American College of Cardiology

Most Cardiology Fees See Less Significant Cuts In Proposed Fee Schedule
A closer analysis of the proposed rule on the 2004 Medicare fee schedule provides a few positive findings in an otherwise disappointing development that could mean a 4.2 percent cut in physicians’ Medicare fees. In general, cardiology fees fared better than the average specialty in Medicare by 0.249 percent, or $14.6 million. Of all cardiology services, only fees for pacing/EP services would fare worse. The positive result is due primarily to efforts by the ACC, SCAI, and NASPE/The Heart Rhythm Society to get the CMS to increase practice expense RVUs for several catheterization procedures. The proposed rule also includes a 21.7 percent increase in the average malpractice RVU, new G codes for remote ECG monitoring, and changes in the direct inputs for holter monitoring codes. A more detailed analysis of the rule with a procedure-by-procedure breakdown should be available on the ACC Web site by the end of the week. The ACC, which is still pushing legislative efforts to avert a cut next year, will work with subspecialty societies to submit comments on the proposed rule.

Surveys Offer Conflicting Reports on Cardiologists’ Compensation
The results of two recent surveys, one significantly larger than the other, give conflicting accounts of changes in specialists’ compensation last year. According to the results of a compensation survey released last week by the Medical Group Management Association (MGMA), while specialists reported a median compensation increase of 4.3 percent in 2002, both invasive and noninvasive cardiologists reported income decreases of 6.17 percent and 3.9 percent, respectively. The MGMA survey is the largest of its kind, covering 40,000 providers. According to the results of a similar survey from the American Medical Group Association, which covers 28,000 providers, cardiologists experienced compensation increases in 2002 of slightly more than 7 percent.

FDA Approves Rosuvastatin
The FDA last week made AstraZeneca’s rosuvastatin (Crestor) the latest entry into the statin market, approving it as an adjunct to diet to treat hypercholesterolemia, mixed dyslipidemia, and isolated hypertriglyceridemia. The approval is for doses ranging from 5 mg to 40 mg, with a 10 mg recommended starting dose. AstraZeneca had initially applied for FDA approval for doses ranging from 10 to 80 mg. However, review of the original application revealed safety concerns at the 80 mg dose. AstraZeneca subsequently resubmitted for approval at the lower dose range. Rosuvastatin could be available in pharmacies by next week, The Independent (London) reported.

CMS Considering Modifying ICD Coverage Decision
At the request of the ACC and NASPE/The Heart Rhythm Society, the CMS is considering modifying its recently issued national coverage decisions on ICDs. As currently written, the ruling, which covered the so-called MADIT II indication, improperly prevents Medicare from covering patients enrolled in all clinical trials for noncovered indications of ICDs. In a tracking sheet posted to the CMS Web site, the CMS explained that “it was not the intention of CMS to nationally disallow coverage of implantable defibrillators under these circumstances. CMS is reevaluating this language and will issue a decision memorandum addressing this clinical trial issue only.”

Patient Education Materials on Medical Liability Reform Available
As the debate on medical liability reform continues in Congress and in many state legislatures, ACC members who are interested in obtaining printed materials to help educate patients about the medical liability crisis are encouraged to contact their ACC chapters. The materials—which can be previewed via the ACC Medical Liability Reform Resource Center on the ACC Web site—encourage patients to contact their legislators about the need for liability reform. Interested members and their practices are encouraged to contact their respective ACC chapters for more information on these materials. Two items—a flyer and a sample pattern patient letter—are also available in the Medical Liability Reform Resource Center that members can download for free and reproduce as needed for their waiting rooms.

Fla. Gov. Bush Signs Medical Liability Bill, Medical Societies Oppose Cap Exception
The months of turmoil in the Florida legislature over medical liability reform legislation ended last week, with Gov. Jeb Bush, R, signing a compromise bill that caps noneconomic damages against physicians at $500,000, with an aggregate cap of $1 million if more than one physician is involved, and against hospitals at $750,000, with an aggregate cap of $1.5 million. The bill also includes an exception to the individual physician cap for catastrophic cases, under which damages can go as high as $1 million. The ACC Florida Chapter has worked very closely with the Florida Medical Association on the medical liability reform issue. The FMA issued a statement saying that, due to the catastrophic exception, it could not support the bill as passed because it will not provide the necessary relief from increasing liability insurance premiums.

Retainer Fees Illegal, ‘Concierge’ Services Suspect, Washington State Insurance Commissioner Rules
Physicians who charge insured patients an additional fee to maintain their services for routine, covered medical care are breaking state law, the Washington State Insurance Commissioner has ruled. And medical practices that have set up ‘concierge’ services where patients pay a monthly or annual fee for additional, personalized care may also be illegal because the practices are not licensed as health insurers, the commissioner ruled. According to a Seattle Times report, while only a handful of practices in Washington are charging retainer fees or offer concierge services, many are considering the option. The commissioner’s office held a hearing last week to get public comments on the issue.

Medicare Coverage of TEB Left to Carrier Discretion
As a result of a request to cover the management of hypertension for thoracic electrical bioimpedance (TEB), the CMS has announced that coverage for the treatment of drug-resistant hypertension is being left to carrier discretion. Drug-resistant hypertension is defined as failure to achieve goal blood pressure in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic. The CMS announced that all other forms of hypertension treatment for TEB are noncovered. Lastly, the CMS said that it found no evidence to support removing the noncoverage restrictions listed in the current TEB national coverage policy. TEB continues to be noncovered when used for monitoring patients 1) with proven or suspected disease involving severe regurgitation of the aorta; 2) with minute ventilation sensor function pacemakers, since the device may adversely affect the functioning of that type of pacemaker; or 3) during cardiac bypass surgery.