American College of Cardiology

March 21, 2005

IMAGING

ACC Tells Congress: Keep Patients in Imaging Picture
Last week, the House Ways and Means Subcommittee on Health held a hearing to evaluate recent recommendations from the Medicare Payment Advisory Commission (MedPAC) on managing the growth of imaging services. Representing the ACC and the Coalition for Patient-Centered Imaging, Dr. Kim Williams, M.D., F.A.C.C., told members of Congress, “The result of in-office imaging has been better health outcomes for patients with acute conditions and better maintenance and treatment of those with chronic conditions.” Dr. Williams outlined the clinical value of in-office imaging services and emphasized that quality of care and patient safety are paramount in any imaging debate, regardless of which specialist interprets the imaging tests.

Representatives from the American College of Radiology, the National Electrical Manufacturers Association and the National Coalition for Diagnostic Imaging Services all weighed in on the MedPAC recommendations, but in the end Subcommittee Chairman Nancy Johnson, D-Conn., re-emphasized earlier testimony by the MedPAC witness indicating they could not tell whether the growth in imaging utilization is appropriate or not. She questioned whether creating a government regulatory structure for imaging services would be duplicative of efforts already underway in the private sector, and Congress should instead focus on changing the payment system to encourage collaborative quality improvement initiatives that benefit patients. Click here to view testimonies from the hearing.

REIMBURSEMENT

Medicare Expands Carotid Artery Stenting Coverage
The Centers for Medicare and Medicaid Services (CMS) recently announced plans to expand coverage of carotid artery stenting in patients who are at high risk for carotid endarterectomy. Medicare’s decision expands coverage for carotid artery stenting to high risk patients with symptomatic narrowing of the carotid artery of 70 percent or more.

CMS is limiting use of carotid stenting to facilities and providers who have been deemed competent in performing the evaluation, procedure and necessary follow-up care. Competency will be based on published clinical guidelines that outline physician training and facility support requirements for carotid artery stenting. The coverage decision became effective March 17. Click here to learn more.

ASNC Joins Aetna Settlement
The American Society of Nuclear Cardiology’s (ASNC) Board of Directors approved the Society's official entrance into the compliance dispute process against Aetna. ASNC’s action comes in the wake of numerous complaints from nuclear cardiologists around the country over denials and bundling issues related to Aetna’s reimbursement for myocardial perfusion image testing.

At issue is Aetna’s continued practice of inappropriately bundling the ejection fraction and/or wall motion codes in conjunction with a SPECT myocardial perfusion imaging study. In July 2004, ASNC and ACC leadership invited Aetna representatives to observe these procedures and discuss this issue in greater detail. Aetna requested ACC support for a change in the CPT code structure for myocardial perfusion imaging to the CPT panel, but the ACC Coding Committee rejected this request. ASNC has already identified a nuclear cardiology practice, which has been denied reimbursement for the above add-on codes, to join the Society in entering the compliance dispute process. Contact Chris Gallagher, ASNC Director of Health Policy, at gallagher@asnc.org for more information.

MEDICAL LIABILITY REFORM

Missouri Legislature Passes Reform Bills
Gov. Matt Blunt, R-Mo., is considering a bill passed by the state legislature last week that would cap overall non-economic damages in medical liability cases at $350,000. The new legislation would replace current liability laws that allow patients to claim the maximum award for each injury or defendant named in the suit. Missouri has been categorized as a medical liability crisis state because of skyrocketing insurance rates that are driving many specialists out of practice. Visit the Doctors for Medical Liability Reform Web site — www.protectpatientsnow.org — to learn more.

Governor Expected to Sign Liability Reform into Law
South Carolina is one step closer to achieving meaningful medical liability reform after the state’s General Assembly passed legislation aimed at preventing frivolous lawsuits from ever reaching the courtroom. The bill also stipulates where liability lawsuits can be filed, punishes trial lawyers who file frivolous lawsuits and sets new thresholds for joint and several liability. Republican Gov. Mark Sanford has consistently supported liability reform as part of his legislative agenda and is expected to sign the bill this week.

FDA Issues IV Solution Alert
The Food and Drug Administration alerted hospitals on March 18 against the use of an IV solution commonly used with heart patients. The alert pertains to one lot of Pharmedium Services magnesium sulfate solution. Click here to view the alert.

Senate Bill Helps Small Businesses Buy Health Insurance
The House Education and the Workforce Committee passed a bill on March 16 that would provide incentives for small businesses to work together to buy health insurance for their employees. The legislation creates “association health plans,” or AHPs, and exempts these plans from state laws that require coverage for certain services and procedures. The Senate has introduced a companion bill, but similar legislation passed by the House last year never made it to the Senate floor for a vote.

ACC '05 ADVOCACY HIGHLIGHTS

ACC PAC Welcomes Congressional Colleague to Orlando
The ACC PAC welcomed Rep. Tom Price, M.D., R-Ga. to its annual PAC Chair’s Leadership Circle Dinner on March 6 during the Annual Scientific Session in Orlando. Rep. Price, an orthopaedic surgeon, received support from the ACC PAC during the 2004 campaign as he sought to make the transition from the Georgia Senate to the U.S. House of Representatives. As a physician, Rep. Price is keenly aware of the legislative and regulatory challenges facing cardiologists, including Medicare reimbursement and skyrocketing medical liability insurance rates. He thanked ACC members for their support and encouraged physicians to work together on key legislative initiatives, such as the debate over imaging growth and utilization. To learn more about ACC PAC events and activities, log on to www.epacweb.com/acc.