American College of Cardiology

It's Official! Revised Final Rule on '03 Medicare Fee Schedule Published
The Centers for Medicare and Medicaid Services last week made the physician community's legislative victory complete with the publication of the revised final rule on the 2003 Medicare fee schedule on Feb. 28. The revised fee schedule reflects the changes allotted for in legislation passed by Congress approximately two weeks ago that will turn what would have been a 4.4 percent cut in Medicare fees into a 1.6 increase. Because of an ACC-secured technical correction, fees for most cardiology procedures will increase by 2.2 percent on average. Average cardiac surgery fees will remain the same, while thoracic surgery fees will rise by 1 percent. "This rule restores the confidence of physicians, and patients, that the federal government will be a fair partner in the Medicare program," said CMS Administrator Tom Scully. The rule took effect on March 1. The CMS is sending revised payment files to Medicare carriers to reflect the change. A detailed breakdown of 2003 Medicare fees for cardiology procedures is available on the ACC Web site. For details on surgical fees, contact the Society of Thoracic Surgeons.

Liability Premium Hikes Having Dramatic Impact on Practices
Premiums for physician practices' medical liability insurance increased by 53.15 percent between 2002 and 2003, according to the results of a new survey released by the Medical Group Management Association last week. As a result of the increases, 26.1 percent of the practices that responded to the survey said some of their physicians would retire, relocate, or restrict services over the next three years. Slightly more than 14 percent said they already have stopped treating certain high-risk patients. The survey included responses from 700 group practices, the median size of which was nine physicians. The survey results were presented at a House Energy and Commerce Committee hearing on the HEALTH Act, an ACC-supported medical liability reform bill. The HEALTH Act is expected to go through the House committee "mark-up" (formal consideration) process this week and is likely to go to the House floor for a vote the week of March 10.

Group Calls for 'Entirely New' Medical Liability System
The practice of medicine has been "fundamentally altered" by the threat of malpractice suits and the United States needs an "entirely new system of medical justice," according to a statement released last week by Common Good, an organization dedicated to reforming the American legal system. The statement was signed by some of the most prominent names in the health care community, including leaders of some of the nation's biggest academic medical centers, health plans, business groups, and think tanks. "Providing relief to doctors squeezed by insurance premiums is important, but will not heal the deep distrust of justice that skews daily decisions," the statement reads. "We call upon Congress immediately to initiate hearings on the broad effects of litigation on health care … and to consider recommendations on how to create new systems of medical justice that will promote better care, not undermine it."

Bill Introduced to Speed Up Medicare Coverage Decisions
Legislation has been introduced that is aimed at decreasing the amount of time it takes for the CMS to make decisions about coverage of new treatments, tests, and technologies. Under the bill—introduced by Reps. Anna Eshoo, D-Calif., and Jim Ramstad, R-Minn.—deadlines would be established for the CMS to implement national coverage, coding, and payment decisions and a Council for Technology and Innovation would be established to improve the timeliness and coordination of these decisions. According to a news release issued by the two lawmakers, the bill, the "Medicare Innovation Responsiveness Act," would also require Medicare to implement a policy announced more than two years ago to cover Medicare beneficiaries' costs for participating in clinical trials, reduce delays on payment for new medical technologies in the inpatient setting, and implement reforms passed by Congress more than two years ago to reduce delays in the Medicare patient appeals process. The ACC is in the process of evaluating the legislation and, in particular, the implications of providing coverage for clinical trial expenses from a fixed pool of Medicare funds.

Second House Committee Passes Medical Error Reporting Bill
The House Ways and Means Committee has approved the "Patient Safety Improvement Act," a bill that would create "patient safety organizations" to which health care providers would voluntarily and confidentially submit reports on medical errors. The House Energy and Commerce Committee has already passed the bill. Under the legislation, legal protections would be offered to those who submit error reports and a database would be created to track "national trends and reoccurring problems," according to a Ways and Means Committee news release. This same bill was introduced in both the House and Senate last year. The ACC offered conditional support for the bill.

Miami Court To Handle All Claims in Physician Class-Action Suit Against HMOs
A panel of three federal judges has ordered that all claims in a massive class-action suit involving more than 700,000 physicians against some of the nation's largest managed care plans be handled by Miami district court judge Federico Moreno. Moreno has been overseeing much of the lawsuit—which accuses the insurers of racketeering, among other things—for more than three years, the Miami Herald reported. He has often ruled in the plaintiffs' favor during that time. Late last year, however, Cigna, one of the HMOs involved in the case, announced that it had reached a settlement in an Illinois court with some of the physicians involved in the class-action suit, which in effect would have extricated the insurer from the national suit. Judge Moreno blocked the settlement, calling it "an underhanded maneuver." The issue was then sent to a three-judge panel to decide how best to proceed with the entire suit.

FDA Issues Warning About Cardiac Valvulopathy Related to Parkinson's Drug
The FDA has issued a warning via its MedWatch program about reports of cardiac valvulopathy in a very small number of patients using Permax (pergolide mesylate) to treat Parkinson's disease. In reports of such problems, aortic, mitral, and tricuspid valves were involved. Of the estimated 500,000 people who have been treated with pergolide since 1989, valvulopathy has been reported in less than 0.005 percent, according to the drug's manufacturer, Eli Lilly, which is now revising the drug's package insert. More details are available on the FDA MedWatch Web site.

Maryland Fines CareFirst BCBS for Prompt-Pay Violations
Maryland Insurance Commissioner Steven B. Larsen has fined CareFirst Blue Cross and Blue Shield (BCBS) $400,000 for repeated violations of the state's "prompt-pay" law. According to a Maryland Insurance Administration (MIA) news release, a six-month investigation revealed that CareFirst BCBS had illegally denied nearly 70 percent of claims that contained modifier 25 and failed to pay more than 50 percent of physicians' clean claims within 30 days. Both issues were first raised with the MIA by the Maryland State Medical Society. The MIA investigation also found that the insurer's pharmacy vendor was making utilization review determinations on behalf of the vendor, despite the fact that it is not licensed to do so, and that the plan was inappropriately requiring preauthorization for certain pharmacy claims.