American College of Cardiology

Congress Passes Medicare Reform, But Help for Physicians Still Not Certain
Both the House and Senate passed Medicare reform packages last week, setting up what is likely to be a contentious conference committee to resolve the differences between the two bills. The House bill includes a measure that would prevent a projected 4.2 percent cut in physician Medicare payments from taking effect next year. The provision provides for a 1.5 percent increase in 2004 and 2005, but, because of cost constraints, future steep reductions would compensate for those increases in 2006 and beyond. The Alliance of Specialty Medicine, of which the ACC is a member, issued a statement urging Congress to address the physician payment issue in its final conference agreement. Although both bills have prescription drug benefits as their cornerstone, the House bill contains greater involvement by private health insurers—something that is likely to be a major sticking point in conference. Both bills contain provisions to provide increased funding to rural health care providers and new coverage for cholesterol screening.

The ACC and other physician groups will be targeting the conference committee to improve upon the existing House physician payment provision and, ultimately, ensure something to restore physician payments remains in the bill. ACC members are encouraged to contact their legislators about this issue and let them know that they expect their support in preventing further Medicare cuts. ACC members can easily send a message to their legislators using the College’s Web-based grassroots advocacy tool. Go to the ACC Web site and click on the “Take Action Now” icon.

ACC Members Encouraged to Contact Senators to Support Liability Reform Bill
The Senate is scheduled to formally consider a medical liability reform bill strongly supported by the ACC and other physician groups the week of July 7. This bill, the "Patients First Act," S. 11, is nearly identical to the reform bill already passed by the House. ACC members are encouraged to contact their senators and urge them to support S. 11. Members can easily contact their senators using the ACC's grassroots advocacy tool on the ACC Web site. Go to www.acc.org and click on the "Take Action Now" icon.

CMS Cancels Requirement for Carriers to Obtain Refunds from Physicians
The CMS has cancelled plans to require Medicare carriers to perform a mass adjustment in July to compensate for physician overpayments related to the delay in the 2003 Medicare fee schedule. Because the Medicare physician fee schedule did not become effective until March 1, 2003, a substantial number of claims were overpaid for services performed in January or February but not processed until after March 1, the CMS said last week. The CMS had previously directed Medicare carriers to automatically adjust these claims, beginning in July 2003, and to recover any applicable overpayments. But the CMS told carriers last week that it was rescinding this directive. If an overpayment exists, physicians should not receive any "Demand" letters related to an incorrect payment based on the delay of the 2003 fee schedule. The CMS also advised, however, that if physicians bring an overpayment to a Medicare carrier's attention, the carrier will still process an adjustment.

ACC Expresses Concern About ICD-10 Provisions in Medicare Reform Bill
The Alliance of Specialty Medicine last week urged that clarifications be included in the House Medicare reform package related to the adoption of the ICD-10 system in hospitals. In a letter to House Rules Committee Chair Rep. David Dreier, the Alliance, of which the ACC is a member, stressed that, as currently drafted, the bill language could be “misinterpreted to mean that ICD-10-CM and ICD-10-PCS should also apply to physician services.” The letter noted that the ICD-10 system is much more complicated than the ICD-9 system used by physicians for diagnosis reporting for in-patient services, and that the CPT coding system used to reimburse physicians and the ICD coding systems are not interchangeable. “We believe that implementing ICD-10 for physician services would throw hundreds of thousands of physician practices into administrative chaos,” the letter warned. “We are asking that the provision be clarified to specify that the HHS Secretary could not apply [the ICD-10 system] for physician services, regardless of site of service.”

Specialists in Demand, Survey Finds
Cardiologists are in high demand in hospitals across the country, according to the results of a survey released last week. In a survey by Merritt, Hawkins, and Associates of hospital physician recruitment trends, cardiologists were being highly recruited by hospitals with more than 100 beds, and ranked in the top five recruited specialists in both mid-size and larger hospitals. Cardiology ranked third in average salary offered by recruiting hospitals ($280,000), behind radiology ($317,000) and orthopedics ($315,000). Overall, 85 percent of hospitals that responded to the survey were actively recruiting physicians, and of those that were not, more than half planned on doing so in the next six months.

Despite Major Concerns, HHS Will Not Delay Implementation Deadline for Transaction Standards
In the face of concerns within the CMS and among physician groups, the HHS will not push back the Oct. 16 deadline for implementation of the HIPAA transactions and code set standards. Many physician practices have reported serious concerns about their ability to be compliant by the deadline, largely because of difficulties with their practice management software. Many software vendors’ products are not compliant, in large part because the government has not yet released final guidance on the transaction and code set regulations. As a result, practices have not been able to conduct transaction tests and are concerned that they will not be able to submit appropriate claims to health plans/payers. Under the regulations, health plans/payers who make payments for inappropriately submitted claims could be in violation of the law. According to a Health News Daily report, CMS Administrator Scully said that the deadline would not be pushed back, but is considering offering protection to providers who have made a good faith effort to be compliant.

Florida Legislators Struggle for Consensus in Medical Liability Reform Special Session
A special session of the Florida legislature called by Gov. Jeb Bush, R, to address medical liability reform legislation is apparently over. According to a Miami Herald report, the Florida Senate President Jim King, R, sent Senate members home, as negotiations over the governor’s reform package continued to be rocky. As has been the case in many states, the main sticking point has been noneconomic damage caps. While Gov. Bush wants a bill that caps noneconomic damages at $250,000, a proposal strongly supported in the Florida House, the Senate favors a stronger focus on insurance industry reforms and a $1.5 million noneconomic damages cap with a catastrophic exemption as high as $6 million. There has been some progress in ironing out the 90 differences between the House and Senate packages, the Herald reported, leading some legislators to call for passage of a bill now that contains the agreed upon reforms, while continuing to work on the outstanding issues. Another special session is scheduled to begin July 8.

FDA Approves Statin/Aspirin Combo Package
The Food and Drug Administration (FDA) has approved Pravigard PAC (co-packaged pravastatin sodium and buffered aspirin tablets) for use in patients for whom both pravastatin (Pravachol) and buffered aspirin is appropriate. Packaging the two together, the FDA said in a Talk Paper, “may be more convenient for some patients.” Patients receiving treatment with Pravigard should also be placed on a standard cholesterol-lowering diet, the FDA advised.

CMS Abandons Plan to Expand Self-Referral Ban, But Legislation Still a Possibility
The CMS announced last week that it’s dropping its plan to eliminate a whole-hospital ownership exception in regulations promulgated under the Stark “self-referral” laws. The CMS previously had announced that it planned to publish revised regulations that would limit physician ownership in hospitals that focus on treatment of one disease, something that would have a direct impact on so-called heart hospitals. According to a report in Report on Medicare Compliance, CMS Administrator Tom Scully said he was uncertain whether the agency had the regulatory authority to make the change. An early version of the Senate Medicare reform package, however, included a provision that would expand prohibitions on physician referral to specialty hospitals. At press time, it was unclear whether this provision was in the final bill passed by the Senate.