American College of Cardiology

May 2, 2005

REIMBURSEMENT

CMS Considers Refining Coronary Artery Stent DRGs
As part of a proposed rule released by the Centers for Medicare and Medicaid Services (CMS) last week, diagnostic related groups (DRGs) associated with insertion of coronary artery stents would be refined to improve the accuracy of payment. The proposal would replace DRGs 516 and 526 with four new DRGs to reflect the presence or absence of a secondary diagnosis on a list of comorbidities and complications. DRGs with secondary diagnoses would be assigned higher weights and reimbursed at a higher amount than those without. The ACC will review the proposed rule, which will be published May 5 in the Federal Register, and will provide comments as appropriate.

McClellan Testifies on Medical Liability Reform
On April 28, CMS Administrator Mark McClellan, M.D., Ph.D., testified on medical liability reform before the Joint Economic Committee, one of the only legislative committees composed of lawmakers from both the Senate and the House of Representatives. McClellan emphasized that the current system is not only expensive but unfair to patients with just cause for seeking compensation for their injuries. The burdensome process for patients and physicians needs to be expeditiously addressed by Congress, McClellan said, by implementing reforms such as caps on noneconomic damages, revisions to collateral source rules and abolition of punitive damages. Click here to read Dr. McClellan’s written testimony.

Senate Considers Additional CDC Funding
Last week, the Senate Health, Education, Labor and Pensions (HELP) Committee approved a bill that would provide an additional $1 million in funding to the National Foundation for the Centers for Disease Control and Prevention. The Foundation is currently funded at $500,000. The bill, sponsored by Sens. Johnny Isakson, R-Ga., and Saxby Chambliss, R-Ga., now goes to the full Senate for its consideration.

“Patient Navigator” Bills Advance in Both Houses
The Senate HELP Committee and the House Energy and Commerce Health Subcommittee approved bills that would allocate $25 million in grants over the next five years to programs that help patients obtain health care services. Award recipients will use the money to hire “patient navigators,” who will help patients coordinate chronic disease screenings and other preventive care services, identify clinical trials, understand insurance policies and apply for federal assistance from government programs such as Medicaid and Medicare. The bills are designed to help low-income, rural and uninsured patients obtain medical care.