American College of Cardiology

Medical Liability Reform on Bumpy Road in Senate
Sen. Dianne Feinstein, D-Calif., has said that she is going to hold off introducing a much-talked-about compromise bill that would cap noneconomic damages in liability reform cases at $500,000, with a special "catastrophic exemption" for cases in which patients were severely disfigured or there was severe disability or death. In those cases, awards would be limited to $2 million or $50,000 times the number of years the patient is expected to live, whichever is greater. The liability reform bill passed in the House earlier this month would cap noneconomic damages at $250,000, with no special exemptions. Senate Majority Leader Bill Frist, R-Tenn., has gone on record saying he supported a compromise, but without specifically endorsing Sen. Feinstein's approach. Sen. Feinstein, the only Senate Democrat to publicly state that she supports caps on noneconomic damages, said she was going to hold the bill "in abeyance," the New York Times reported, after the AMA and California Medical Association argued that the approach was not proven and could actually increase premiums.

With Economy Still Slumping, CMS Estimates 4.2% Reduction for '04 Physician Medicare Fees
The flaw in the formula used by the Centers for Medicare and Medicaid Services (CMS) to update physicians' Medicare fees each year is once again leading to estimates of reductions in physicians' Medicare fees. The CMS last week estimated that fees would be reduced by 4.2 percent in 2004 and that additional reductions are expected through 2007. This is despite legislation passed in February that resulted in a 1.6 percent increase in physician payments for 2003. The estimated reductions for 2004 are a result of the formula used by Medicare to calculate annual fee updates. The primary culprit of the expected decreases, according to CMS officials, is increased volume of physician services in the last quarter of 2002 and a decline in the GDP, both of which are factored into the payment formula. The news of severe cuts over the four years comes as a surprise to the physician community, administration officials, and lawmakers who were instrumental in stopping the 4.4 percent cut this year. The ACC has already began discussions with key lawmakers about the pending fee cuts and has begun to map out a legislative and regulatory strategy, along with other physician groups, to make changes to the formula. In addition, the ACC will be meeting with the Medicare Payment Advisory Commission to discuss the reasons for the growing number of cardiovascular services.

CMS Creates Council To Assist with Coverage Decisions for New Technology
The CMS has created a Medical Technology Council (MTC) to help the agency with its decisions about coverage for new and emerging technologies. The creation of the council is the direct result of a recommendation by the now-defunct HHS Advisory Committee on Regulatory Reform, which was chaired by Douglas Wood, MD, chair of the ACC Coding and Nomenclature Committee. The MTC's primary function will be to expedite resolution of technology coverage issues, including reviewing the appropriate use of Medicare-specific medical codes and qualification standards for new technology payments. The committee also may consider applications for national coverage decisions and for special payments under inpatient and outpatient technology provisions.

Senate Joins House in Exempting Medicare from 1% Cut in '04
The budget resolution passed by the Senate last week spares the Medicare system from a one percent across-the-board cut in federal spending. The budget resolution recently passed by the House also exempted Medicare from an across-the-board cut. The Senate resolution, however, also exempts Medicaid from any cuts, which the House resolution does not do. While the resolutions do not have the force of law, they will serve as guideposts as the House and Senate develop spending bills for FY 04 and other major legislation, including Medicare reform and tax cuts.

Average Physician Income Dropped in Late '90s
A new study shows that average physician net income from the practice of medicine decreased 5 percent in real dollars between 1995 and 1999. In comparison, skilled professionals' average income increased 3.5 percent, according to the study, released last week by the Center for Studying Health System Change (HSC). The decline was likely linked in part to the growth of managed care in the mid-1990s. The study is based on results from HSC's Community Tracking Study Physician Survey, a survey of approximately 12,000 practicing physicians. Specialists earned an average $219,000 in 1999, the report stated, compared with $138,000 for primary care physicians. The study does not provide specific data by specialty.

Company Launches Drug Discount Program for Altocor
Senior citizens willing to pay cash for lovastatin (Altocor) will be able to receive a discount under a program being launched in April by the drug's manufacturer, Andrx Corp. According to a Health News Daily report, the discount card program is aimed at senior citizens taking atorvastatin (Lipitor), simvastatin (Zocor), or pravastatin (Pravachol) who will pay cash for lovastatin, which could save them as much as $500 to $1,000 annually, Andrx CEO Richard Lane said at a Banc of America Securities conference last week. The cash-paying sector represents approximately 8 percent of the statin market, Lane said.

Regulatory Reform Bill Moving Through House
The House Energy and Commerce Committee last week approved the Medicare Regulatory and Contracting Reform Act. In addition to provisions that would provide regulatory relief to physicians, the bill allows physicians to act as independent contractors when billing Medicare, Reuters Health reported. The provision, supported by the American College of Emergency Physicians, is intended to make it easier for physicians who work at different facilities to get reimbursed by Medicare. The bill also contains a provision that would replace the current ICD-9 coding system with an updated version called ICD-10, a provision supported by AdvaMed, the primary trade group for medical device manufacturers. AdvaMed contends that the ICD-9 system makes it too difficult for new technologies to gain reimbursement, Reuters reported. Rep. Charlie Norwood, R-Ga., voiced concern about the provision, but said he was assured that further deliberations on the provision could take place before the bill is brought up for formal consideration before the full House. A similar bill is moving through the House Ways and Means Committee. This bill resembles regulatory reform legislation passed by the House twice in the 107th Congress that was supported by the physician community. The ACC's Medicare Reform Working Group and Coding and Nomenclature Committee will be discussing this legislation in Chicago this week.

CMS Revamps Web Site for Physicians
The CMS has revamped the section of its Web site with information for physicians. The Physicians' Information Resource for Medicare site now provides easy access to the Medicare Physician Fee Schedule Lookup, which allows users to find physician service information regarding fee schedule amounts and geographic practice cost indices for every carrier and locality. It also provides information on physician Medicare participation, payment and billing information, and important publications like the CMS Quarterly Provider Update, among many other resources.

Because of the ACC 52nd Annual Scientific Session, Advocacy Weekly will not be published next week. The next issue will be published on April 14.