American College of Cardiology

ACC Action Helps, But 2003 Medicare Fees Still Cut
Thanks to ACC efforts, the 2003 Medicare fee schedule released on Dec. 27 offers a somewhat better picture for cardiovascular specialists than for other physicians. In the absence of congressional intervention to avert the cuts, while the average cut will be 4.4 percent, average cardiology fees will decline only by 3.5 percent. According to an ACC analysis of the fee schedule:

• average echocardiography fees will decline 2.0 percent
• average heart rhythm fees will decline 3.6 percent
• average nuclear fees will decline 1.6 percent
• average interventional fees will decline 5.3 percent
• average general cardiology fees will decline 4.0 percent.

A detailed summary of the 2003 fee schedule and procedure-by-procedure breakdown (Excel file) of its impact on cardiovascular specialists are now available on the ACC Web site in the "Fight Medicare Fee Cuts" resource center.

As 108th Congress Convenes, Fight to Avert Further Cuts Goes Into High Gear
With Congress set to reconvene this week, the ACC, both on its own and in conjunction with the Alliance of Specialty Medicine, will step up its ongoing efforts to avert further Medicare cuts. College representatives focused their efforts in December on talks with White House officials and key Capitol Hill staff about halting the payment cuts. With Congress back in session, there will be an emphasis on grassroots and lobbying activities, including town hall meetings in congressional districts. ACC members who are interested in organizing or attending such a forum should call the ACC Advocacy Division at 800-435-9203 and staff can help start the organizing process and/or connect members with activities that are already under way in your state. The ACC is also working with ACC Governors and chapter presidents in each state to publish op-eds in newspapers and will be calling upon all ACC members to contact their legislators once Congress convenes.

New Tool Available for Members to Educate Patients about Impact of Medicare Cuts
The ACC has created a flyer for members to use to educate their patients about and enlist their help in the fight against further reductions in Medicare fees. The flyer is available in a downloadable PDF format so that it can be easily reproduced on either a black-and-white or color printer. Members are encouraged to print copies of the flyer and leave them in their waiting rooms and other places for their patients to read. The flyer, along with updated key messages and talking points for members to use with legislators, is available in the "Fight Medicare Fee Cuts" resource center on the ACC Web site.

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.

Rx Companies Raise Objections to Compliance Guidelines
Pharmaceutical manufacturers have submitted comments to the Department of Health and Human Services (HHS) objecting to many components of the draft compliance program guidelines for the industry issued by the Bush Administration last year. The guidelines address practices, including financial incentives, that could violate anti-kickback statutes. According to a New York Times report, the manufacturers and their umbrella organization, PhRMA, have argued that the rules fail to appreciate long-established, standard "industry practices," including providing discounts to health plans and pharmacy benefit managers as rewards for creating "shifts in market share" toward their products. In comments submitted to the HHS last November on the draft guidelines, the ACC argued that the guidelines could have "unintended consequences for medical education and ultimately the delivery of quality health care" because industry may shy away from sponsoring educational programs conducted by medical societies out of fear of violating kickback laws.

NIH Could See Only Minimal Increase Under Bush '04 Budget
Under President Bush's forthcoming budget proposal for 2004, the National Institutes of Health (NIH) could see a budget increase of as little as 0.3 percent, the Wall Street Journal reported last week. As it currently stands, the president's proposed budget, to be unveiled on Feb. 3, will contain an increase for NIH of less than 1 percent, the Journal reported, and could be as low as 0.3 percent. Beginning in the Clinton administration, Congress committed to doubling the NIH budget by 2003, something the Bush administration has also supported. When Congress reconvenes this week, they are expected to take up the 2003 appropriations bills they failed to act on in 2002, including a bill that would increase the NIH 2003 budget by 15 percent and fulfill the commitment to double the budget in five years. Current budget shortfalls, however, have led many on Capitol Hill to speculate that Congress could pass the legislation with a lower funding level.

Pa. Gov.-Elect Announces Major Changes to Address Liability Insurance Crisis
Pennsylvania Gov.-elect Ed Rendell, D, last week announced a series of short-term measures aimed at addressing the state's mounting medical liability insurance crisis. The most radical of the changes is legislation that Rendell will send to the General Assembly on Jan. 22 that would completely cover high-risk specialists' costs of purchasing state-provided liability insurance for claims up to $1 million, known as MCARE, and cover 50 percent of MCARE costs for all other physicians. The more than $200 million cost of the proposal would be funded by a one-time emergency assessment on surpluses held by all companies writing health insurance in Pennsylvania, including all four Blue Cross plans. The assessment would vary depending on the insurers' surplus levels. The plan also calls for the reintroduction of a bill to subsidize the cost of trauma center operations, require an independent physician to certify the validity of any malpractice suits before they could be brought, and calls on health insurers to increase their reimbursements to physicians. The proposal was enough, at least temporarily, to prevent hundreds of physicians from going through with a threat to walk-off the job in protest of the skyrocketing liability insurance rates.

W. Va. Surgeons Hold Work Stoppage to Protest Liability Insurance Hikes
While a work stoppage was averted in Pennsylvania, surgeries at four West Virginia hospitals in the Wheeling vicinity are being cancelled following the departure from those facilities of more than two dozen surgeons, mostly in the form of 30-day leave of absences. "The problem just grows every day," one of the surgeons, Greg Saracco, MD, said on CBS' 'The Early Show.' "Physicians no longer want to come to work. Physicians are afraid to accept liability." Although emergency rooms at the four hospitals remain open, the Charleston Daily Mail reported, there are few emergency surgeons available to treat emergent patients. Late in the week, the hospitals were transferring emergent patients in need of surgery to hospitals in Morgantown, Ohio, and Pennsylvania.