American College of Cardiology

Bush FY '04 Budget Includes Fix for Physician Medicare Fee Schedule
President Bush's FY 2004 budget proposal contains a provision to adjust the formula used by Medicare to make annual updates to physicians' fees by using actual cost data instead of estimates of the gross domestic product. The ACC and other physician groups have long argued that tying the formula to the gross domestic product is a major flaw because it punishes physicians for downturns in the economy, even as their costs continue to increase faster than the general rate of inflation. The change would prevent the cuts in physicians' Medicare fees forecasted for 2004 and 2005. The cost of the provision has been estimated to be $30 to $40 billion over 10 years.

ACC-Supported Liability Reform Bill Reintroduced in House
Rep. James Greenwood, R-Pa., has reintroduced federal liability reform legislation that is strongly supported by the ACC and other physician groups. The bill, dubbed the Help Efficient Accessible, Low-Cost, Timely Health Care Act—or HEALTH Act—would limit the number of years a plaintiff has to file a medical liability suit, allocate damages in proportion to a party's degree of fault, and cap noneconomic damages, such as pain and suffering, at $250,000. President Bush has endorsed the bill. It was passed by the House in the 107th Congress but was not taken up by the Senate. While there is strong support among the GOP for medical liability reforms along the lines of those included in the HEALTH Act, the Associated Press reported that some key Senate Republicans have indicated that a $250,000 cap on noneconomic damages could hinder the bill's chances of passage. "We're going to have to pass a bill that going to be a little weaker in some respects," said Sen. Rick Santorum, R-Pa.

CMS Responds to Questions about Payments Under 2003 Fee Schedule
The Center for Medicare and Medicaid Services (CMS) has posted a question-and-answer document on its Web site in response to questions about the delay in 2003 fee schedule and physician reimbursement. In addition to the question-and-answer document—available at http://cms.hhs.gov/physicians/physicianques2.pdf—the CMS has also posted a related Program Memorandum B-03-011. Visit the Physician and Health Care Practitioners section of the CMS Web site for updates to this document. Details on the 2003 Medicare fee schedule and updates on legislative efforts by the ACC and other physician groups to prevent further cuts in Medicare fees are available on the ACC Web site in the "Fight Medicare Fee Cuts" resource center.

N.J. Physicians Wary of Proposed Compromise on Liability Reform
A job action involving thousands of physicians in New Jersey continued to garner headlines last week and—more importantly—appears to have succeeded in getting state lawmakers to act on medical liability reform legislation. But some physicians are questioning whether the compromise would actually do anything to curtail frivolous lawsuits. Under the compromise, damages for pain and suffering paid by liability insurers would be capped at $300,000, with the remainder of awards in the excess of that amount to be covered by a state-administered catastrophic fund, the Star-Ledger (Newark) reported. The fund would be financed by surcharges on health insurers, physicians, and trial lawyers. Medical Society of New Jersey President Robert S. Rigolosi, MD, responded to the compromise, saying that the physician group had not yet seen any details of the compromise in writing and that they "remain cautious about any approach that may set up a system of unlimited and inadequately funded compensation." There were some media reports late in the week that, even before the proposed compromise was announced, the physician job action was waning. Dr. Rigolosi noted, however, that the "slowdown" would continue until physicians felt that "progress has been made."

One More Try for A Patients' Bill of Rights?
Rep. Charlie Norwood, R-Ga., has introduced two bills in an attempt to once again pass patients' rights legislation—an effort that has proved futile for the better part of the last decade. According to a Reuters Health report, the first bill, dubbed the "Patient Protection Act," provides many of the protections included in previous versions of the bill, including unfettered access to specialty care. It does not contain, however, a provision on the one issue that has consistently stalled patients' rights legislation in previous years—the right to sue managed care plans. "I'm no longer trying to forge a compromise on liability," Rep. Norwood said. "In the end, all I got was a few hundred beatings and no law." The second bill, the "ERISA Clarification Act," would clarify that ERISA does not bar a patient from suing health plans in state court for medical-based coverage decisions that result in injury.

Missouri Physicians Use "White Coat Day" to Call for Reform of Liability Law
Physicians in Missouri recently held a "White Coat Day" to rally at the state capital to urge legislators to pass legislation to rein in escalating medical liability insurance rates. Media reports indicated that more than 750 physicians participated in the event, which was partly organized by ACC PAC Vice Chair Jerry Kennett, MD. Dr. Kennett is also chair of the Missouri State Medical Association Government Relations Committee. Missouri physicians are supporting legislation that has been introduced in the state Senate and House that, among other things, would cap noneconomic damages at $250,000 and $350,000, respectively. Missouri already has a cap on noneconomic damages that is adjusted annually for inflation. For 2003, the cap is $557,000. Missouri Gov. Bob Holden, D, in issuing his own, less-extensive liability reform proposal last week, argued that further caps on noneconomic damages are not needed. Physicians argue, however, that the cap is ineffective because it is not limited to one defendant, meaning that plaintiffs can recover up to the amount of the cap for each defendant in the lawsuit.

CMS Revises Policy on ABPM Interpretation
The CMS has announced a policy change under which physicians will be required to perform the interpretation of the data obtained through ambulatory blood pressure monitoring (ABPM). Under the revised policy (Coverage Issues Manual policy section 50-42), however, there are no requirements regarding the setting in which the interpretation is performed. In September 2001, the CMS announced a limited national coverage policy for ABPM for patients with so-called white coat hypertension.