American College of Cardiology

March 14, 2005

IMAGING

Ways and Means Announces Hearing on Medical Imaging
Congress is holding its first hearing exclusively on medical imaging this week as the Ways and Means Health Subcommittee convenes on March 17 at 10 a.m. ACC member Kim Allen Williams, M.D., F.A.C.C., will testify on behalf of the College and the Coalition for Patient-Centered Imaging, highlighting the clinical value of diagnostic images performed by qualified physicians, regardless of specialty. ACC members are urged to contact subcommittee members in advance of this important hearing. More information, including talking points, can be found at www.acc.org/egrassroots.htm.

REIMBURSEMENT

CMS Aims to Clarify National Coverage Process
The Centers for Medicare and Medicaid Services (CMS) issued the first three drafts in a series of documents related to the Medicare National Coverage Determination process. The documents aim to clarify the process CMS uses to determine whether an item or service is “reasonable and necessary” for coverage as a Medicare benefit. The draft guidance documents are open for public comment until May 8, 2005, and can be found here.

House and Senate Propose Steep Cuts for FY06
House and Senate budget negotiators released their FY06 budget resolutions last week, reflecting President Bush’s call for significant reductions in mandatory spending programs. The House budget panel took the more austere approach, calling for $69 billion in cuts over the next five years. The Senate resolution includes $32 billion in proposed cuts. Although neither proposal mentions Medicare, the spending targets appropriated to committees such as the House Energy and Commerce Committee will challenge legislators to consider all health care programs as potential sources of cost-savings. Both resolutions are scheduled for a floor debate this week and House and Senate leadership hoping to finish discussions before a two-week congressional recess.

QUALITY

Senate Committee Approves Medical Errors Bill
The Senate Health, Education, Labor and Pensions Committee passed a bill on March 9 that would create a confidential medical error reporting system for physicians. The legislation aims to encourage physicians to report medical errors without fear of legal retribution. The bill also creates a database that can be used to track and analyze trends in order to prevent future errors. Similar legislation passed the Senate last year and the House in 2003.

MedPAC Recommends Extending Specialty Hospital Moratorium
In 2003, the Medicare Modernization Act halted the construction of physician-owned heart, orthopedic and surgical specialty hospitals until June 8, 2005, and instructed the Medicare Payment Advisory Commission (MedPAC) and the Department of Health and Human Services (HHS) to report back to Congress on issues concerning these specialized facilities. Last Tuesday, the Senate Finance Committee received MedPAC’s recommendations, which include improving Medicare’s inpatient prospective payment system and extending the current specialty hospital moratorium until Jan. 1, 2007. Specifically, MedPAC advised the HHS Secretary to reevaluate current DRGs to better reflect differences in the severity of patient illness and the cost of providing care.

State Smoking Bans Get Research Lift
New research linking breast cancer to secondhand smoke has renewed interest in the effects of tobacco smoke, which have already been shown to cause heart disease and lung cancer. This new information released by California’s Air Resources Board may help advance clean air legislation in several states and lead to stricter regulations pertaining to smoking in public places such as bars and restaurants. Maryland, Minnesota and New Mexico are just a few of the states with statewide smoke-free legislation moving through their respective legislatures, and local governments such as Philadelphia are considering clean air policies of their own. To see smoke-free legislation pending in your state, click here.

ACC '05 ADVOCACY HIGHLIGHTS

Media Panel Provide CV Legislative Outlook
Drawing on years of experience working with and reporting on members of Congress, four panelists came together at ACC ’05 to deliver their predictions for the upcoming legislative session. The panel of legislative reporters and political consultants concluded that any policy changes this year will be driven by an urgent need to contain costs. Medicare’s recent introduction of pay-for-performance models of reimbursement symbolizes the government’s quest to show added value for healthcare expenditures.

Despite the cost-conscious legislative environment, panelist Frank Luntz, Ph.D., of Washington-based Luntz Research implored ACC members to use their clinical experience and expertise to convince legislators of the long-term value of fixing immediate problems, such as the medical liability system. “Go see members of Congress in your district. When they see you at home, you’re not a lobbyist — you’re a constituent. When they see you with 10 people, you’re a focus group. When they see you with 50 people, you’re a pressure group.”

Reimbursement Session Gives Inside Look at Coverage Process
In a session dedicated to unraveling the complex coverage process for new cardiovascular devices and services, the ACC brought together experts from government agencies and private payers to explain the system from A to Z. From the FDA approval process to Medicare coverage decisions and valuation of cardiac services, attendees learned the ins and outs of coding and reimbursement procedures. To learn more about recent developments in cardiac coding, check out ACC’s 2005 CPT guide for an overview of new codes and guidelines for reimbursement.