American College of Cardiology

ACC, Alliance Highlight Concerns About E-Prescribing, Drug Payments in Medicare Reform Debate
In letters to House and Senate members of the conference committee debating Medicare reform legislation, the Alliance of Specialty Medicine, of which the ACC is a member, urged the conferees to address several issues that could directly affect physicians. The Alliance noted concerns about provisions in the legislation that would mandate electronic prescribing, a move the Alliance stressed would be unworkable for many smaller practices and practices in rural areas and be plagued with problems such as lack of data integrity, improper drug substitutions, and increased economic stress on physician practices. In separate letters, the Alliance urged conferees to work toward a more long-term fix to physician Medicare payment problems and to ensure that any efforts to increase practice expense payments to oncologists for the administration of outpatient oncology drugs, as a result of reductions in the average wholesale price of outpatient drugs, do not unfairly penalize other physician specialties.

Cardiologists Would Benefit Under Medicare Part B Drug Payment Rule
Practice expense relative values for cardiology services would receive a 3 percent increase under a proposed rule published in the Federal Register on August 20.The payment reform for Part B drugs: (1) solicits comments on four options to cut the price of drugs administered in physicians' offices by about 10 percent; (2) increases practice expense payments for oncologists and cardiac and thoracic surgeons; (3) removes clinical oncology from the nonphysician work pool (NPWP); and (4) increases practice expense relative values by approximately 3 percent for those procedures (including cardiovascular procedures with a separate technical component payment) remaining in the NPWP. Under the rule, payments for the pharmacological stress agents adenosine, dipyridamole, and dobutamine used by cardiologists in approximately 40 percent of stress tests would be lowered, but radiopharmaceuticals used by nuclear cardiologists and contrast agents employed by echocardiographers will not be affected by these changes because they are not classified as drugs.

Electronic Claims Only to Medicare After Oct. 16
The CMS has reiterated that only electronic claims will be accepted and paid by Medicare beginning on Oct. 16—the deadline for compliance with the transaction and code set regulations. Some small providers are exempted from this requirement. In an interim final rule, the CMS notes that there are very few exceptions to the electronic-only edict, including interruptions in electronic claims submission mechanisms that are outside a provider’s control or "extraordinary circumstances precluding submission of electronic claims." Last week, the ACC began a series of meetings on Capitol Hill to discuss the need for further clarification from the CMS on its policies and interpretation of the transactions and code sets rule. For more information, visit the ACC HIPAA Resource Center.

Texas Physicians Pushing Proposition to Allow Noneconomic Damage Caps
Texas Gov. Rick Perry, R, has joined calls from physician groups in the state urging the public to vote in favor of a ballot measure on medical liability reform. The measure, Proposition 12, would allow the state's constitution to be amended to allow laws that place caps on noneconomic damages in medical liability lawsuits. The vote on the ballot measure vote is scheduled for Aug. 27. The ACC Texas Chapter has worked closely with the Texas Medical Association on medical liability reform efforts and has been deeply involved in fundraising and other activities to encourage the public to vote in favor of Proposition 12.

First OIG Review of Cardiac Rehab Finds Lack of Physician Oversight
In the first of a series of reviews of Medicare payments for hospital outpatient cardiac rehabilitation services, the HHS Office of Inspector General (OIG) faulted Saint Luke’s Medical Center in Milwaukee on several fronts. The CMS requested that the OIG review cardiac rehab services at facilities across the country. The goal of these studies is to assess the amount of physician involvement in cardiac rehabilitation, which is currently covered as a physician service. In the review, the OIG faulted the hospital for failing to designate a physician to directly supervise the cardiac rehab services and said that it could often not identify the physician professional services to which the cardiac rehabilitation services were provided “incident to.” The OIG estimated that the hospital claimed and received more than $47,000 in improper Medicare reimbursement for outpatient cardiac rehabilitation services. The ACC is developing a response to this report.

Appropriations Amendments Would Significantly Increase NIH Funding
ACC members are encouraged to contact their senators in support of efforts to increase NIH funding for FY 2004. As currently written, the Senate HHS appropriations bill would give the NIH about a 3.7 percent boost in FY ’04, or approximately $1 billion. The House bill, which has already been passed, includes a similar increase. An amendment to the Senate appropriations bill to be introduced by Sens. Arlen Specter, R-Pa., Tom Harkin, D-Iowa, and Dianne Feinstein, D-Calif., would increase funding for the NIH by 9.2 percent over the current level of $26.9 billion. The amendment will be debated as early as September 2. ACC members can easily contact their senators using the ACC grassroots advocacy tool on the ACC Web site or by calling toll-free at (877) 432-7841.

Specialty Hospitals Trying to Oust Medicare Reform Bill Language Limiting MD Involvement
Specialty hospital groups are engaged in a pitched lobbying battle to eradicate language in the Medicare reform legislation being debated in Congress that would limit physician investment in such hospitals. The enactment of the limitation, some analysts have said, would be the death knell for the burgeoning industry. While the House-passed Medicare bill calls for more study of specialty hospitals and their role in patient care, the Senate bill includes a provision that would prevent physicians from referring patients to specialty hospitals in which the physicians have an interest. It would exclude those hospitals already in existence or under construction as of June 12, 2003. According to a Health News Daily report, both The MedCath Corporation, which owns and operates many cardiovascular care hospitals, and the American Surgical Hospital Association have been active in opposing the Senate bill. The American Hospital Association has launched its own campaign in favor of the Senate bill provision.

FDA Warns Philips About MR Device Cardiac Perfusion Promotional Language
The FDA has issued a warning letter to Philips Medical Systems about “false and misleading” information in promotional language about its Intera magnetic resonance imaging device. The language is misleading, the warning letter states, because it “implies that these devices have been cleared or approved by FDA for use with contrast agents in cardiac perfusion.” The letter cites several places on the Philips Web site where use of the device for cardiac perfusion studies is discussed. “Philips has not been granted clearance or approval from FDA for use of these devices for cardiac perfusion,” the letter states, “and there are currently no contrast agents approved for use in imaging of the heart in the United States.” The agency gave Philips 15 days to submit the corrective actions it plans on taking in light of the letter.

Advocacy Weekly will not be published next week because of the Labor Day holiday.