American College of Cardiology

SPECIAL REPORTS ON MEDICARE REFORM BILL

Medicare Fee Schedule Final Rule Released: 4.5% Cut for 2004, Cardiologists Fare Better on Average
Physicians face an average 4.5 percent cut in Medicare fees on Jan. 1 unless Congress intervenes, the Centers for Medicare and Medicaid Services (CMS) announced on Oct. 31. According to a preliminary analysis by the ACC, the average cardiologists' fees will fare better than other physicians, with a 3.9 percent cut, although the reduction will vary according to the mix of services offered. The combination of increased physician services and an ailing Gross Domestic Product, the two driving factors in the formula used to update Medicare fees, caused the decrease, explained CMS Administrator Tom Scully. “The Medicare reform package now pending before Congress contains a provision that would adjust these payments for 2004," he said in a news release. “If Congress does pass legislation improving payments to physicians, CMS will implement the new payment rates as quickly as possible.”

The fee breakdown for different types of cardiovascular services is as follows:

Echocardiography   -4.2 percent
Heart rhythm         -6.4 percent
Nuclear                 -4.3 percent
Invasive                 -2.4 percent
General                 -3.9 percent

In addition, several ACC-supported changes are included in the final rule that will have a positive impact, including increased practice expense for catheterization and EP procedures to account for clinical staff. A detailed analysis on the final rule’s impact on cardiovascular specialists' costs will be published in next week’s Advocacy Weekly.

Medicare Reform Conferees Reach Agreement to Prevent Cut in ’04 Physician Fees
In related news, the ACC has learned that the conference committee working on Medicare reform legislation has reached an agreement on the Medicare physician payment update provisions. The agreement would provide physicians with a statutory positive update in Medicare fees for 2004. There is no indication yet, however, of what the update would be. The agreement comes in the wake of a letter signed by one-third of the House and 36 members of the Senate to House and Senate leaders urging them to ensure that physicians do not receive a cut in Medicare fees next year. As reported last week, the letter was drafted on behalf of the Alliance of Specialty Medicine—of which the ACC is a member—by Reps. Mark Foley, R-Fla., and Sherrod Brown, D-Ohio, and Sens. Arlen Specter, R-Pa., and Jeff Bingaman, D-NM. The Alliance ran an ad last week in the Capitol Hill publication Roll Call to thank the legislators for their support and to call on congressional leaders to respond to the letter.

Specialty Hospital Deal Close, Hospital Reimbursement Possibly Tied to Quality Reporting
Meanwhile, the conference committee working on the Medicare reform bill continues to make slow progress. Conferees are close to agreeing on an important provision that would put a moratorium on so-called specialty hospitals while their impact on acute-care hospitals is studied. The provision is significant because conferees were seriously considering a ban on physician-owned specialty hospitals. The ACC also has also learned that conferees are nearing agreements on several issues of importance to the ACC, including e-prescribing, conversion to the ICD-10 coding system, and reimbursement changes related to drugs administered in physicians' offices. Further details should be available next week. Finally, the New York Times reports that conferees are set to agree on a provision that would give hospitals a full market-basked update in 2004, but with future reimbursement cuts of $12 billion over the next decade. Hospitals who report data on quality of care under a CMS initiative, however, would not be subject to the cuts.

FDA Issues Advisory on Cypher Stent
The FDA last week issued an advisory to physicians about the potential for subacute thromboses in patients who receive the Cordis’ drug-eluting stent, the Cypher coronary stent. According to the advisory, the FDA has received more than 290 reports of thrombosis occurring one to 30 days after the stent implantation procedure, with more than 60 deaths attributed to the problem. The FDA has also received more than 50 reports of “possible hypersensitivity reactions” in patients who have received the stent, including pain, rash, respiratory alterations, hives, itching, fever, and blood pressure changes. Approximately 300,000 people have been treated with the Cypher stent, according to Johnson & Johnson. The ACC encourages members to submit to the FDA adverse event reports potentially related to implantation of a drug-eluting stent. Reports can be submitted to the FDA via MedWatch at www.accessdata.fda.gov/scripts/medwatch/.

ACC/MGMA Audioconference on '04 Medicare Reimbursement Scheduled for Dec. 2
The first joint ACC/Medical Group Management Association (MGMA) audioconference will be held on Dec. 2 from 2:00-3:30 p.m. EST. The audioconference will provide an update on Medicare reimbursement issues for 2004. Kenneth P. Brin, MD, PhD, chair of the ACC Coding and Nomenclature Committee, and John Schaeffer, MD, co-chair of the ACC Advocacy Committee will lead the discussion, including covering changes published in the final rule on the 2004 Medicare fee schedule. More information, including how to register, is available on the ACC Web site. The audioconference is the first product resulting from the recently announced agreement between the ACC and MGMA. Under the agreement, the ACC and MGMA will collaborate on specialized practice management and cardiovascular audio conferences, and practice cost survey reports.

New Hopes for Tobacco Regulation Bill?
Following the breakdown of negotiations less than a month ago, Sen. Mike DeWine, R-Ohio, is trying to jump start talks over a bill that would grant the FDA new regulatory authority over tobacco products. According to a report in the Capitol Hill publication Roll Call, Sen. DeWine has once again approached Philip Morris USA and anti-tobacco groups like the Campaign for Tobacco-Free Kids about a bill that would, among other things, give the FDA the authority to require tobacco companies to eliminate nicotine from their products and restrict advertisements aimed at children. The agency would not be allowed to outright ban tobacco products, however. The ACC has consistently supported expanding the FDA’s authority to regulate tobacco.

Judge Finally Approves Aetna Settlement with Medical Societies
U.S. District Court Judge Federico Moreno has given final approval to a $470 million settlement between managed care giant Aetna and 17 state medical societies representing more than 900,000 physicians. Judge Moreno—who has been overseeing the class-action suit, which also involves a number of other insurers—had delayed the final approval just a few weeks ago. According to a Wall Street Journal report, both currently practicing and retired doctors can submit claims of improper payment without documentation and receive between $55 and $165. At least $20 million of the settlement will go to a newly established health care foundation, and approximately $300 million will be used by Aetna to overhaul its claims payment systems.

FDA Considering Downclassifying AEDs
The FDA is contemplating convening an advisory panel to consider downclassifying AEDs from a class III device to a class II device. According to a notice in the Oct. 28 Federal Register, the proposal is part of the agency’s effort to investigate ways to enhance efficiency in the approval process of devices already proven safe and effective. There is a 90-day comment period on the proposal. ACC members with concerns about a declassification should contact Carrie Kovar at ckovar@acc.org. The FDA last week also published a final rule downclassifying arrhythmia detectors and alarms from class III devices to class II. Class III devices require the submission of a Pre-Market Approval application, which includes data from prospective clinical trials. Class II devices may or may not require such data. Class II and III devices are also subject to specified "special controls" that must be submitted and approved prior to being approved.