' request to place CRT in higher paying DRGs in the proposed rule. The proposed rule does include a new DRG (525) for ventricular assist devices, which would raise payment for this procedure significantly. In the rule, rheumatic heart failure with cardiac catheterization was placed into a higher paying DRG. The agency rejected requests from professional societies, however, to make separate payments for procedures using glycoprotein IIb/IIIa inhibitors, arguing that the cost of this drug is offset by a shorter length of stay.

Nevada Gov. Guinn Signs Liability Reform Bill
Nevada Gov. Kenny Guinn last week signed into a law a medical liability reform bill that will cap noneconomic damages in most malpractice cases, as well as other reforms strongly supported by physician groups. There are several significant exceptions to the $350,000 cap on noneconomic damages, including cases in which the conduct of the defendant is determined to constitute gross malpractice. In addition, defendants cannot be held liable for noneconomic damages for any claim that exceeds the money left in his or her professional liability insurance policy, minus economic damages that have been awarded. The law is the result of a special session called by Gov. Guinn after many physicians from across the state reported being unable to afford the skyrocketing costs of liability insurance, with some limiting services and others being forced to leave the state. In response to the law's enactment, Nevada Mutual Insurance Co., a physician-owned company, said it would begin reducing liability insurance premiums in September. "There will be reductions for everybody, and there will be reductions soon," a spokesperson for the insurer told the Las Vegas Review-Journal.

Hospitals Get Payment Increase Under Proposed Medicare Outpatient Rule
Under the proposed rule on hospital outpatient services released last week by the CMS, hospitals would receive a 3.5 percent payment increase in 2003, with rural hospitals receiving a 7.6 percent increase. According to a CMS release, under the rule, for the first time payment rates for APCs "are being set using actual data from claims submitted by hospitals under the Outpatient Payment Prospective System." The changes significantly redistribute payments among different payment groups. Initial analysis by the ACC indicates that the proposal includes significant fee reductions for many cardiology procedures. The ACC will be developing comments and recommendations on this proposal. The rule also creates a new APC for procedures that use drug-eluting stents, assuming that the devices are approved by the FDA, and would allow separate payment for observation services for patients with congestive heart failure and chest pain directly admitted from a physician's office.

California Bill Would Disclose Physician Malpractice History
Legislators in California have reached a compromise on a bill that would allow patients to obtain information on physicians' malpractice settlements from the state medical board Web site. According to a Los Angeles Times report, physicians would have to have a certain amount of settlements to trigger disclosure. Physicians in low-risk specialties such as family practice would have to have three or more settlements of $30,000 or more in a 10-year period to trigger disclosure, while higher-risk specialists would have to have four or more settlements. Only future settlements are covered under the bill. The legislation, which has been passed by the Senate and now goes to the Assembly, would also require board investigations of patient injury or death because of suspected physician misconduct to take precedence over other investigations.

Crestor Approval Likely Delayed Until 2003
AstraZeneca issued a statement last week indicating that FDA approval of its so called superstatin rosuvastatin (Crestor) will likely be delayed until late next year. The company received an approvable letter for rosuvastatin in June, with the FDA indicating that it needs further information before it can approve rosuvastatin for marketing. In its statement, AstraZeneca noted that it is in the process of gathering the requested information and will submit it to the FDA in the first quarter of 2003. In addition, the submission will only be for approval of rosuvastatin over the 10 mg to 40 mg dose range.