American College of Cardiology

With Medicare Fee Cuts on Horizon for ’04, Legislative Efforts Heating Up
Physician groups are starting to gear up efforts to prevent an estimated 4.2 percent reduction in Medicare fees in 2004. Early indications are that there is limited support in Congress and the administration to prevent the reduction after helping physicians in 2003, which cost $54 billion. The ACC and other members of the physician specialty community have hired a well-respected economist to look at the physician payment formula and help develop policy options that would prevent the cut in 2004 and future years. Congressional leaders have made clear that their top priority is a Medicare prescription drug benefit and that spending offsets will likely be necessary for any payment increases to Medicare providers. Speaking at a health care investment conference last week, a Finance Committee staffer said that lawmakers will be very hesitant to support preventing the reduction, Health News Daily reported, unless physicians make a very strong case that patient access to care will be affected.

Liability Reform-Related Protests, Work Stoppages Continue
Work stoppages by physicians to protest rising liability insurance rates and to call for liability reform have left some communities scrambling to ensure they have enough physicians to care for patients. In Jacksonville, Fla., last week, emergency rooms transferred patients to other hospitals, often because there were no surgeons to treat them, the Associated Press reported. In Pennsylvania, between 5,000 and 6,000 physicians engaged in a work stoppage, with some completely shutting their offices, according to a Wall Street Journal report. The protests appear to be having the desired effect. In Florida, for example, where the legislative session just ended without passage of a liability reform bill, Gov. Jeb Bush, R, told the St. Petersburg Times that he is “extremely concerned” about the last week’s events and is “committed to bring the legislature back to Tallahassee until this issue is resolved.”

State AGs Ask Congress to Control Drug Costs, Promote Generic Competition
Nearly 40 state Attorney Generals have sent a letter to Congress requesting an investigation of alleged pharmaceutical industry anti-competitive behavior and that more be done to promote generic drugs. According to a Star-Bulletin (Honolulu) report, the AGs complained in the letter that they have witnessed “a number of anti-competitive actions that continue to alarm us.” Such actions include filing additional patents on drugs to extend patent protection and agreements between brand-name companies and generic producers aimed at delaying the entry of generic drugs.

La. Bill Would Require MDs to Reveal Interests in Referred Hospital
A bill moving through the Louisiana legislature would require physicians to reveal to patients any interest that they have in a hospital to which the patient is being referred for treatment. The legislation is similar to bills introduced in a number of states aimed at addressing the proliferation of so-called boutique hospitals. According to a Times-Picayune (New Orleans) report, the bill would require physicians to reveal whether they had an investment in, owned, or were employed by the hospital. Federal legislation introduced in April by Rep. Pete Stark, D-Calif., would only allow physicians to refer patients to hospitals in which they have a financial interest if that interest was obtained via terms that were also available to the public at large.

Decision on Medicare Coverage of MADIT II ICD Indication Still in Limbo
A decision by the CMS on whether it will issue a national coverage decision on the use of ICDs for what has come to be called the MADIT II indication is still under consideration, CMS Administrator Tom Scully said last week. The coverage under consideration is for the prophylactic use of an ICD in patients with a previous MI and an ejection fraction of 30 percent or less, without the need for evidence of an arrhythmia. In February, the Medicare Coverage Advisory Committee recommended that Medicare provide coverage for this indication. The ACC testified at the hearing, discussing the ACC/AHA/NASPE's guidelines on ICD/pacemaker implantation released last September, which gave a Class IIa recommendation for ICD use in patients who meet the MADIT II criteria. Several ACC members were on the MCAC panel in both voting and nonvoting roles. According to a Health News Daily report, Scully did not give a definitive timeline for a decision, but he indicated that it may have to wait until the results of the SCD-HeFT trial are published, which isn’t expected until some time in 2004.

Push Being Made to Include Cholesterol Screening in Medicare Reform Bill
The American Heart Association is leading a push to urge Congress to ensure that any Medicare reform legislation include coverage for cholesterol screening for all Medicare beneficiaries. Currently, only beneficiaries with a prior history or illnesses, such as heart disease, stroke, and diabetes, are eligible for screening. An ACC-supported cholesterol screening bill was passed by the House last year and was included in the Medicare reform bill that Congress failed to pass. Senate Majority Leader Bill Frist, R-Tenn., recently said that he plans to try to move Medicare reform legislation, including a prescription drug benefit, through Congress over the next two months. Letters to members of Congress in support of this effort can be sent via the AHA Web site.

Survey: Providers Outpace Payers in HIPAA Privacy Compliance
According to the results of a new survey, nearly 80 percent of health care providers said they were compliant with the HIPAA privacy regulations by the April 14 deadline, up from only 9 percent just a few months earlier. In the survey, conducted by HIMSS/Phoenix Health Systems, 28 percent of responding health care providers were small to medium-sized physician practices. Payers lagged behind providers, with 68 percent reporting compliance by the deadline. In general, “compliance” did not necessarily mean complete compliance. While nearly all providers reported having implemented the Notice of Privacy Practices, for example, only 88 percent said they had implemented other requirements, such as a process for providing an accounting of disclosures to patients.