American College of Cardiology

Freeze of Medicare Fees at '02 Levels Added to Senate Appropriations Bill
A provision in the mammoth FY 2003 spending package being considered by the Senate would freeze physicians' Medicare fees at 2002 rates from March 1 to Sept. 30, 2003. Several senators, including Majority Leader Bill Frist, R-Tenn., Senate Finance Committee Chair Charles Grassley, R-Iowa, Finance Ranking Member Max Baucus, D-Mont., and Appropriations Chairman Ted Stevens, R-Alaska, were instrumental in adding the provision, which also contains money for rural hospitals. The provision would cost $1.1 billion, $800 million of which would cover the physician Medicare fees freeze. There appears to be support for the provision and—considering that the Senate has twice failed to act on House-passed legislation to help physicians—passage would be an important victory for the physician community. The spending package, which includes all 11 FY 2003 appropriations bills that the Senate failed to act on last year, still faces an uphill battle. Democrats are unhappy about its overall funding levels and have offered several amendments that will increase the package's total price tag. The White House, however, is opposed to any further spending increases, citing looming budget deficits and the need to conserve funds for a potential war in Iraq.

Last week, House Ways & Means Committee Chair Bill Thomas introduced a bill that would nullify the 2003 Medicare fee schedule, which would also freeze physicians' Medicare fees at 2002 levels. The ACC is following the Senate and House bills closely and, in conjunction with the Alliance of Specialty Medicine, is in talks with lawmakers' offices in the House and Senate to better assess the situation and determine the best strategy to ensure passage of a bill to prevent another round of cuts. ACC members should continue to contact their members of Congress and urge them to stop further Medicare cuts to physicians.

Educational Tool for Patients on Medicare Fee Cuts Still Available
The flyer for ACC members to use to help educate patients about the impact of the reductions in Medicare reimbursement is still available in the "Fight Medicare Fee Cuts" resource center on the ACC Web site. The flyer includes an 800-number that patients can use to call their legislators and urge them to prevent further cuts. At the current time, the 800-number will be operational through Feb. 28. The flyer is available in PDF format. For best results, copies of the flyer should be made using a color printer.

President Pitches Medical Liability Reform In Pa.
In a visit to Scranton, Pa., last week, President Bush called on Congress to pass medical liability reform legislation that would cap noneconomic damages in malpractice cases at $250,000 and limit the time in which malpractice cases can be brought. Physicians in Pennsylvania have been among the hardest hit by increases in liability insurance, and state physician groups have been extremely vocal about the need for tort reform. "You need reform in Pennsylvania, and we need reform all across America, and we need a law coming out of the United States Congress," President Bush told attendees at the event. "No doctor could have done better than that," said ACC member Madhava S. Rao, MD, who was in attendance at the Scranton event. "It gives credibility to what doctors have been saying all along." Pennsylvania's newly elected Governor, Ed Rendell, D, has made medical liability reform one of his top priorities and is scheduled to introduce new legislation in the state legislature this week aimed at providing short-term relief for physicians from rising liability insurance premiums.

Liability Crisis Affecting Access to Care, BCBSA Survey Finds
Meanwhile, the president's call for federal liability reform was bolstered by a new report last week showing that access to care is being significantly affected by the medical liability crisis. The Blue Cross and Blue Shield (BCBS) Association released a survey last week of all 42 BCBS plans on the liability situation. It compared the responses of BCBS plans in states identified by the American Medical Association as being in a "crisis" situation versus "noncrisis" states. Compared to noncrisis states, plans in crisis states reported that far more physicians are refusing some high-risk procedures (56 percent vs. 32 percent), leaving practice or retiring (56 percent vs. 42 percent), and reducing emergency room calls (44 percent versus 17 percent) or refusing to see patients (38 percent versus 17 percent).

Care of Medicare Patients Improving; Some States Outperform Others in Key Measures
The care of Medicare patients has improved significantly since 1998, the Centers for Medicare and Medicaid Services (CMS) reported last week. The study, published in the Journal of the American Medical Association, also found that the states that outperformed others on 22 key quality indicators in 1998-1999 did so again in 2000-2001. The study assessed performance on quality measures—including eight for acute MI and two for heart failure—from observational cross-sectional studies of national and state-level fee-for-service data for Medicare beneficiaries. In terms of inpatient care of MI patients, for example, the study found improvements in the percentage of patients who received beta-blockers at hospital discharge and door-to-balloon time for those underwent PCI.

Survey Details Physicians Views on DTC Rx Ads
Many physicians think direct-to-consumer (DTC) advertising of prescription drugs has had a positive impact on public health, according to the results of an FDA survey. Many of the 500 physicians surveyed reported that their patients who came in because of a DTC ad asked more thoughtful questions and made them want to be more involved in their own care. On the negative side, the physicians surveyed also felt that DTC ads misled patients into believing that the advertised drug works better than it actually does and that patients would also try to pressure them into writing a prescription for the drug. The pharmaceutical industry has been the subject of intense criticism because of DTC ads, with critics arguing that the ads are fueling the skyrocketing spending on prescription drugs over the past few years. A recent study released by the CMS found that prescription drugs represent the fastest growing component of health care spending.

Revised Rules for Industry-Sponsored Education Programs Released
Revised rules for industry sponsorship of physician continuing medical education programs released last week place greater emphasis on physicians' disclosing potential conflicts of interest and exclusion of those with conflicts of interest from leadership roles in programs. The revised rules were released last week by the Accreditation Council for Continuing Medical Education (ACCME). Under the draft rules, physicians involved in a program as a planning committee member, manager, teacher, or author must be excluded if they have a relationship that "reveals a conflict between the interests of the individual and the interests of the public or learners." Other proposed changes include prohibiting physicians who are a paid member of a sponsoring-company's speakers bureau from making clinical interpretations and recommendations during the program. ACCME-accredited organizations have until March 15 to submit comments on the revised rules.

Supreme Court Hears Case on 'Any Willing Provider' Law
The Supreme Court has begun hearing a case brought by the managed care industry protesting Kentucky's "any willing provider" law. Under the law, managed care plans in the state must allow patients to see a physician of their choice as long as the physician agrees to plans' conditions and rates. More than 20 states have similar laws, according to a Chicago Tribune report. The managed care industry has argued that the federal law ERISA pre-empts the state laws. In a ruling by the Supreme Court last June related to outside reviews of managed care plans' coverage denials, the court ruled against the industry, arguing that regulation of insurance falls under states' purview. Another ruling in states' favor could have major ramifications. "If the court ends up finding ERISA does not pre-empt these laws," lawyer Mark Rust, who was involved in that ruling, told the Tribune, "then the managed care industry will be hard-pressed to maintain that ERISA has broad and complete pre-emptive effect on a wide range of laws."

Guidant's CONTAK RENEWAL Approved by FDA
The FDA has approved for marketing Guidant Corp.'s CONTAK RENEWAL cardiac resynchronization therapy defibrillator (CRT-D). The RENEWAL was designed specifically for patients and physicians struggling with heart failure, Guidant noted in a statement. The device is "the first and only CRT-D device available in the United States to provide independently programmable sensing and pacing in both the right and the left ventricles," said said Joseph M. Smith, MD, PhD, chief medical officer for Guidant Cardiac Rhythm Management. The RENEWAL also has two new heart failure specific diagnostic features, including the ability to monitor heart rate variability and an "Activity Log" that uses data from a motion sensor to track trends in patients' activity.