American College of Cardiology

	ACC Issues Alert on House Committee Markup of Liability Reform Bill
	Medical Liability Reform Resource Center Launched on ACC Web Site
	Proposed Rule Released on Appeals of Medicare Coverage Determinations
	ACC Appeals Maryland Proposed Regulation on Use of -25 Modifier
	Following Tissue Recall, FDA Advises Physicians on Heart Valves
	Illinois Chapter Action Prompts Changes to Problematic Cath Lab Regulation
	FTC Settles Antitrust Suits With Physician Practice Groups
	Iowa Gov. Threatens to Sue CMS Over Medicare Reimbursement Disparities
	Illinois Pharmacists Given Bonus for Switching Brand Names to Generics

ACC Issues Alert on House Committee Markup of Liability Reform Bill
The House Judiciary Committee is scheduled to consider an important medical liability reform bill on Sept. 5. Ensuring support for the legislation, the "Help, Efficient, Accessible, Low Cost, Timely Health Care Act," or HEALTH Act (H.R. 4600), is critical if the bill is be passed out of committee for consideration by the full House. The ACC is urging members to contact their representatives before Sept. 5 in support of this important legislation. For more information about this issue or how to contact your member of Congress, visit the new Medical Liability Reform Resource Center (see next item) or contact Camille Sorosiak in the ACC Advocacy Division at csorosia@acc.org or 800-435-9203.

Medical Liability Reform Resource Center Launched on ACC Web Site
In related news, with medical liability reform continuing to be a critical issue on both the state and the federal level, the ACC has developed a special resource center dedicated to this issue on its Web site. The resource center—modeled after a similar resource center on the ACC Web site on the fight to prevent future Medicare fee cuts—provides talking points on the medical liability crisis, details of "The HEALTH Act," and links to media coverage of liability reform efforts. The resource center will be updated regularly to provide ACC members with the most up-to-date news on efforts to enact liability reform legislation. To access the resource center, go to http://www.acc.org/advocacy/advoc_issues/rc_malpractice2.htm.

Proposed Rule Released on Appeals of Medicare Coverage Determinations
Under a proposed rule released by the CMS last week, Medicare beneficiaries will have new avenues for appealing local or national coverage determinations. Appeals of local coverage determinations would first be reviewed by an administrative law judge and then could be brought before the HHS Departmental Appeals Board. Appeals board decisions could be appealed to federal court. Appeals of national coverage determinations can also be brought before the HHS Departmental Appeals Board, and beneficiaries would also have the ability to challenge the underlying coverage policy. The new appeals process, the CMS noted in a news release, "would ensure that complaints are reviewed in a predictable, uniform manner," and the decisions from the appeals could "have implications for future Medicare coverage of the item or service for all Medicare beneficiaries." The proposed rule was published in the Aug. 22 Federal Register. The CMS will accept public comments on the rule until Oct. 21. The ACC will be developing comments on this proposed rule.

ACC Appeals Maryland Proposed Regulation on Use of -25 Modifier
The ACC has joined with 11 other medical societies to oppose action by the Maryland Insurance Administration (MIA) that would allow any claim with a modifier -25 to be pended for further documentation. The proposal is part of the MIA's revision of the Maryland Clean Claims Act. The modifier -25, the groups explained in a letter to MIA Associate Commissioner Alexandra Thomas, is intended specifically to address those situations where a significant, separately identifiable evaluation and management service is performed by the same physician on the same day of the procedure or other service. "By changing this rule," the groups explained, "the MIA will be ignoring the intent of the AMA regarding modifier -25 and will take a huge step backwards in the effort of HIPAA to increase electronic transactions."

Following Tissue Recall, FDA Advises Physicians on Heart Valves
One week after announcing the recall of human allograft tissue products supplied by CryoLife, Inc., since Oct. 31, 2001, the FDA last week issued further guidance to physicians caring for patients who have received CryoLife-supplied tissue products. The agency reiterated its "serious concerns" about allograft heart valves supplied by CryoLife, even though they were not included in the recall. The FDA recommended that physicians carefully monitor their patients who were recently implanted with a Cryolife allograft heart valve for both fungal and bacterial infections; report all adverse reactions to both the FDA and CryoLife; and inform these patients about the agency's concerns with CryoLife allograft heart valves "and discuss the potentially higher risk for infection."

Illinois Chapter Action Prompts Changes to Problematic Cath Lab Regulation
In response to action by the ACC Illinois Chapter, the Illinois Health Facilities Planning Board (IHFPB) has agreed to halt implementation of a problematic proposal on the regulation of catheterization laboratories. Illinois Chapter representatives, including chapter President Alan Brown, MD, testified before the IHFPB last week to suggest an alternative to a proposal that would require physicians and hospitals to perform a minimum number of catheterization procedures annually to maintain licensure. The chapter recommended that the ACC-National Cardiovascular Data Registry™ program be used to track outcomes in Illinois catheterization labs—similar to an approach soon to be implemented in Massachusetts. They also proposed use of the continuous quality improvement (CQI) tool kit being developed by the College and the Society for Cardiac Angiography and Interventions. Following the hearing, the IHFPB announced that it would work with the Illinois Chapter on developing an alternative to the proposed regulation.

FTC Settles Antitrust Suits With Physician Practice Groups
The Federal Trade Commission (FTC) has reached settlements with large physician groups in Dallas-Ft. Worth and Denver in antitrust cases. In both instances, the FTC alleged that the physician groups illegally restrained price and engaged in other anticompetitive actions. "The FTC is committed to stopping fee-fixing and other forms of anticompetitive conduct among health care industry participants," said Joe Simons, director of the agency's Bureau of Competition. In the case against the Dallas-Fort Worth-based System Health Providers (SHP), for example, the FTC alleged that SHP's parent corporation "actively bargained with payors for contracts on [its] members' collective behalf—often proposing and counter-proposing fee schedules, among other terms," and that "to maintain its bargaining power, SHP discouraged [its] members from entering into unilateral agreements with payors." In related news, the FTC will hold a workshop in September that will focus on the impact of competition laws on the "cost, quality, and availability of health care."

Iowa Gov. Threatens to Sue CMS Over Medicare Reimbursement Disparities
In what some are calling an election-year maneuver, Iowa Gov. Tom Vilsak, D, has threatened to sue the CMS over the wide disparity between Medicare payments to Iowa health care providers and hospitals and those in other states. Gov. Vilsak alleges that the CMS is failing to follow the laws that govern Medicare reimbursement, which require reimbursements from state to state to be actuarially equivalent, the Associated Press reported. Iowa is ranked last in the United States in per-patient reimbursement, at $3,053. The national average is $5,490. On a per-procedure basis, Medicare's physician payments are 90 percent of the national norm. CMS Administrator Thomas Scully called the threatened suit "ridiculous" and "absurdly irresponsible." Gov. Vilsak reportedly faces a tough reelection battle against his GOP competitor, Doug Gross.

Illinois Pharmacists Given Bonus for Switching Brand Names to Generics
Beginning in January, Blue Cross & Blue Shield of Illinois will pay pharmacists a bonus for switching a prescription from a brand-name drug to a generic equivalent. The insurer is launching the program to rein in escalating drug costs and counter the increasing number of direct-to-consumer ads for expensive drugs, a company representative told the Chicago Tribune. "We don't want to have all of these commercials driving what everybody is taking," said Brad Buxton, Illinois Blues senior vice president of health care management. "If there is a generic drug that is as good as a brand-name, patients could save up to $40 to $60 a prescription." The bonus is $1 per prescription. Buxton also noted that pharmacists will still have to check with a physician before switching to a generic, but it will be up to pharmacists to tell the consumer about the bonus program.