MedPAC
Steps Closer to Imaging Recommendations for Congress
Last week the Medicare Payment Advisory Commission (MedPAC)
discussed draft recommendations on strategies for managing
the use of imaging services in fee for service Medicare. While
in-office ancillary exception was not explicitly named in
draft recommendations, MedPAC is likely to recommend that
Medicare establish imaging standards through accreditation,
credentialing, and privileging for all imaging providers.
The ACC has aggressively lobbied MedPAC commissioners and
staff to conduct a thorough, balanced and well-documented
analysis before making recommendations. Suma Thomas, M.D.,
F.A.C.C., spoke
to the commission for the ACC. MedPAC is also deliberating:
the sustainable growth rate (SGR) formula, resource use measurement
(or physician profiling), and pay for performance. The ACC
along with other physician organizations sent a letter to
MedPAC recommending against pay for performance without making
new funding available. Transcripts from the meeting will be
available at http://www.medpac.gov.
Payer
Imaging Decisions Weigh Heavily on Cardiologists
Radiologists continue to make their presence known
in the imaging decision-making arena. The American College
of Radiology (ACR) and UnitedHealth Group announced a joint
initiative in which UnitedHealth Group will utilize the American
College of Radiology Appropriateness Criteria and Accreditation
Program to create a tiered imaging network. UnitedHealth Group,
the nation’s largest insurer has begun pilot-testing
initiatives in what will likely be a multiyear phase-in. 1199SEIU
National Benefit and Pension Funds has initiated “exclusive”
and “preferred” agreements with MedFocus Radiology
Network, a national provider. Effective immediately SEIU providers
across the country are requested to refer all radiology tests
to a MedFocus radiology site.
Bush
Nominates EPA Chief for HHS
President Bush has nominated Mike
Leavitt, administrator of the Environmental Protection
Agency and former governor of Utah, to replace Tommy Thompson
as Secretary Of Health And Human Services. Leavitt, who has
been at EPA only a year, apparently shares Bush's enthusiasm
for technological and market-based approaches to fixing problems
and will take that philosophical approach to HHS.
CMS
Announces Medicare Advantage Regions
The Centers for Medicaid and Medicare Services
have announced the coverage regions for insurers to consider
in bidding to participate in the Medicare Advantage and prescription
drug programs for 2006. CMS’
map divides the country into 34 regions for prescription
drug plans and 26 regions for Medicare Advantage. Insurers
may bid in one or all of the regions. The largest region comprises
seven states. CMS chief Mark McClellan feels confident that
the regions, as planned, will provide enough private insurers
to ensure competitive drug pricing and access to medical care
for all Medicare recipients in rural, urban or suburban locations.
Medicare,
Medicaid Pay More than Half for Seniors
According to a new CMS study on health spending estimates,
Medicare and Medicaid combine to cover approximately 61 percent
of the average yearly medical expenditures for people 65 or
over. The average person in the United States spends $3,834
in personal health goods and services. People 65 or older,
who represent 13 percent of the population, average $11,089
a year in spending or 36 percent of national health care consumption.
The study, based on 1999 numbers, was prepared by the CMS
Office of the Actuary and is published online
by Health Care Financing Review. The last study of health
care spending by age was 1989. Specific age data can be found
at http://www.cms.hhs.gov/statistics/nhe/age.
FDA
Issues Warning on Bextra Use with CABG
Citing results from a Pfizer-conducted study of its
NSAID drug Bextra, the FDA
has called for a new bolded label warning contraindicating
the use of Bextra in patients undergoing coronary artery bypass
graft surgery. Pfizer reported to the FDA in November that
its results showed increased cardiovascular risk in patients
post-surgically treated with Bextra compared to placebo. The
FDA is planning to seek input from the public and outside
experts on appropriate uses of Bextra and other NSAIDs at
a previously announced Advisory Committee meeting to be held
in January 2005.
Medical
Liability Reform in Washington State Unresolved
Because tort reform efforts in the state legislature reached
a political impasse at the end of the 2004 session, the Doctors
for Sensible Lawsuit Reform group in Washington state
have been collecting the signatures needed to send a bill
for medical liability reform, I-330 or the Health Care Access
Initiative, to the state legislature for a vote. If the petition
gathers 197,734 valid signatures by the end of 2004, the state
legislature will be forced to approve it or put it on the
ballot in 2005 and let the voters decide its fate. I-336,
a rival initiative developed by the lawyer activists in the
state, submitted its petition to the secretary of state on
Dec. 3, 2004, with an excess of 200,000 signatures. Supporters
of I-330 feel confident that they will have the necessary
signatures before the end of the year.
Advocacy
Weekly is a product of the Advocacy Division of the American
College of Cardiology. Questions or comments regarding this
publication should be directed to the Advocacy Division at
800-435-9203 or to advocacydiv@acc.org.
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