American College of Cardiology

	House Approves Medicare Reform Package
	Proposed Rule on 2003 Medicare Fee Schedule Offers Some Good News
	FDA Approves InSync ICD System, Extended-Release Lovastatin
	AMA HOD Votes to Form Organization of Organizations
	CMS Addresses ACC Concerns Surrounding NCCI Edits
	Florida Physicians Groups Protest Expansion of "Board-Certified" Designation
	FDA Approves Skin-Based Cholesterol Test
	More Than 1 Percent of Hospitals Closed in 2000, OIG Reports

House Approves Medicare Reform Package
In a mostly party-line vote, the House approved the "Medicare Modernization and Prescription Drug Act of 2002," H.R. 4954. The ACC endorsed H.R. 4954 on the grounds that it would provide an approximate 6 percent increase in Medicare physician payments—2 percent each year from 2003 to 2005. The College commends those members who responded to the ACC's legislative alert and contacted their U.S. representative. Most Democrats were strongly opposed to the legislation because they believe the centerpiece of H.R. 4954, the $310 billion prescription drug benefit, is inadequate. The prescription drug benefit is a key issue for both parties in this election year. It is anticipated that the Senate will debate Medicare legislation in July. The ACC is working with other physician organizations to ensure that physician payment is addressed in any legislation. For more information on the effort to prevent future reductions, members should visit the "Fight Medicare Fee Cuts" section on the ACC Web site.

Proposed Rule on 2003 Medicare Fee Schedule Offers Some Good News
Under the proposed Medicare Physician Payment rule for 2003 released on June 28, physician payments would be reduced by 4.4 percent in 2003 as opposed to the earlier estimates of a 5.7 percent reduction. However, if the physician payment provisions of the "Medicare Modernization and Prescription Drug Act of 2002" passed by the House are enacted and the final rule is similar to the proposed rule, the average physician will see a 2.7 percent increase in 2003, and cardiologists will see a 3.7 percent increase. Cardiovascular specialists are projected in the proposed rule to fair better than the average physician with a 3.4 percent reduction-due in large part to ACC efforts to persuade the CMS to propose some technical changes in its practice expense methodology. Changes in the legislation and in the final regulation could affect the final payment numbers significantly. The impacts will vary according to the mix of services each physician provides. A more detailed summary of the proposed rule is available on the ACC Web site.

FDA Approves InSync ICD System, Extended-Release Lovastatin
The FDA last week approved Medtronic's InSync ICD system for the treatment of heart failure patients who have ventricular dysynchrony and who are also at risk for ventricular arrhythmias that could lead to sudden cardiac arrest. The approval follows close on the heels of the publication of the MIRACLE ICD trial, in which the InSync ICD system improved quality of life measures and exercise capacity, and improved patients' functional status. The FDA also approved Andrx Corp.'s Altocor, an extended-release lovastatin. Altocor is Andrx's first internally developed drug. Up to this point, the company had only produced generics. According to an Andrx statement, the extended-release drug achieves "sustained blood levels of the active drug, resulting in LDL choleseterol lowering of 24 to 41 percent for the 10 mg to 60 mg dosing ranges approved."

AMA HOD Votes to Form Organization of Organizations
At the recent AMA House of Delegates meeting, the House voted to create a committee to develop a plan to transform the AMA into an organization of organizations. The committee will bring together interested state medical societies, national medical specialty societies, and other appropriate components of the Federation to develop a business plan for the transition. The plan will be presented to the House of Delegates at the 2003 annual meeting. The House also voted to form an Advocacy Coordinating Forum (ACF), which will include state and specialty societies, to better allow medicine to speak with a unified voice; launch a medical liability reform initiative; and endorse an 80-hour work week for residents.

CMS Addresses ACC Concerns Surrounding NCCI Edits
The Administar Federal/CMS has responded to the ACC's letter of appeal concerning several upcoming edits in the most recent version of the National Correct Coding Initiative (NCCI), effective July 1, 2002. As was reported last week, the ACC had expressed concerns about new edits that require a modifier when an ECG was performed on the same day as Microvolt t-wave alternans, 3-D mapping, and electrophysiology studies. The Administar Federal/CMS clarified that an ECG can be billed and paid if done on the same date of service using modifier -59, as long as it is separately performed on the patient for a reason unrelated to the other procedure. For example, it is a misuse to report the ECG code when only 3-D mapping is performed on the patient and an ECG has not been performed for a separate reason. The edits were not meant to imply that the ECGs were a component code of the other procedure being performed, Administar Federal/CMS explained. It was also clarified that new edits affecting anesthesia codes and cardiology will not affect cardiologists because they do not bill anesthesia codes.

Florida Physicians Groups Protest Expansion of "Board-Certified" Designation
State specialty societies in Florida are protesting the state Board of Medicine's recent decision to allow physicians who are certified by the American Association of Physician Specialists (AAPS) to say that they are "board-certified" specialists. According to a report in the Palm Beach Post, prior to this decision, only physicians who have completed an American Board of Medical Specialties-approved residency program could advertise themselves as board certified. The expansion was made in February when AAPS, based on a 725-page report that assessed its certification process, successfully petitioned the Board to recognize as board-certified specialists those who had met the AAPS criteria. "One can conclude that such a change will result in a decrease in the quality of medical care provided our citizens, a change that is unacceptable to the profession and our citizens," the state specialty groups argued in a letter to the Board of Medicine.

FDA Approves Skin-Based Cholesterol Test
The FDA has approved a new skin-based laboratory test to measure cholesterol levels. The test-Cholesterol 1,2,3, made by International Medical Innovations Inc. of Toronto, Canada-is only to be used in people suspected of having severe coronary artery disease (defined as 50 percent closure of two or more arteries) and those with a history of heart attack. The FDA noted in a statement that the Cholesterol 1,2,3 test "is intended to be used along with—not as a substitute for—the standard blood tests." The agency based its approval on a review of clinical studies that showed, in patients with severe disease or previous heart attack, it could provide 4 to 15 percent more information about the risk of severe coronary artery disease beyond that already available with blood cholesterol and other risk factors.

More Than 1 Percent of Hospitals Closed in 2000, OIG Reports
In its 13th annual report on hospital closures, the HHS Office of Inspector General reported last week that 64 general, short-term, and acute care hospitals closed in 2000—1.4 percent of all hospitals. Although the same number of hospitals closed in 2000 as in 1999, 29 hospitals opened or reopened in 2000, while only 22 opened or reopened in 1999. According to the report, the average daily patient load in the year prior to closure was 23 in rural hospitals and 69 in urban hospitals. Although residents of a few communities had to travel greater distances for hospital care, the OIG found, most had emergency and inpatient medical care available within 10 miles of a closed hospital. After closure, 31 percent of the hospitals were being used for other health-related services.

Because of the July 4 holiday, Advocacy Weekly will not be published next week.