American College of Cardiology

FEE CUTS AVERTED! Appropriations Package Provision Turns 4.4% Cut into 1.6% Increase
In perhaps the biggest legislative victory for physicians and their patients in recent memory, Congress has passed a provision as part of the omnibus FY 2003 appropriations package that will avert another cut in physicians’ Medicare reimbursement and instead provide a modest increase of 1.6 percent. Importantly, because of ACC-recommended technical corrections in the fee schedule, most cardiovascular specialists will receive a slightly larger increase of 2.2 percent on average. For further details, please read the complete member alert issued by the ACC on Friday, Feb. 14 at www.acc.org/advocacy/advoc_issues/alert_021403.htm.

Medical Liability Hearing Draws Calls for Reform, But No Agreement on Best Solution
The debate over medical liability reform took center stage last week at a Senate hearing, with little agreement on the best solution for fixing what most consider a broken liability reform system. "We, at the federal level, absolutely must respond to this crisis," Senate Majority Leader Bill Frist, R-Tenn., told the Senate Health, Education, Labor and Pensions Committee. Sen. Edward Kennedy, D-Mass., the ranking Democrat on the committee, argued against reforms that include tight caps on noneconomic damages, the Associated Press reported. Such damages "compensate victims for the very real, though not easily quantifiable, loss of quality of life that results from a serious permanent injury." The physicians who testified countered that reasonable caps on noneconomic damages are essential to liability reform. "Liability isn't about fault or bad practice," said Shelby L. Wilbourn, MD, an OB-GYN who relocated her practice from Nevada to Maine because she couldn't afford the increase in her liability reform premiums. "It's about hitting a jackpot."

Democrats Pursue Insurance Industry Reform To Curtail Liability Crisis
Meanwhile, a handful of Democratic senators have introduced a bill that aims to curtail skyrocketing medical liability premiums through insurance industry reform. The "Medical Malpractice Insurance Antitrust Act of 2003" would amend current law that exempts insurance companies from many federal antitrust laws, a move that the bill's primary sponsor, Sen. Patrick Leahy, Vt., said would prevent commercial insurers from implementing sharp increases in liability premiums. Sen. Leahy also argued against tort-reform focused federal medical liability legislation. "Each state should endeavor to develop its own solution to rising medical malpractice insurance rates because each state has its own unique problems," he said. According to an Associated Press report, Rep. Joseph Hoeffel, Pa., is expected to introduce a bill similar to Sen. Leahy's, but with a $1 million cap on noneconomic damages. Rep. Jim Greenwood, R-Pa., has introduced an ACC-supported bill that would cap noneconomic damages in liability cases at $250,000. For up-to-date information on this issue—including talking points and fact sheets—visit the "Medical Liability Reform" resource center on the ACC Web site.

Caring for Uninsured Costs U.S. $35 Billion
Patients in the United States without health insurance received approximately $35 billion in uncompensated care in 2001, according to a new study. The study—conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU)—found that of the $35 billion spent on caring for the uninsured, approximately $31 billion represents federal, state, and local government funds. "This report demonstrates that we are already paying a substantial amount to care for a large uninsured population without a guarantee of coverage," said Diane Rowland, executive director of KCMU. "The implication is that we pay for care in the least efficient way possible—after people get sick and need emergency or hospital care."

Advisory Committee Recommends Medicare Coverage of Prophylactic ICD Use
The Medicare Coverage Advisory Committee (MCAC) recommended last week that Medicare coverage of ICDs be expanded to include prophylactic use in patients who meet the inclusion/exclusion criteria of the MADIT II trial. Published last March, the MADIT II trial found that patients with a previous MI and an ejection fraction of 30 percent or less who received an ICD had a 31 percent reduced risk of mortality compared to those on optimal medical management. Given the broad population of Medicare beneficiaries who fall into this category, concerns have been raised about the potential economic implications if there is a sudden, sharp increase in patients receiving ICDs—the cost of which is in the $30,000 to $40,000 range. Gabriel Gregoratos, MD, testifying on behalf of the ACC, discussed the ACC/AHA/NASPE's guidelines on ICD/pacemaker implantation released last September, which gave a Class IIa recommendation for ICD use in patients who meet the MADIT II criteria. Several ACC members were on the MCAC panel in both voting and nonvoting roles.

House Committee Passes Medical Error Reporting Bill
The House Energy and Commerce Committee has unanimously approved the "Patient Safety and Quality Improvement Act," a bill that would create "patient safety organizations" to which health care providers would voluntarily and confidentially submit reports on medical errors. Under the bill, legal protections would be offered to those who submit error reports. The bill would also allow for grants to hospitals for information technology investments aimed at improving patient safety. This same bill was introduced in both the House and Senate last year. The ACC offered conditional support for it. A House Ways and Means Committee representative told Health News Daily that the committee will work with the Energy and Commerce Committee to bring the "Patient Safety and Quality Improvement Act" to the House floor.

NY, Conn. Physicians To Protest Liability Premium Hikes
Physicians in New York and Connecticut next month are planning to join the ranks of their colleagues in states like Ohio and Missouri and hold rallies and lobbying days at their state capitols in protest of skyrocketing medical liability premiums. "Our physicians are more and more angry," Lynda Lee Adams, a spokesperson for the Medical Society of the State of New York, told the New York Times. There are no plans by the physicians, however, to engage in walkouts or "job actions" like the ones recently seen in New Jersey, Mississippi, and West Virginia. The physicians in both states support legislation that would place a $250,000 cap on noneconomic damages.

ACC Testifies on Need for Federal Support of Smoking Cessation
The ACC testified before the Surgeon General and the Interagency Committee on Smoking and Health last week on the need for stronger federal support of smoking cessation programs and initiatives. The College supported a recommendation for the government to create an action plan for the Secretary of Health and Human Services to promote tobacco use cessation and stressed the importance of ensuring that any resulting programs address clinician training, including the background information and training needed to counsel patients.