CMS Releases Final Decision on CAS

On Oct. 14, 2008, CMS released its final decision memo for percutaneous transluminal angioplasty of the carotid artery (CAG-00085R6), in which CMS declined to expand coverage for stenting in high-risk patients with certain anatomic factors. Earlier this year, the ACC joined with the Society for Cardiovascular Angiography and Interventions and others in requesting that CMS expand coverage to this patient population. In its decision memo, the agency strongly urged publication of peer-reviewed data as soon as possible for several studies that appear to indicate noticeable clinical benefits of carotid artery stenting for these patients. CMS is open to an expedited review and reconsideration process after that data is published. The final decision memo is available here.

ACC Comments on ICD-10 Proposed Rule

The ACC last week sent a comment letter to the Department of Health and Human Services (HHS) Secretary Michael Leavitt in regards to the department’s proposed rule to transition to the International Classification of Disease Version 10 (ICD-10) from ICD-9 by Oct. 1, 2011. According to the letter, while the ACC “supports the transition to ICD-10, it believes that the proposed timetable will lead to significant short-term difficulty for the entire health care community and will reduce the long-term benefits of this switch.” It continues, “The ACC does not believe that ICD-10 can be successfully implemented before Oct. 1, 2013, and even that extension ... will require significant work in preparation from the health care industry.” The full letter can be viewed here.

In related news, the ACC on Tuesday signed on to an ICD-10 comment letter led by the American Medical Association. The letter stated the necessity of a workable implementation process and timeline for implementing the proposed rule, and comprehensive outreach and education initiatives to support health care providers, in particular small physician groups, in the transition to ICD-10.

ACC, AMA Request CMS Refrain from Auditing Consultations

The ACC recently signed on to a letter led by the American Medical Association requesting that the Centers for Medicare and Medicaid Services (CMS) instruct all contractors, including Recovery Audit Contractors, to refrain from auditing visits billed as consultations. The request is a result of “significant and ongoing concerns” over CMS’ “Consultation Followed by Treatment” policy, which is “inconsistent with the way medicine is practiced,” according to the letter. The letter requests that CMS cease auditing consultations until the policy is clarified and better understood by health care providers, especially those in the inpatient setting.

SAVE THE DATE: Webinar on 2009 Coding Changes

In 2009, cardiovascular health care professionals will see a fundamental shift in coding for cardiac device monitoring services, including pacemaker and ICD interrogations and programming sessions, remote monitoring, ICMs and ILRs. CPT 2009 includes 23 new codes for reporting these services. To help members understand the new structure, the ACC and MedAxiom will hold a Webinar on November 14 from 2:00 to 3:30 p.m. EST to discuss the changes. The Webinar is designed for physicians, practice administrators, coders and clinical staff and will feature presentations by physicians who wrote the new codes. Additional details will be available soon on the homepage and in ACC News. Mark your calendar now!

CMS Releases 2007 Hospital Outpatient Payment Information

The Centers for Medicare and Medicaid Services (CMS) last week updated the publicly available payment information for hospital outpatient departments in calendar year 2007 for common elective procedures and other hospital admissions. The payment information release is part of a Bush administration directive to the Department of Health and Human Services to make available quality and cost data, in an effort to make health care more affordable and accessible. Similar information is available for Ambulatory Surgery Centers, Hospital Inpatient and Physician Services. More information is available on the CMS Web site here.

Medicaid Spending on ‘Unsustainable’ Path, Leavitt Says

Medicaid spending is expected to increase 7.9 percent annually as the result of newer, more complex treatments and rising enrollment, according to the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS). The report is the first of its kind on Medicaid trends by CMS, which examines trends for Medicare and Social Security annually. The report estimates that Medicaid enrollment will increase 1.8 percent to 50 million in 2008, reaching an enrollment level of 55.1 million by 2017. Last year, Medicaid per beneficiary spending averaged $2,435 for non-disabled children and $3,586 for non-disabled adults, the report found. Read more coverage from the Associated Press, or view the report.

Technology Major Driver of Health Care Costs, Report Finds

Medical technology is a major driver of health care costs, as is obesity and a lack of productivity in the delivery of care, Paul Ginsburg, president of the Center for Studying Health System Change (HSC), said last week at an HSC briefing on how to limit rising health care costs and expand coverage. The report found that “technological change is the most important driver of spending increases over time” while the aging US population “plays only a minor role,” Ginsburg said. In addition, experts at the briefing said that professional liability lawsuits and unhealthy lifestyles are not major drivers of health care costs. Other panelists included Robert Galvin, director of global health care for General Electric, Robert Laszewski of Health Policy and Strategy Associates LLC and David Nexon, senior executive vice president of AdvaMed. The HSC study is available here. More coverage is available at The Lewin Report.

Drug, Device Makers To Study Stent-Related Blood Clots

Several medical device and drug manufacturers announced last week that they will work together on a study to determine the ideal length of time to keep angioplasty patients on blood-thinning drugs. The multi-center study is expected to begin patient enrollment late this year or in early 2009. The companies – Johnson & Johnson, Boston Scientific Corp., Abbott Laboratories, Inc., Medtronic Inc., Bristol-Myers Squibb Co., Sanofi Aventis SA, Eli Lilly & Co., and Daiichi Sankyo – decided to perform the study at the request of the Food and Drug Administration. Read more coverage from the AP/Chicago Tribune.