American College of Cardiology

CMS Proposes New Pay-for-Performance Standards for Medicare
The Centers for Medicare and Medicaid Services (CMS) announced proposed standardized measures aimed at evaluating physicians’ treatment of patients with specific clinical conditions. CMS submitted the set of 84 standards, called ambulatory care measures, to the National Quality Forum for review and comment. Although Medicare officials do not expect to incorporate all of these measures into the final evaluation tool, the survey will be used to evaluate the quality of care provided in physicians’ offices for specified conditions, including coronary artery disease and heart failure, diabetes, and high blood pressure. Physicians will receive payment for monitoring and reporting information on these measures to CMS.

The announcement by CMS coincided with a meeting of the Medicare Payment Advisory Commission (MedPAC), which is exploring various pay-for-performance models for adoption by Medicare. MedPAC is in the beginning stages of examining tying quality care with reimbursement levels, and is expected to make recommendations on Medicare pay-for-performance in its March 2005 report to Congress.

House Passes Physician Visa Bill, Bush Expected to Sign
By an overwhelming margin of 407-4, the House passed a bill renewing a visa program for foreign doctors who complete their training in the United States. Typically, foreign doctors must leave the country for two years after completing their training, but the bill passed by the House last week and the Senate on Oct. 11, allows physicians with J-1 visas to stay in the United States if they agree to practice in an underserved community for three years. Each state will be allowed to grant 30 waivers per year, including five waivers for physicians practicing in areas not specifically deemed “underserved” by the Department of Health and Human Services. The bill now goes to President Bush for his signature.

Senate Holds Hearings on Vioxx
Amid criticism of the market withdrawal and safety review of the blockbuster pain medication Vioxx, representatives from the Food and Drug Administration (FDA) and the drug’s manufacturer, Merck, were called to testify before the Senate Finance Committee on Nov. 18. Senate Finance Chairman Charles Grassley, R-Iowa, issued a stern warning to the FDA, commenting that “one of my concerns is that the FDA has a relationship with drug companies that is too cozy.” David Graham, the Associate Director for Science and Medicine at the FDA’s Office of Drug Safety, offered a grim assessment of the FDA’s safety review process, calling the injuries resulting from Vioxx the “single greatest drug safety catastrophe in the history of this country or the history of the world.”

Graham also warned that without immediate reform the public remains at risk and he mentioned five drugs currently on the market that need to be closely monitored by the FDA: weight-loss drug Meridia, cholesterol-lowering drug Crestor, acne drug Accutane, pain relief medication Bextra, and asthma drug Serevant. Other FDA officials who attended the hearing denied any elevated risks associated with these drugs and told the panel that they should be considered safe. Raymond Gilmartin, Merck’s CEO, also testified at the hearing, emphasizing the company’s constant evaluation of Vioxx while it was on the market and its voluntary withdrawal of the drug when it was found to lead to a higher risk of heart attack and stroke.

Congress Passes Spending Bills for FY2005
In a rare Saturday congressional session, Senate and House negotiators wrapped up discussions on nine appropriations bills and passed an omnibus spending package totaling $388 billion. The final bill reflected the desire of Republican leadership to limit domestic spending in favor of increased funding for homeland security and the war in Iraq. The White House had threatened to veto the bill if domestic spending rose by more than 1 percent. Congress met this demand by issuing a modest 2.8 percent funding increase for the departments of Labor, Health and Human Services, and Education. Some health-related allocations include:

• National Institutes of Health: $28.5 billion (an $849 million increase)
• National Heart, Lung, and Blood Institute: $2.9 billion (an $85 million increase)
• Centers for Disease Control and Prevention: $4.5 billion (a $196 million decrease)
• Agency for Healthcare Research and Quality: $318 million (a $14 million increase)
• CDC Heart Disease and Stroke Program: $45 million (a $3.4 million increase)

These numbers do not reflect an 0.8 percent cut mandated for all non-defense, non-homeland security spending.

Hospitals Committing Fewer Errors, But Consumers Still Have Doubts
Two studies released last week revealed that although hospitals have made headway in reducing medical errors, the public continues to harbor concerns about hospital safety. The LeapFrog Group, which is comprised of more than 160 large health benefits purchasers, released a survey last week demonstrating that hospitals are taking steps to ensure patient safety. Eighty percent of hospitals reported implementing procedures to prevent wrong-site surgeries and 70 percent of hospitals require a pharmacist to review medication orders before administering the drug to a patient. The survey also pointed to areas where hospitals need to improve in their safety standards, including ensuring appropriate nurse staffing levels, explaining risks associated with procedures to patients, and preventing bed sores.

Despite these systemic reforms to hospital care, 40 percent of Americans believe that the quality of health care has lessened over the past five years. According to a survey released by the Kaiser Family Foundation, the Agency for Healthcare Research and Quality, and the Harvard School of Public Health, more than half of the public is dissatisfied with the quality of care. One-third of the 2,000 people surveyed said either they or a family member had experienced a medical error and 92 percent of the respondents believed medical error reporting should be mandatory. The survey also revealed that most Americans do not believe litigation is a viable method of reducing errors. Instead, hospitals and providers should report errors promptly and give consumers access to this information, so they can make informed choices about their delivery of care.

Medical Liability Online Resource: Protect Patients Now
Doctors for Medical Liability Reform (DMLR) continues to offer physicians, patients and the public the most comprehensive online resource for medical liability reform through its Web site—www.protectpatientsnow.org. Filled with detailed information reflecting the impact of the 2004 elections on the campaign for reform, the DMLR site provides users with a state-by-state analysis of medical liability reform, a look at eight Senators who signed the DMLR pledge, and a national perspective of the medical liability crisis.

Advocacy Weekly is a product of the Advocacy Division of the American College of Cardiology. Questions or comments regarding this publication should be directed to the Advocacy Division at 800-435-9203 or to advocacydiv@acc.org.

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