American College of Cardiology

BREAKING NEWS: Medicare Fee Schedule Released
The 2003 Medicare fee schedule was released on Dec. 20 and, as expected, includes a 4.4 percent reduction in physicians' Medicare fees. Because of efforts by the ACC, for the first time in many years, most cardiologists will fare better than their colleagues by about 1 percent. How individual cardiologists will be effected, however, depends on their mix of services. Payments for services provided in the office are scheduled to fall by about 2 percent and services provided in hospitals are scheduled to fall about 6 percent. The effective date of the 2003 fee schedule is March 1. "In the rule we are announcing today, CMS has done everything it can to shore up physician payments for 2003, but only Congress has the authority to fix the formula," said CMS Administrator Tom Scully. The CMS refined the methodology for calculating the rate of inflation in providing physicians' services by adjusting the measure of productivity. As a result, physicians will see a reduction of 4.4 percent rather than the 5.1 percent reduction that would have occurred without the change. "These methodological adjustments translate into an additional $14.5 billion in Medicare payments to physicians over the next 10 years," Scully noted. An ACC analysis of the final rule's impact on cardiovascular specialists will be available soon. In addition, members should be receiving a letter from ACC President Bruce Fye, MD, addressing the fee cuts and how the College is working to address them.

CMS Instructs Medicare Carriers To Continue Paying at 2002 Rates
The CMS has instructed Medicare contractors to pay all claims submitted after Jan. 1, 2003, at 2002 rates, with the exception of any new 2003 HCPCS codes. The CMS encouraged physicians not to submit new 2003 HCPCS codes for services performed until the 2003 Medicare fee schedule takes effect on March 1. Medicare contractors must suspend payment for any claims submitted after the first of the year that contain new 2003 CPT or HCPCS codes for services paid under the physician fee schedule. Claims filed with both 2002 and new 2003 codes will be held until March 1, when the fee schedule becomes effective.

Survey Seeks Physician Input on Impact of Medicare Cuts
The American Medical Association (AMA) is conducting a Web-based survey to determine whether Medicare access problems are increasing for patients because of past and projected payment reductions. The collected data will be used in the ongoing efforts to enact legislation to prevent further cuts in physicians' Medicare fees. Because issues of patient access differ across specialty lines, it is important that the data reflect the practices and experiences of all specialties. Physicians who would like to participate must register on the AMA Web site and then will receive a copy of the questionnaire by e-mail.

United Reverses Course on Inappropriate MPI Payment Policy
United Healthcare has notified the ACC and American Society of Nuclear Cardiology (ASNC) that it will correct an onerous reimbursement policy that exists in selected regions. The current policy only reimbursed for the exercise portion of myocardial perfusion imaging and not for the rest portion of the procedure. United based its policy reversal on detailed information submitted by Greg Thomas, MD, chair of the ASNC Community Based Practice Committee, about the differences between these portions of the test.

Member Feedback Requested on Improper Bundling
As part of an ongoing effort by the ACC to address issues related to improper/inappropriate bundling by third-party payers, the College met recently with McKesson Corp., an information technology company that develops the claims editing software used by 80 percent of private-sector health plans. McKesson has expressed a strong interest in learning more about cardiovascular procedures and what is involved in providing these services to patients. In response, the ACC is working to identify procedures that health plans inappropriately bundle into other payments. ACC members are encouraged to submit examples of improperly bundled procedures to the College via the ACC Web site. All information will remain confidential. For more information, contact Kathy Flood by phone at (301) 897-2607 or via email at kflood@acc.org.

Thompson Calls for Medical Liability Reform at Fla. Forum
HHS Secretary Tommy Thompson last week called for "common-sense reform" in medical liability laws. Speaking at a town hall meeting in Jacksonville, Fla., Thompson said liability reform is desperately needed in the health care system, the Florida Times-Union (Jacksonville) reported. Chances of federal liability reform legislation passing in 2003 are good, Thompson added. "I think the stars are aligned correctly." Earlier this year the Bush administration released a blueprint for medical liability reform that included caps on damages in medical malpractice cases and other reforms supported by the ACC and other physician organizations. Congressional insiders are predicting that medical liability reform legislation could pass the House within the first three months of 2003. However, intense lobbying and grassroots efforts by the physician community will be necessary if medical liability reform legislation is to ever reach the president's desk.

DOJ Orders 1,100-Physician IPA to Dissolve
An 1,100-member independent physician organization in North Carolina has been ordered by the Justice Department to cease operations and dissolve for engaging in anticompetitive behavior. According to the Justice Department, the Ashville-based Mountain Health Care "restrained price and other forms of competition among physicians in Western North Carolina by adopting a uniform fee schedule governing the prices of its participating physicians." The Justice Department said that physicians and physician groups in the IPA that normally would have competed with each other adopted a uniform price schedule and authorized Mountain Health Care to negotiate with health plans on their behalf. The result was "higher rates charged to health plans leading to higher health costs for ultimate consumers." The order must still be approved in U.S. District Court.

Mass. BCBS Plan Launches Physician Bonus Initiative
Beginning in January, Blue Cross and Blue Shield (BCBS) of Massachusetts will launch a program through which it will pay bonuses to physician practices with which it contracts. Bonuses will be paid based on improvements in quality of care, ability to control costs, and patient satisfaction. The insurer already has a more limited quality bonus program in place. This expansion will initially involve about half of the physicians who contract with BCBS in the state, with the goal of enrolling all of its physicians. Some physicians have voiced concern with the program, the Boston Globe reported, arguing that money that might normally be allocated to annual increases in reimbursement will be diverted to bonus payments—something that BCBS admitted could happen.

Public Report Shows Pa. Hospital Performance Improving
Improvements were seen in in-hospital patient mortality rates for 10 of 11 common procedures and in hospital length of stay for 9 of 12 treatment groups, according to a report released last week by the Pennsylvania Health Care Cost Containment Council (PHC4). The report is available on the PHC4 Web site and provides hospital-specific information on facilities' performance in areas such as diagnosing myocardial infarction and heart failure and angioplasty/stent placement. Other measures covered in the report include case volume; risk-adjusted mortality, average length of stay, and readmissions for any reason; and average charges. Pennsylvania has been one of the most aggressive states in terms of public reporting of treatment outcomes. "Hospitals and physicians continue to improve the quality of care they provide, and the patients are the winners," said Marc P. Volavka, Executive Director of PHC4. "The process of public reporting is making a difference in Pennsylvania."

Advocacy Weekly will not be published next week. Have a safe and happy holiday.