Former
Senate Minority Leader Tom Daschle (D-S.D.) has accepted the
position of secretary of the Department of Health and Human
Services offered by President-elect Barack Obama. Daschle,
who served as a Democratic leader for 10 years, has said that
the federal government should play a larger role in increasing
access to health insurance and improving the quality of patient
care. Meanwhile, for more on health care reform, don’t
miss November’s “Lewin
Report” on CVN. ACC President Doug Weaver, ACC CEO
Jack Lewin and Reps. Joe Barton and Lois Capps discuss health
care reform and approaches to improving quality.
REGULATORY
ACC,
MedAxiom Hold Cardiac Device Webinar; Recording Now Available
More
than 400 cardiovascular professionals last week participated
in a Webinar intended to assist ACC members in understanding
revisions to cardiac device monitoring codes made under in
the final 2009 Medicare Physician Fee Schedule. The Webinar,
sponsored by ACC and MedAxiom, discussed changes to pacemakers
and ICD interrogations and programming sessions, remote monitoring,
ICMs and ILRs. CPT 2009 includes 23 new codes for reporting
these services. Speaking on the Webinar were Bruce Wilkoff,
M.D., F.A.C.C., director of cardiac pacing and tachyarrhythmia
devices at the Cleveland Clinic, Linda Gates-Striby, CCS-P,
ACS-CA, compliance manager at The Care Group, and Cathie Biga,
president and CEO of Cardiovascular Management of Illinois.
Wilkoff, Gates-Striby and Biga provided suggestions as to
what practices can do now to start preparing for the changes.
For program
materials, including a recording of the Webinar, visit the
Quality First Web site by clicking
here. The ACC will continue to provide detailed information
about the Physician Fee Schedule. Look to ACC.org and Cardiology
for more information.
Med
PAC Considers Structural Change to Imaging Payments
The
Medicare Payment Advisory Commission (MedPAC) at its November
meeting considered recommending a revision to the physician
payment formula for certain advanced imaging procedures to
address perceived overutilization that may be related to payment.
Medicare determines payment for imaging services in part based
on an assumption of how frequently the required equipment
is used, with a lower utilization assumption resulting in
a higher payment. The Commissioners discussed raising the
estimated equipment use rate for advanced imaging (CT, MRI,
nuclear medicine) from 50 percent of the time that providers
are open for business to 75 percent or 90 percent, which more
closely matches with studies of utilization performed in some
communities.
MedPAC estimated
that Medicare would reduce spending on advanced imaging by
$600 million annually at a 75 percent assumption and about
$900 million annually at 90 percent. Under Medicare rules
regarding budget neutrality, the savings would be redirected
to other physician services. However, because the payment
for the technical component of many advanced imaging services
is already limited to no more than paid to hospitals in the
outpatient setting, the redistributed funds may be lower than
estimated. Some commissioners said that there are incentives
to overuse for both too large and too small reimbursement
and others discussed that utilization expectations may be
lower in rural areas than in the urban areas that were studied.
MedPAC could include a recommendation on the utilization assumption
in a March report to Congress.
BCBSA
Recognizes ACC’s Role in Blue Distinction Program
This
week the Blue Cross Blue Shield Association (BCBSA) released
outcomes data based on a three-year experience with the Blue
Distinction Centers designations in the areas of cardiac care,
bariatric surgery, complex and rare cancers and transplants.
BCBSA acknowledged the ACC as a key component of the evidence-based
medicine and nationally established quality measures embraced
as part of the designation in cardiac care. HealthCore, Inc.,
prepared the cardiac outcomes data and confirmed that readmission
rates for certain procedures performed at Blue Distinction
Centers for Cardiac Care were lower than those performed at
other hospitals for Blue Cross and Blue Shield patients. BCBSA
is requiring participating in the National Cardiovascular
Data Registry (NCDR) CathPCI Registry® as part of the
designation cycle currently in process. For more information,
click
here.
QUALITY
ACC
Endorses 30-Day PCI Mortality Measures
The
ACC has endorsed the following 30-day PCI mortality measures
submitted by the Centers for Medicare and Medicaid Services
(CMS) to The National Quality Forum for measure evaluation.
30-day
all-cause risk-standardized percutaneous coronary intervention
(PCI) mortality rate for patients with ST segment elevation
myocardial infarction (STEMI) or cardiogenic shock measure;
and
30-day
all-cause risk-standardized PCI mortality rate for patients
without STEMI and without cardiogenic shock measure.
CMS has
indicated that these measures are intended for use in its
public reporting program. Both measures were developed by
the Yale New Haven Hospital-Center for Outcomes Research and
Evaluation (YNHH-CORE) using rigorous scientific methodology,
and rely on data from the CathPCI Registry for the risk-adjustment
of patients. An advisory group consisting of ACC physician
members and staff supported the Yale research team. In addition,
the ACCF Task Force on Public Reporting of Hospital-Level
Outcomes Measures and the Interventional Council advised both
the Yale team and the ACC Board of Trustees to ensure that
both measures are consistent with ACC's public
reporting policy. The Society for Cardiovascular Angiography
and Interventions, ACC’s partner on the CathPCI Registry,
has cautiously endorsed these measures as well.
Priorities Partnership Announces Health Reform Plan
On
Nov. 17, the National Priorities Partnership, convened by
the National Quality Forum (NQF), announced
its priorities for improving the nation's health care
system. The partnership of 28 organizations will focus its
collective health reform activities on six priority areas:
engaging patients and families in making decisions about their
health; population and community health; health care safety
and reliability; care coordination; access to palliative and
hospice care for patients with life-limiting illnesses; and
eliminating inappropriate and unnecessary care.
Cardiologists,
among other medical specialties, were targeted in the priorities
for reform. Under the priorities, the Partnership with work
with health care organizations and hospitals to:
Reduce
preventable and premature hospital-level mortality rates
and improve 30-day mortality rates following hospitalization
for select conditions
Reduce
30-day readmission rates for heart failure, AMI and pneumonia.
Improve
the delivery of appropriate patient care and substantially
and measurably reduce extraneous services and/or treatments.
The NQF
intends to develop action plans in 2009 with the goal of meeting
these priorities in 3 - 5 years.
