Legislators
Point to Hard Road for Medicare Reform Bill at Alliance
Event
Speaking at an Alliance of Specialty Medicine Capitol
Hill “fly-in” last week, Republican and Democratic
legislators confirmed what many pundits have been saying
for several weeks: the passage of Medicare reform legislation
will be very difficult. The ACC is one of the 13 physician
specialty societies in the Alliance. One legislator, Rep.
Mark Foley, R-Fla., however, was optimistic that Congress
would pass legislation to prevent a cut in physicians’
Medicare fees next year. “Regardless of what happens
with the [Medicare reform package], we’re going to
address physician payments,” he said. Rep. Foley and
Rep. Sherrod Brown, D-Ohio, who also spoke during the Alliance
event, have sent a letter to Speaker of the House Dennis
Hastert, R-Ill., and House Democratic Leader Nancy Pelosi,
D-Calif., requesting that Medicare physician payment provisions
be carved out of the House Medicare reform bill and addressed
as a stand-alone bill. The provisions would provide a 1.5
percent increase in physicians’ 2004 and 2005 Medicare
fees. A more detailed report on the Alliance event will
be available on the ACC Web site this week.
ACC
members are encouraged to contact their House representatives
and tell them to sign onto the Foley/Brown “Dear Colleague”
letter on Medicare physician payment, and to contact their
Senators and tell them to sign onto a similar letter to
the Senate leadership from Sens. Arlen Specter, R-Pa., and
Jeff Bingaman, D-NM. Members can easily contact their legislators
via the ACC
Legislative Action Center on the ACC Web site.
Medicare
Coverage of VADs Expanded
Medicare coverage of ventricular assist devices (VADs) will
be expanded to include “destination therapy,”
or permanent support in patients with end-stage heart failure
who are not candidates for a heart transplant. The per-procedure
payment for the VAD implant procedure also will be increased
by about 25 percent to approximately $70,000. Only hospitals
that have implanted at least 15 VADs as bridge-to-transplant
or destination therapy between Jan. 1, 2001, and Sept. 30,
2003, qualify for payment. The ACC testified earlier this
year before the Medicare Coverage Advisory Committee in
favor of expanded coverage, based on the results of the
REMATCH trial. The decision
memorandum on the new coverage is available on the CMS
Web site.
HHS
Inspector General To Look at Stent Placement, Outpatient
Multiple Procedures in’04
The HHS Office of Inspector General’s (OIG) 2004 workplan,
released last week, includes a review of inpatient and outpatient
claims for stent procedures; the hospital outpatient prospective
payment system, including multiple procedures performed
during a single encounter, which is highly common for cardiovascular
specialists; and continued review of outpatient cardiac
rehabilitation services. The OIG has already released two
reviews of outpatient cardiac rehab facilities, noting in
both
cases that there was a lack of physician oversight and
inappropriate Medicare payments.
Past
ACC President Dr. Garson to Chair AHRQ National Advisory
Council
ACC Past President Arthur Garson, Jr., MD, MPH, has been
selected to be the chair of the Agency for Healthcare Research
and Quality’s (AHRQ) National
Advisory Council. The advisory council is a 19-member
panel of experts who advise the AHRQ on its research initiatives
aimed at improving quality of care, outcomes, and cost-effectiveness
of clinical practice. Dr. Garson is currently the dean and
vice president of the University of Virginia Medical School.
The College congratulates Dr. Garson on this outstanding
honor.
Bill
Giving FDA Regulatory Authority Over Tobacco Hits Snag
Negotiations on legislation that would give the FDA regulatory
authority over tobacco products came to a standstill last
week, with leading Democrats and anti-smoking groups saying
the proposed legislation has a serious loophole. According
to a Wall Street Journal report, the behind-the-scenes
deliberations between the bill’s primary sponsor,
Sen. Judd Gregg, R-NH, Sen. Edward Kennedy, anti-smoking
groups, and tobacco industry representatives fell apart,
with Sen. Kennedy saying the proposal “falls far short
of the strong FDA authority needed to effectively do the
job.” Despite the setback, Sen. Gregg and Sen. Kennedy
still hope to move forward with the bill, the Washington
Post reported.
Aetna
Launches New Specialist Network Tiered by Quality, Cost
Effectiveness
Aetna has launched a new physician specialist network that
is tiered according to “indicators of effective care
delivery,” the company announced last week. The new
network, called Aexcel, involves medical specialties “with
large portions of health care spending,” including
cardiology and cardiothoracic surgery. According to an Aetna
spokesperson, to be included in the network, specialists
must meet criteria in four categories: volume, specific
quality of care measures, efficient use of resources throughout
the course of care, and adequate member/employer access.
The network initially will be available in three areas:
Dallas/Ft. Worth, North Florida, and Seattle/Western Washington.
Employers will be able to purchase the Aexcel network as
part of most existing Aetna products.
Ranks
of Uninsured Swell by More than 2 Million
The number of people in the United States without health
insurance jumped by 2.4 million from 2001 to 2002, largely
driven by employers dropping health insurance as a covered
benefit, the U.S. Census Bureau reported last week. With
an election year on the horizon, some are predicting that
the alarming results may be enough to spur Congress to address
the issue, but probably not until 2004. Democrats and Republicans
have been at odds over how to increase coverage, with Republicans
favoring tax credits toward the purchase of basic health
insurance, and Democrats favoring public program expansions.
In response to the new statistics, the Coalition
for Affordable Health Coverage, of which the ACC is
a member, called on Congress to use the $50 billion set
aside in the budget to establish advanceable and refundable
tax credits for the purchase of health insurance.
Blues
Added to Class-Action Suit, Aetna Not Shielded by ERISA
in Negligence Suit
The massive class-action suit brought by 17 state medical
societies against some of the nation’s biggest managed
care plans has a new defendant, the 41 Blue Cross and Blue
Shield plans, Modern Healthcare reported. The class-action
suit alleges that the managed care plans have engaged in
racketeering and other unfair business practices that have
denied or delayed payments to physicians. Two plans, Aetna
and Cigna, have already reached settlements with the medical
societies. Meanwhile, a federal judge has ruled that ERISA
laws do not prevent Aetna from being sued for medical negligence.
Under ERISA, health plans have generally been considered
administrators of insurance benefits, not medical providers,
and thus could not be sued for medical negligence. The decision
is one of several recent rulings that have begun to erode
that protection.
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. 
