American College of Cardiology

Bill Introduced to Freeze Physician Medicare Fees at 2002 Rates
A bill introduced on Jan. 7 by House Ways and Means Committee Chair Rep. Bill Thomas, R-Calif., would prevent implementation of the 2003 Medicare fee schedule and freeze physicians' Medicare fees at 2002 rates for one year. The bill takes advantage of the Congressional Review Act of 1996 (CRA), under which Congress may disapprove a rule issued by a federal agency by passing a joint resolution of disapproval. "It is critical that we modernize Medicare so that reimbursements more accurately reflect the market," Rep. Thomas said in introducing the bill. "One of the biggest problems is that physicians face significant and successive payment cuts that could harm patients' access to care." Under the CRA, a joint resolution requires only a simple majority in each chamber for passage. In addition, consideration of a CRA can be expedited through the Senate because it cannot be amended or filibustered.

The ACC is working with the Alliance of Specialty Medicine to formulate a strategy in response to the legislation. Last week, ACC representatives were in Washington, DC, for a physician legislative "fly-in" and were meeting with key congressional offices to gather further information on the approach and to gauge Senate reaction to the House strategy (see story below).

Rep. Thomas was not alone in introducing legislation to help physicians. Rep. Benjamin Cardin, D-Md., has introduced the Medicare Payment Restoration and Benefits Improvement Act, a nearly identical bill to one passed by the House last year that would give physicians a 2 percent increase in Medicare fees in 2003 and create special rules for determining the update for 2004 and 2005. The bill also has provisions that would increase funding for in-patient hospital services, home health services, and preventive services such as cholesterol screening. Rep. Cardin is the senior Democrat on the Ways and Means Committee.

Details on the 2003 Medicare fee schedule, which becomes effective March 1, are now available on the ACC Web site. In addition, 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 includes an 800-number that patients can call that will connect them directly with their members of Congress. Please be advised that, at this point, this number is only scheduled to be active until Jan. 20, 2003. This deadline may be extended, however, and members are encouraged to check Advocacy Weekly next week for more information. For the most up-to-date information on this issue, visit the "Fight Medicare Fee Cuts" resource center on the ACC Web site.

Physicians Converge on Capitol Hill to Lobby Against Fee Cuts
Just one day after the swearing in of the 108th Congress, nearly 100 physicians converged on Capitol Hill as part of a coordinated legislative "fly-in" to urge lawmakers to stop implementation of another round of Medicare fee cuts. Participating in this sweeping lobbying effort was former ACC President Sylvan Weinberg, MD, and Jay Kleiman, MD, who joined the president and president-elect of the American College of Physicians-American Society of Internal Medicine in at least 15 meetings with key members of Congress and their staff. The meetings revealed that most lawmakers remain supportive of helping physicians avoid another round of Medicare fee cuts, but that helping physicians without also helping other health care providers will be a significant obstacle. Drs. Weinberg and Kleiman reminded Hill staffers that the plight of physicians differs from other providers in that the cuts are a result of a mistake made by the government, a mistake that requires Congress' help in order to be corrected.

Illinois Chapter Leads Public Forum on Impact of Medicare Cuts
More than 50 Illinois physicians spent an afternoon away from their practices on January 8 to come together and voice concern over the impending 4.4 percent cut in Medicare reimbursement scheduled to take effect on March 1. Rep. Mark Kirk, R-Ill.—who spoke at the event via phone from Washington, DC—said that Medicare fee cuts and medical liability reform are among several critical health care issues before the 108th Congress. Rep. Kirk said that he expects that the House will consider Rep. Thomas's bill after the State of the Union address. On medical liability, Rep. Kirk said that the issue is no longer being ignored in Washington and that he is working on his own bill to provide physicians relief from soaring liability premiums. The event was moderated by Illinois ACC Governor Alan Brown, MD. Also participating was Carl Tommaso, MD, past president of the Society of Cardiac Angiography and Interventions and John Schneider, MD, president of the Illinois State Medical Society.

Medicare Participation Deadline Extended to February 28
CMS has informed Medicare carriers that the deadline for physicians to decide on their participation status in the Medicare program is February 28. Because carriers had printed their participation materials in October 2002, before the 2003 physician fee schedule final rule was delayed, materials being mailed to physicians incorrectly state that the participation deadline was in December 2002. The College is also expecting clarification from the CMS on claims payment issues relating to the delay. The CMS has been asked to provide the correct information to physicians, as well as to provide clear information about submission and payment of 2003 claims. Additional information will be provided as soon as it is available in Advocacy Weekly.

Health Care Spending Surges
Spending on health care in the United States in 2001 reached $1.4 trillion—a nearly 9 percent increase over 2000 and equivalent to 14 percent of the gross domestic product, the CMS reported last week. The increase marks the largest increase in a five-year run of regular jumps in health care spending. Spending on health care in 2001, the report noted, grew three times faster than the 2.6 percent nominal rate of growth in the economy. "While still the greatest in the world, our health care system is stretched and stressed to the point of nearly breaking," HHS Secretary Tommy G. Thompson said. Although managed care managed to restrain spending throughout most of the 1990s, the CMS said, a rise in the quantity and intensity of services consumed, along with slow and steady price increases, caused aggregate spending to accelerate in 2001. Hospital spending was the largest single driver of the spending increase, while spending on prescription drugs grew at the fastest rate. Spending for physician services accelerated from 6.9 percent in 2000 to 8.6 percent in 2001.

FDA Adding "Black Box" Warning to Estrogen Products
The Food and Drug Administration (FDA) announced last week that is requiring revisions to the labeling of all estrogen and estrogen with progestin products for use by postmenopausal women. The new "black box" warning highlights the increased risks for heart disease, heart attacks, strokes, and breast cancer among women taking estrogen and estrogen/progestin products. The warning also emphasizes that the drugs are not approved for the prevention of heart disease. The changes, explained FDA Commissioner Mark McClellan, MD, PhD, are based on the FDA's analysis of data from the Women's Health Initiative study published last year.

Advisory Panel Okays New Indications for Carvedilol, Losartan
The FDA's Cardiovascular and Renal Drugs Advisory Committee has recommended approval of new indications for the angiotensin 2 receptor blocker losartan and the beta-blocker carvedilol. Based on the results of the LIFE trial, the committee recommended that the agency expand losartan's labeling to indicate that it reduces the risk of stroke. The drug's manufacturer, Merck and Co., had requested expanded labeling to indicate the drug reduced the risk of stroke, cardiovascular death, and myocardial infarction (MI). The committee also recommended approving as a new indication for carvedilol the reduction of mortality in clinically stable, post-MI patients with left ventricular dysfunction. The approval was based primarily on the results of the CAPRICORN trial. GlaxoSmithKline, which makes carvedilol, had requested a new indication for reducing the risk of mortality as well as recurrent MI.

CMS Announces New Process for Claims Appeals
The CMS recently announced a proposed rule to establish a uniform procedure for considering both Medicare Part A and Part B claims appeals as mandated under the Benefits Improvement and Protection Act of 2000. The rule establishes a second-level step for such appeals by mandating the use of qualified independent contractors, who would process reconsiderations by individuals dissatisfied with an initial determination of a claim denial. As of October 2003, administrative law judges will be housed by CMS and no longer within the Social Security Administration.

WellPoint to Offer Discounted or Waived Co-pays for Generics
WellPoint Health Networks Inc. announced last week the launch of a program aimed at increasing the use of generic drugs among its members. Under the program, dubbed GenericSelect, most WellPoint members can obtain select generic drugs at a discount of up to $10.00 off their co-pay for their first prescription when they begin a new drug therapy with one of a proscribed list of drugs. In some cases, the co-pay may be waived altogether. "Unfortunately, when a patent [on a brand-name drug] expires, the marketing of these drugs to patients and physicians stops. However, this doesn't make these drugs any less effective," said Robert Seidman, MD, WellPoint's chief pharmacy officer. "The use of these time-tested and clinically proven drugs provides a value-added alternative for our members." One generic statin (lovastatin), three generic ACE inhibitors, and two diuretics are included in the GenericSelect program. WellPoint operates Blue Cross and Blue Shield plans in California, Georgia, and Missouri.