American College of Cardiology

May 16, 2005

IMAGING

Rhode Island Looks to Broaden Imaging Provider Approval Process
The Rhode Island House of Representatives passed a bill last week that broadens the definition of an accrediting organization for magnetic resonance imaging from the American College of Radiology to “a nationally recognized organization.” The legislation upholds current regulations that require licensed physicians and imaging technologists to be “accredited.” The ACC supports the provisions of this bill, and the Rhode Island Chapter has been working diligently on this and other imaging bills in the state.

It should be noted that the bill and Rhode Island code confuse certification with accreditation. Facilities are accredited; individuals, technologists and licensed physicians, in this case, are certified. A similar bill has been approved by a Senate committee, and the full Senate may vote on either bill at any time.

Specialty Hospitals in Government Spotlight
With the 2003 specialty hospital moratorium set to expire June 8, Congress and the Centers for Medicare and Medicaid Services (CMS) are considering whether to lift the ban on new facilities or extend the moratorium indefinitely. The House Energy and Commerce Subcommittee on Health considered this issue at a hearing last week, where CMS Administrator Mark McClellan, M.D., Ph.D., indicated that Medicare will be adjusting payments to more accurately reflect the cost of providing inpatient care. “Our current payment system may not provide appropriate incentives for maximizing quality and costs for our overall beneficiary population,” McClellan testified. House Energy and Commerce Chairman Joe Barton, R-Texas, strongly opposes extending the ban, emphasizing the need for a competitive health care marketplace.

The timing of the hearing coincided with the introduction of a bill by Senate Finance Committee Chairman Chuck Grassley, R-Iowa, and Sen. Max Baucus, D-Mont., that would prohibit physicians from referring Medicare and Medicaid patients to specialty hospitals in which they have a financial interest. The bill reflects recommendations made by the Medicare Payment Advisory Commission (MedPAC) in March, and includes a directive to the Department of Health and Human Services to make changes to the current diagnostic related group (DRG) prospective payment system to minimize the profitability disparity within DRGs.

CMS Advises Providers on National Provider Identifier Process
Beginning May 23, health care providers will be able to apply online for the National Provider Identifier (NPI) mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The NPI will be used to identify providers who conduct electronic transactions covered by HIPAA, including claims, eligibility inquiries and responses, referrals and remittance advices. CMS sent a letter to providers earlier this month outlining the NPI application process and a NPI fact sheet is available here. Providers must obtain an NPI by May 23, 2007, although health plans may require use of an NPI before this date.

Medicare Helps Hospitals Provide Care to Undocumented Aliens
On May 9, CMS released its final rule on Medicare reimbursement for services provided to undocumented immigrants. Medicare will provide $1 billion over the next four years to hospitals that provide emergency care for uninsured patients, regardless of their citizenship. California, Texas, Arizona, New York, Illinois and Florida will receive the highest funding amounts based on the size of their immigrant populations. A CMS fact sheet on the new policy is available at http://www.cms.hhs.gov/media/press/release.asp?Counter=1452.

Illinois Legislators Battle over Reform Bill
The Illinois House held a contentious debate last week over a bill that would cap noneconomic damages in medical liability lawsuits at $250,000. The legislative battle over the bill continues as Illinois physicians continue to struggle with rapidly rising insurance premiums. Illinois has been deemed a state in medical liability "crisis" by the American Medical Association due to the number of specialists electing to practice in other states or leave medical practice entirely. Physicians and legislators are working together to achieve meaningful reform by launching an online petition calling for immediate action by the state legislature. Click here to lend your support to this campaign.

Clinton, Gingrich Team Up for Health IT Bill
Former legislative rivals Sen. Hillary Rodham Clinton, D-N.Y., and former Speaker of the House Newt Gingrich have joined together to introduce a bill aimed at speeding the adoption of health care information technology. The bill, known as The 21st Century Health Information Act, would set up regional health information organizations (RHIOs) to facilitate consistent interoperability and privacy standards as hospitals and practices invest in electronic health records and other technology services.

Providers who participate in RHIOs may be rewarded with Medicare payment "adjustments," although the bill does not specify the amount of money allocated for this incentive. Another important provision of the bill would provide an exemption to a federal law preventing hospitals from making donations to physician offices. The bill's sponsors explained that this exemption would allow hospitals to supply physician offices with electronic health record systems. Click here to view Sen. Clinton's press release on the bill.