American College of Cardiology

House Passes Liability Reform Bill
The House last week passed the "HEALTH Act" by a vote of 229 to 196. Sixteen Democrats joined 213 Republicans in support of the bill. This bill, strongly supported by the ACC and other physician organizations, would make important reforms to the medical liability system, including a $250,000 cap on noneconomic damages. "Today's House vote is an important step toward creating a liability system that fairly compensates those who are truly harmed, punishes egregious misconduct without driving good doctors out of medicine, and improves access to quality, affordable health care by reducing health care costs," President Bush said. While there is strong support for liability reform, especially among Republicans, the fate of the companion legislation introduced in the Senate (S. 607) is still unclear. Senate Majority Leader Bill Frist, R-Tenn., has pledged to bring the legislation to the Senate floor as early as March 24. Because of strong Democratic opposition, however, some GOP Senate leaders have publicly said that passage will likely require the $250,000 cap on noneconomic damages to be increased. For more information on this issue, visit the medical liability reform resource center on the ACC Web site.

Medical Errors Bill Passes House
The House of Representatives last week passed by a 418-6 vote the "Patient Safety Improvement Act," a bill that would create "patient safety organizations" (PSOs) to which health care providers would voluntarily and confidentially submit reports on medical errors. Under the legislation, legal protections would be offered to those who submit error reports to the PSOs and a database, maintained by the Agency for Healthcare Quality and Research, would track national trends and reoccurring problems. The legislation would also direct the HHS to develop methodologies by which medical error and other patient safety data would be collected and standards on the compatibility of information technology systems used in health care settings, Health News Daily reported.

LVAD 'Destination Therapy' Endorsed by MCAC
The Medicare Coverage Advisory Committee (MCAC) has voted that the use of a left ventricular assist device (LVAD) for "destination therapy" in end-stage heart failure patients is "substantially more effective" than optimal medical management. The committee based its decision largely on the results of the REMATCH trial, which involved the use of the Thoratec HeartMate VE. The vote paves the way for the CMS to issue a national coverage decision for LVAD implantation for destination therapy. The ACC presented testimony during the meeting and submitted comments to the CMS last year in support of coverage of LVADs for destination therapy. Last November, the FDA approved the HeartMate for use in patients who are not eligible for a heart transplant, often referred to as destination therapy. Currently, LVADs are covered only for use in patients waiting for a heart transplant.

Legislation in States Focuses on Rx Representative Interaction with Physicians
Legislators in Maryland and California have introduced legislation focused on items given to physicians by pharmaceutical company representatives. According to a Baltimore Sun report, under the Maryland bill, physicians, nurse practitioners, and pharmacists would be prohibited from accepting any item worth more than $50, with a potential penalty of license suspension or revocation for violating the prohibition. In California, pharmaceutical representatives would be required to submit annual reports to the State Board of Pharmacy on items given to physicians worth more than $25. Drug samples would be excluded under the bill, Modern Physician reported.

Analysis Reveals Little or No "Business Case" for Quality Improvement
Programs aimed at improving quality of care achieve that goal, but fail to provide a positive return on investment in a reasonable period of time for the institutions running the programs, a new analysis shows. In the study, published in Health Affairs, a research team analyzed smoking cessation, diabetes management, and cholesterol management programs, respectively, at three large health care systems and found little or no positive return on investment in the programs. "One significant challenge is to change the payment system to reward quality, instead of paying the same for poor or even defective quality as we pay for optimal quality," said Donald Berwick, MD, president and CEO of the Institute for Healthcare Improvement, who was involved in the study. [Note: An article entitled "Closing the Gap Between Science and Practice: The Need for Professional Leadership," written by ACC members Kim A. Eagle, MD, Arthur J. Garson Jr., MD, MPH, George A. Beller, MD, and Cary Sennett, MD, PhD, division vice president of the ACC Science and Quality Improvement Division, was also published in this same issue of Health Affairs.]

House Passed Bill Would Provide Funds to Help Schools Set up AED Programs
A bill passed by the House of Representatives would help communities establish information clearinghouses to provide schools with how-to and technical advice on establishing public access to defibrillation programs. The ACC-supported bill allows public access defibrillation program grant dollars to be used to establish these clearinghouses, which would ensure that schools have access to information on appropriate training, successful fundraising techniques, and other logistics.

Medicare Contains Spending Better than Private Insurers, Study Shows
Medicare health care spending per enrollee rose at a slower rate than private health insurance between 1970 and 2000, according to a study published last week in Health Affairs. According to the study, Medicare spending grew at an average annual rate of 9.6 percent per enrollee, while private insurer spending grew at an average annual rate of 11.1 percent. The study also found that Medicare outperformed private insurers in terms of controlling spending for comparable health care services over the same time period.