American College of Cardiology

ACC Testifies at Senate Hearing on Medicare Reimbursement
There was broad agreement at a Senate committee hearing last week that the Medicare reimbursement system is in serious need of reform. Sen. Arlen Specter, R, Pa.—who called the hearing as chair of the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies—described the way Medicare reimburses physicians as "behind the curve." CMS Administrator Tom Scully, as he has done repeatedly over the past several months, said that the reimbursement system for physicians was "imploding" and "badly needs to be fixed." Testifying on behalf of the ACC and the Alliance of Specialty Medicine, ACC Advocacy Committee member Jay Kleiman, MD, MPA, told the committee that any fix to this problem must come soon. "The ultimate victims of this brewing catastrophe are patients," Dr. Kleiman said. Sen. Specter criticized the CMS for its use of 1996-1998 data in calculating the medical liability insurance component of the Medicare fee schedule. He advised Mr. Scully that he intends to direct CMS to find more current data to update medical liability relative value units.

More Physicians Walking Off Job to Protest Liability Insurance Hikes
What began as a decision by some surgeons in West Virginia earlier this month to take leaves of absence to protest liability insurance has turned into a full-fledged trend in a matter of weeks. Last week, surgeons in Mississippi took leaves of absence because of the liability insurance crisis, and anywhere from 800-1,000 physicians in Florida left their offices for two days this week to attend a symposium on liability insurance sponsored by the Palm Beach County Medical Society. Physicians in New Jersey are scheduled to stage a "job action" this week, refusing to see any nonemergency patients. With so many physicians off the job, emergency rooms have gone into full alert mode, expecting to see a flood of patients who couldn't get in to see their regular doctor. There has been some criticism of physicians for these activities and there are concerns about the economic impact on some hospitals because of loss of income from surgeries and other procedures. But those participating in the actions have argued that they have no choice. "I'm not happy having to do this," one New Jersey surgeon told the Philadelphia Daily News, "and I never thought when I went to medical school 25 years ago that this is the kind of battle I would have to face."

Acceptance, Use of Clinical Practice Guidelines Growing
A new survey indicates that clinical practice guidelines are finding more acceptance among physicians. In a survey conducted by the Center for Studying Health System Change, clinical practice guidelines "influenced" more than half of the physicians surveyed, with nearly two-thirds of those physicians reporting that the guidelines had a positive influence. The study found similar positive results for patient satisfaction surveys, with 62 percent of physicians reporting that patient satisfaction surveys had a moderate, large, or very large effect on their practice of medicine, with 77 percent of affected physicians rating the use of patient surveys positively.

Pa. Liability Reform Law Being Put to the Test
Even as physicians in Pennsylvania are fighting for stronger medical liability reform laws, the one already on the books—passed in March 2002—is being challenged on two fronts in the state courts. The law withstood the first challenge last week, Modern Physician reported. The Pennsylvania Supreme Court ruled in favor of the provision in the law that requires plaintiffs who wish to bring a malpractice suit to obtain a "certificate of merit" from a physician with expertise in the suit's subject matter. A second challenge to the law is now being heard in a lower court. According to a Philadelphia Daily News report, the suit is challenging the provision in the law that bars expert testimony from a physician who has not practiced in or taught about the same specialty in question within five years of the suit being brought.

WellPoint, CareFirst to Merge
Two Blue Cross and Blue Shield (BCBS) plans moved a step closer to a sizable merger last week. The boards of directors for WellPoint Health Networks and CareFirst approved WellPoint's $1.37 billion takeover deal of Carefirst. California-based WellPoint operates BCBS plans in California, Missouri, and Georgia. CareFirst, which is based in Maryland, operates BCBS plans in Maryland, Delaware, the District of Columbia, and northern Virginia. Because of legislation passed last year in Maryland, WellPoint had to pay the entire takeover price in cash. The deal must now be approved by the Maryland insurance commissioner, a decision that is subject to review by the Maryland General Assembly.

'Improper' Medicare Payments Remain Stable for 2002
The rate of improper Medicare payments has remained stable for the past two years at 6.3 percent or $13.3 billion, the HHS Office of Inspector General (OIG) reported last week. The improper payment rate estimates the portion of Medicare fee-for-service payments that do not comply with all Medicare laws and regulations. Improper payments include those for services determined to be "medically unnecessary," that have documentation deficiencies, or that were miscoded. When the OIG began calculating improper payment rates in 1996, the rate was 13.8 percent. The sample used by the OIG to estimate the improper payments rate from 1996 to 2002 has been based on a "small but statistically valid number of Medicare beneficiaries and claims," the agency said. In 2002, it examined 4,985 claims filed on behalf of 610 beneficiaries nationwide. Beginning in fiscal year 2003, however, the improper payment rate will be calculated based on approximately 120,000 claims nationwide, a process that from now on will be handled by the CMS using the Comprehensive Error Rate Testing (CERT) program.