American College of Cardiology

Physician Payment Likely to Be Focus of Senate Medicare Legislation
Congressional Quarterly last week reported that Medicare physician payment could be the centerpiece of any Senate Medicare legislation this next year. According to Senate staff, the legislation would likely include an 18-month-long halt to a 10.6 percent cut to Medicare’s physician payment rates now scheduled for July 1. Stopping the July cuts and ensuring a minimum 18 month payment fix without any further cuts to medical imaging is also one of the ACC’s top priorities in the New Year as well. The yearly battles over payment cuts are unacceptable and continue to seriously threaten physician abilities to provide quality patient care. To stay up to date on the latest Legislative news and calls to action, join the ACC’s CardioAdvocacy Network (CAN) at www.acc.org/can. ACC staff is also seeking your feedback on how continued Medicare cuts will impact your practices, whether it’s providing for staff, implementing EHRs, treating Medicare patients, etc. This information is vital when it comes to communicating with members of Congress about finding a long-term solution to the current Medicare payment system. Anecdotes and feedback can be sent to mnichels@acc.org.

CMS Proposal Would Largely Eliminate Medicare Coverage for CCTA
The Centers for Medicare and Medicaid Services (CMS) last month released a proposed national coverage decision (NCD) with coverage with evidence development (CED) for cardiac computed tomography angiography (CCTA). This proposal would largely eliminate Medicare coverage for CCTA and recommends that an outcomes study be performed over five to 10 years to determine CTA's value and determine its future place in the imaging picture.

As proposed, the NCD with CED would only allow Medicare coverage of CCTA for the diagnosis of coronary artery disease (CAD) if the Medicare beneficiary is enrolled in a clinical study approved by Medicare for:

• symptomatic patients with chronic stable angina at intermediate risk of CAD; or
• symptomatic patients with unstable angina at low risk of short-term death and intermediate risk of CAD.

All other uses would be non-covered for Medicare beneficiaries. The American College of Cardiology leaders have joined the leaders of numerous medical professional societies to educate and engage CMS on the substantial evidence-based benefits of CCTA.  A multi-societal comment letter was submitted to the agency last week.

ACC Comments on National Coverage Decisions for INR Monitoring
The ACC has submitted comments on a proposed National Coverage Decision (NCD) for prothrombin time (INR) monitor for home anticoagulation monitoring. An industry coalition representing providers of home INR monitoring services requested a reconsideration of the existing NCD for home INR monitoring, which limits coverage to patients with mechanical heart valves. The coalition requested that Medicare expand coverage to all patients on warfarin therapy for whatever reason and, failing that, an expansion to patients with chronic atrial fibrillation and deep vein thrombosis. CMS opened the reconsideration in June. ACC submitted comments in July, recommending that coverage be expanded for patients with atrial fibrillation and congenital thrombophilic disorders. CMS has now proposed to expand coverage to patients with chronic atrial fibrillation and deep vein thrombosis. The ACC's comment letter supports the proposed expansion; recommends that patients with congenital thrombophilic disorders be covered; addresses some logistical issues with the proposed NCD language; and highlights the lack of separate physician reimbursement for managing patients on warfarin therapy who are monitored remotely. CMS will issue a final decision in mid-March.

UnitedHealthcare Extends Imaging Accreditation Deadline
UnitedHealthcare has extended the deadline for requiring accreditation of specific cardiac imaging services to the third quarter of 2008. The initial deadline was March 1. The ACC played a key role in getting the extension. UnitedHealthcare will notify providers a minimum of 30 days before accreditation becomes effective in their area, or as otherwise required by regulation. Additional information about the imaging accreditation initiative is available online at: http://www.UnitedHealthcareOnline.com.

ACC Issues Statement on ENHANCE Trial Results
The ENHANCE trial results, which were released by Merck and Schering-Plough Pharmaceuticals this week, generated lots of media coverage and raised some concern among patients.  The results of the trial show no benefit from the combination of ezetimibe (Zetia) and simvastatin (sold together as Vytorin) over simvastatin alone in terms of affecting the rate of atherosclerosis progression. However, the ACC released a statement recommending that major clinical decisions not be made on the basis of the ENHANCE study alone and that the study be given serious thought and follow-up. The statement also urges patients not to stop taking any prescribed medications without first discussing the issue with their health care professional. Further research will be needed in this area to provide conclusive evidence about which lipid lowering strategy is preferred (statin alone vs. statin plus ezetimibe). Reports also indicate that the ENHANCE trial has been submitted as an abstract to be presented at the upcoming American College of Cardiology Scientific Session in March, 2008. The late-breaking clinical trial selections by the meeting co-chairs are scheduled to occur in late January. For more information on the ENHANCE trial, please visit Cardiosource at http://www.cardiosource.com/clinicaltrials/trial.asp?trialID=1640.