American College of Cardiology

ACC Urges Conferees to Address Payment Issues in Medicare Reform Deliberations
The ACC is urging the conference committee charged with reconciling the differences between the House and Senate Medicare reform packages to ensure that the final bill addresses physicians’ reimbursement concerns. In a letter to conference committee members, ACC President Carl J. Pepine, MD, stressed the College’s support for the House bill provision that would prevent projected reductions in 2004 and 2005 fees and instead give physicians a 1.5 percent increase in those years. But, he warned, the same provision would result in steep reimbursement decreases in 2006 and, as a result, he urged the conferees to “build upon the House bill language to develop … a more permanent legislative ‘fix’ for this serious problem.”

The letter, which addressed everything from electronic prescribing to recovery audit contractors, also highlighted the ACC’s concerns about the reductions in covered outpatient prescription drugs, which could aversely affect payments for nuclear cardiology and echocardiography procedures. Dr. Pepine also voiced the College’s opposition to the language in the House bill that could be interpreted to replace the ICD-9 and CPT coding systems for physician services with the ICD-10 coding system—which, he explained, “would create a huge financial and administrative burden for physician offices.”

Medicare Reform Snag? Senate and House Bills Both Top $400 Billion Limit
In related news, the Congressional Budget Office (CBO) forecast last week that both the House and Senate Medicare reform packages would cost more than the $400 billion limit set in the budget resolution. The Senate package is the more expensive of the two, clocking in at $461 billion, while the House bill was calculated to cost $408 billion. According to a Washington Post report, members of the conference committee vowed to keep the final bill at the $400 billion ceiling, which could mean scaling back the prescription drug benefit or finding other spending offsets. The CBO report, meanwhile, also concluded that neither bill would move more Medicare beneficiaries into managed care plans—one of the GOP’s chief aims to bring market competition to the Medicare program and bring down costs.

HIPAA Transaction and Code Set Standards Guidance Released
The CMS has released its first guidance on compliance with the HIPAA transaction and code set standards. The guidance comes in response to calls from physician groups, including the ACC, for the development of contingency plans to prepare for any fallout that may occur because of lack of compliance with the regulations by the October 16 deadline. In the guidance, the CMS noted that it realizes that “noncompliance by one covered entity” may put another covered entity “in a difficult position.” As a result, the CMS explained, it “intends to look at both covered entities’ good faith efforts to come into compliance with the standards in determining, on a case-by-case basis, whether reasonable cause for the noncompliance exists and, if so, the extent to which the time for curing the noncompliance should be extended.” The agency also noted that it will rely on voluntary compliance and that enforcement will be complaint driven.

The ACC has developed a toolkit to help members comply with the HIPAA transaction and code set standards. The toolkit, available free of charge to ACC members, provides a step-by-step guide to ensure practices are compliant, as well as checklists and questions that practices should be asking health plans and software vendors about their compliance. To obtain a copy, contact the ACC Resource Center at (800) 253-4636, ext. 694.

Important Senate Committee Passes Medical Error Reporting Bill
The Senate Health, Education, Labor, and Pensions Committee last week unanimously approved legislation, supported by the ACC, that would create "patient safety organizations" (PSOs) to which health care providers would voluntarily and confidentially submit reports on medical errors. Under the “Patient Safety and Quality Improvement Act,” legal protections would be offered to those who submit error reports to the PSOs. The bill states, however, that these protections would not apply if a court determined that “such patient safety data contains evidence of an intentional act to directly harm the patient.” Sen. Edward Kennedy, the committee’s ranking Democrat, said the bill’s protections are still too broad, Health News Daily reported. The House passed a very similar bill in March. The bill must now go to the full Senate for formal consideration and, if passed, to a conference to work out the differences between the House and Senate bills. The Alliance of Specialty Medicine, of which the ACC is a member, sent a letter to Congress last week that was supportive of the voluntary approach to medical error reporting.

State Legislature Organization Adopts Anti-Federal Liability Reform Policy
The National Conference of State Legislatures (NCSL) has adopted an official policy opposing federal liability reform. As previously reported, the leadership of two NCSL committees, one of which is dominated primarily by trial lawyers, had drafted policy statements under which the organization would officially oppose the enactment of federal medical liability reform at its annual meeting this week in San Francisco. The policy passed both committees and was approved by the full NCSL executive committee late last week. The impact of this policy on federal-level efforts is unclear. The ACC and more than 50 other physician groups had sent letters to NCSL leaders and committee members opposing the adoption of such a policy. For the third year in a row, the ACC joined with nine other medical societies in a joint booth at the NCSL meeting, with the theme "Physicians Advocating for Patients." ACC Board of Governors State Advocacy Subcommittee Chair Barry Coughlin, MD, and ACC California Chapter members Michael Nagel, MD, and Gordon Fung, MD, participated in the booth and met with lawmakers in attendance at the meeting to discuss issues of importance to cardiovascular specialists and to highlight ACC Chapters as resources in their states.

FDA Approves Test to Measure Lp-PLA2 to Assess CHD Risk
The FDA has approved diaDexus’ PLAC test, which measures lipoprotein-associated phospholipase A2 (Lp-PLA2) levels, for predicting a patient’s risk for coronary heart disease. The FDA approved the test based on results of an NHLBI-funded study presented at the 2003 ACC annual meeting in which more than 1,300 patients without established heart disease were followed for nine years. In the study, those at the greatest risk of developing heart disease were those with elevated Lp-PLA2 and normal LDL levels.

CMS Clarification: Medicare Does Cover Lipid Screening in Hypertensive Patients
The CMS issued a national coverage analysis last week in which it clarified that lipid screening is covered in Medicare patients with benign essential hypertension. In the analysis, the CMS explained that because of an error in the 2001 final rule on clinical diagnostic laboratory services, the ICD-9 code for lipid screening coverage for patients with benign essential hypertension was accidentally not published. The national coverage of lipid testing, the CMS added, will now be modified to include “any disease leading to the formation of atherosclerotic disease” and an ICD-9 code will be established for lipid testing in patients with benign essential hypertension.

Hospitals Reporting Quality Data to CMS Swells to 1,300
A Medicare initiative under which hospitals will report their performance on 10 clinical measures for three conditions, including AMI and heart failure, is growing in leaps and bounds. According to a joint update from the American Hospital Association, the Association of American Medical Colleges, and the Federation of American Hospitals, nearly 1,300 hospitals have now agreed to participate in the program, dubbed “The Quality Initiative: A Public Resource on Hospital Performance.” The data, in turn, will be made available to the public on the CMS Web site. In the next phase of the initiative, patient assessments of their care at participating hospitals will also be reported to CMS and made publicly available. Additional measures will be added as the initiative progresses, the groups said.

Pa. Medical Society Advises State’s Physicians To Opt Out of Settlement with Insurer
The Pennsylvania Medical Society (PMS) is advising physicians in the state to opt out of a $40 million class-action settlement between the Pennsylvania Orthopaedic Society (POS) and Independence Blue Cross (IBC). As previously reported, IBC agreed under the settlement to take several actions, including disclosing to providers the standard fee schedule and changes in the fee schedule applicable to the providers’ specialty. According to a summary on the PMS Web site, the recommendation to opt out of the settlement is based on several concerns, including that the release physicians grant to IBC under the settlement is too broad, questions about whether the monetary distribution is overly weighted toward surgical specialties, lack of specificity about important details, and that the settlement may be “lowering the bar for future settlements.”