Senate
to Consider Prescription Drug Legislation
The Senate could consider prescription drug legislation as
early as this week. It remains unclear, however, which bill
will be brought to the floor for debate and whether money
to assist physicians and other providers will be included.
Both the Finance and the Health, Education, Labor, and Pensions
(HELP) Committees spent last week developing legislation that
could serve as the basis for Senate debate. The bill approved
by the HELP Committee is a generic drug bill that would place
restrictions on the exclusive marketing time awarded to brand-name
pharmaceutical companies and would restrict the qualifications
generics would have to meet to get their own exclusive marketing
time. Two competing proposals under consideration by the Finance
Committee would provide a drug benefit to Medicare beneficiaries.
With respect to provider payments, one possible scenario is
that a provider payment package, including a remedy to the
flawed Medicare physician payment update formula, will be
offered as an amendment to the underlying bill—a possibility
that is far from certain at this point. The ACC continues
to meet with Senate lawmakers to discuss the importance of
preventing another round of physician payment cuts next year
and of developing a more permanent fix to the update formula.
Check the ACC Advocacy Web
site for updates later this week.
Medical
Societies Protest Anthem Coding Policies, Contract Provisions
The ACC has co-signed a letter from
the American Medical Association and 22 national and state
medical societies to Anthem Blue Cross Blue Shield (BCBS).
The letter addresses Anthem's unfair coding practices and
onerous contract provisions. Anthem BCBS has recently been
identified as including a non-negotiable contract provision
that allows Anthem to bundle CPT® codes but does not allow
physicians to challenge the appropriateness of the bundling
practice. Section 3.5 of Anthem's contract gives the impression
that Anthem may arbitrarily and unilaterally (and potentially
inconsistently) reassign or rebundle CPT® codes without the
provider's express written approval or knowledge. The letter
also addresses improper bundling practices and improper recognition
and payment of modifiers, such as modifier  25,
which is used by cardiologists. Anthem's payment policy regarding
E&M CPT® codes and modifier 25
fails to recognize the additional physician and non-physician
health care professional work involved in providing multiple
services on the same date. Anthem is an Indiana-based BCBS
plan that, over the past several years, has acquired BCBS
plans in Colorado, Connecticut, Indiana, Kentucky, Maine,
New Hampshire, Nevada, and Ohio. It is currently working to
acquire TRIGON in Virginia. A copy of the letter can be obtained
here.
HCLA,
ACC Advocate for Medical Liability Reform
On July 12, the Health Care Liability
Alliance (HCLA), of which the ACC is a member, sponsored a
briefing for congressional staff on medical liability reform.
The briefing was held to educate staff on the medical liability
crisis and how it is threatening patient access to health
care services. The HCLA has been advocating support for H.R.
4600, "the HEALTH Act," introduced in April by Rep. Jim Greenwood,
R-Pa., which currently has 86 cosponsors—only eight of
whom are Democrats. House Democrats are drafting an insurance
reform package as an alternative to H.R. 4600. The House Energy
and Commerce Committee has scheduled a medical liability hearing
for July 17.
FDA
Releases Guidance Document on Cardiac Ablation Catheters
On July 1, the Food and Drug Administration (FDA) announced
the availability of a guidance document "Cardiac Ablation
Catheters Generic Arrhythmia Indications for Use; Guidance
for Industry." The FDA wants to encourage manufacturers of
approved conventional cardiac ablation catheters to submit
supplements to broaden their labeling from arrhythmia-specific
indications to a generic arrhythmic treatment indication.
The guidance is issued to allow companies to label these products
for a broader indication without submitting additional clinical
information. The FDA states that this recommendation is based
on its comprehensive search and review of the medical literature.
The guidance may be found at www.fda.gov/cdrh/guidance.html.
Utah
HMOs Close, Leaving 50,000 Without Health Coverage
Two of Utah's top health care providers, Intermountain Healthcare
and United Health Care, will close their Medicaid health maintenance
organization programs by September 2002. The two health care
providers are reportedly leaving the Medicaid plan due to
large fiscal losses in FY 2002. This decision will leave approximately
50,000 Utah residents seeking alternative health coverage
by the end of the year and the state scrambling to assist
while facing severe budget shortfalls. According to the The
Salt Lake Tribune, Utah Department of Health spokesperson
Jana Kettering commented, "We're working together to make
sure that the standard of care continues through the end of
this year."
TRICARE
Cardiac Rehab Coverage Extended to Valve Surgery, Transplant
Patients
On June 25, the Department of Defense issued a final rule
to revise TRICARE coverage for solid organ and stem-cell transplants
and medically necessary related services or supplies, cardiac
and pulmonary rehabilitation, and ambulance services for transplant
candidates. Specifically, the rule clarifies coverage and
time limits on pre-authorizations for organ and stem-cell
transplants. Cardiac rehabilitation coverage will be extended
to patients who have had heart valve surgery, heart transplantation,
or heart-lung transplantation. Coverage is established for
pulmonary rehabilitation. The rule also eliminates payment
restrictions for ordered ambulance transfers. According to
the rule, detailed policy and patient selection criteria for
each covered transplant will now be included in the TRICARE/CHAMPUS
policy manual, so as to expedite the transplant approval process.
The provisions take effect July 25, 2002. More detailed information
may be found at www.tricare.osd.mil.
New
CDC Director Named
Health and Human Services Secretary Tommy Thompson has named
Julie Gerberding, MD, MPH, the first female director of the
Centers for Disease Control and Prevention (CDC). Dr. Gerberding
joined the CDC in 1998 as director of the Division of Healthcare
Quality Promotion, where she developed the CDC's patient safety
initiatives and other programs to prevent medical errors in
health care settings. Before her appointment as CDC director,
Dr. Gerberding had been acting principal deputy director of
the CDC. Dr. Gerberding also played a major role in leading
the CDC's response to the anthrax attacks last year. Dr. Gerberding
received her medical degree at Case Western Reserve University
in Cleveland and completed her internship and residency in
internal medicine at the University of California-San Francisco.
Advocacy
Weekly is a product of the Advocacy Division of the American
College of Cardiology. Questions or comments regarding this
publication should be directed to the Advocacy Division
at 800-435-9203 or to advocacydiv@acc.org.
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