American College of Cardiology

	Senate Begins Debate on Prescription Drug Legislation
	Medical Liability Crisis Focus of House Committee Hearing
	ACC-Sponsored "Cardiologist for A Day" Program Achieves Quick Results
	FDA Approves Expanded Indication for Guidant ICDs
	ACC Calls on CMS to Provide Payment Data on Prothrombin Time Testing
	ACC Calls for Congress to Grant FDA Authority to Regulate Tobacco Products
	Despite Budget Crunch, Massachusetts Legislators Increase Funding for Provider Oversight
	State Governors Concerned About Skyrocketing Health Costs

Senate Begins Debate on Prescription Drug Legislation
Last week, the Senate began what has already become a highly contentious floor debate on prescription drugs. Under consideration is a bill that would speed generic drugs to market. During the floor debate, which could last as long as two weeks, it is expected that numerous amendments will be offered to the generic drug bill, including legislation that would provide Medicare beneficiaries with a prescription drug benefit. Virtually all amendments offered will need a 60-vote super majority for passage. The conventional wisdom is that no prescription drug proposal currently on the table can garner the necessary 60 votes, with the possible exception of the underlying generic drug bill. It is possible that a Medicare provider payment package will be offered as an amendment, although details are still sketchy at this time. Rumors are that Senate Majority Leader Thomas Daschle, D-ND, is considering offering the House-passed provider package as an amendment. While the ACC supported the physician payment language in the House bill, it continues to lobby Senate lawmakers for a proposal that would provide a more permanent solution to the Medicare physician payment update problem. Visit the "Fight Medicare Fee Cuts" section on the ACC Web site for updates.

Medical Liability Crisis Focus of House Committee Hearing
The House Energy and Commerce Health Subcommittee last week took up the debate on the medical liability crisis facing the nation. The hearing highlighted the stark contrast between Republicans' and Democrats' stance on the issue, with GOP leaders continuing to press for tort reform legislation while Democrats called for further examination of the causes of rising liability insurance premiums. Subcommittee Chairman Michael Bilirakis, R-Fla., stressed that the medical liability crisis requires action by the federal government and called the "HEALTH Act," H.R. 4600, a bill supported by the ACC, a "common sense solution" to the problem that respects the states' role as regulators of the insurance industry. Ranking member Sherrod Brown, D-Ohio, and other Democrats criticized the presumption being made by Republicans that malpractice litigation is the cause of high liability premiums. House Democrats are in the process of drafting legislation that would focus on insurer, rather than tort reforms. On Tuesday, July 23, the House Judiciary Committee will mark-up H.R. 4600.

ACC-Sponsored "Cardiologist for A Day" Program Achieves Quick Results
Ft. Wayne Cardiology (Ind.), a private, 21-physician practice, hosted a "Cardiologist for a Day" program last week. The ACC Indiana Chapter worked with the national office and the Indiana State Medical Association to develop this program. The practice invited local legislators and the CMS Region V Medical Director, Trent Haywood, MD, and staff to go "on rounds" with attending cardiologists to provide a first-hand look at a physician practice. The participants witnessed some common cardiovascular procedures and some of the cumbersome regulatory and administrative issues confronting cardiologists on a daily basis. The program is intended to facilitate constructive dialogue and positive relationships, and, in fact, Dr. Haywood has already taken steps to resolve claims processing issues with Adminstar Federal, the Medicare Carrier in Indiana. "The state legislators found the program educational and particularly were interested in the problems with CMS administration and the impact on their Medicare voters," said Dr. Michael Mirro, ACC Governor for Indiana.

FDA Approves Expanded Indication for Guidant ICDs—Revised 7/29/02
Based on the findings from the MADIT II trial, the FDA has approved an expanded indication for Guidant implantable cardioverter defibrillators (ICDs). The results from MADIT II were released in March at the ACC Annual Scientific Session and simultaneously published in the New England Journal of Medicine. Guidant ICDs now have approved labeling for use in patients who have had a previous myocardial infarction and have an ejection fraction less than or equal to 30 percent. In MADIT II, use of ICDs in this patient population reduced total mortality by 31 percent compared to those in the medical therapy group. More information on the approval is available on the FDA Web site.

ACC Calls on CMS to Provide Payment Data on Prothrombin Time Testing
After four years of ACC effort, the CMS announced last September that it would provide coverage for home prothrombin time testing (PST). While the ACC and other interested parties had advocated that such coverage be provided through a durable medical equipment (DME) benefit to facilitate appropriate payment, the CMS announced in May 2002 that home PST would instead be payable through the physician fee schedule (see Program Memorandum AB-02-064). Although the ACC was successful in achieving payment for physician oversight, the payment rate is so low that patient access to this new benefit is in question. The College has asked the CMS to provide data on how it arrived at a payment rate and to monitor this benefit to make sure it is workable. In the meantime, the ACC has urged that physicians not be required to act like DME suppliers and should be reimbursed for the services that they and their staff provide in the office for the treatment of patients needing PST.

ACC Calls for Congress to Grant FDA Authority to Regulate Tobacco Products
The ACC has joined with numerous other physician and public health organizations in an advertising campaign calling for the regulation of tobacco products by the Food and Drug Administration (FDA). The ACC supports the "Youth Smoking Prevention and Public Health Protection Act," S. 2626, introduced by Sens. Edward Kennedy, D-Mass., Richard Durbin, D-Ill., and Mike DeWine, R-Ohio, which would give the FDA broad authority over tobacco products, from restricting advertising aimed at children to requiring changes to the tobacco products themselves. In March 2000, the Supreme Court ruled that current law does not allow the FDA to regulate tobacco products.

Despite Budget Crunch, Massachusetts Legislators Increase Funding for Provider Oversight
Despite a budget shortfall that has forced state legislators to make significant cuts in many state programs, Massachusetts budget negotiators have increased funding for state oversight of health care providers by $1 million. According to a Boston Globe report, in addition to the increased funding, the budget legislation would shift the boards that oversee physicians, nurses, and other health care providers from the Office of Consumer Affairs to the Department of Health. The budget is expected to be approved by the full state legislature. While funding was increased for the oversight of providers, a $70 million budget cut will mean 50,000 people will no longer be eligible for MassHealth Basic, the state Medicaid program, the Boston Herald reported.

State Governors Concerned About Skyrocketing Health Costs
The National Governor's Association (NGA) met last week to discuss the current status of the faltering economy and ways to reduce escalating state health care costs. "Last year was pretty trying for the nation's governors," said Michigan governor and NGA Chairman John Engler, R. "We've had to battle declining tax revenues … and at the same time there's been an explosion in health care costs." According to an Associated Press report, the governors' general consensus was to promote policies that would increase the affordability and availability of prescription drugs, and to weather the current economic downturn without making drastic cuts to education and other social services.