American College of Cardiology

SPECIAL REPORT: Congress' Return Marks Renewed Debate on Medicare Fee Cuts
	- Senate's Fall Agenda Includes Medicare Reimbursement Bill - Surveys Reveal Medicare Dilemma Facing Congress - Further Medicare Fee Cuts Would Worsen Existing Access Problem, Study Finds - ACC Comments on 2003 Fee Schedule Highlight Access to Care Concerns
	Drug-Eluting Stent To Be Reviewed by FDA Advisory Committee
	Member Assistance Needed for Medical Liability Study
	Ohio Physicians Call for Liability Reform
	Calif. Lawmakers Pass Malpractice History Bill

SPECIAL REPORT: Congress' Return Marks Renewed Debate on Medicare Fee Cuts
After its month-long recess, Congress is now back in session. With the November elections looming, there is renewed action and debate on Capitol Hill and among physician groups and other health care industry experts about how to address further cuts in physicians' Medicare fees. For up-to-date information on this issue, members are encouraged to regularly visit the "Fight Medicare Fee Cuts" resource center on the ACC Web site.

Senate's Fall Agenda Includes Medicare Reimbursement Bill
Action on legislation to prevent future cuts in physicians' Medicare fees is high on the Senate's agenda, Senate Democratic leaders said last week. "We've got to do Medicare givebacks," said Finance Committee Chair Max Baucus, D-Mont. "I do believe a provider payment bill is very important," added Majority Leader Tom Daschle, D-SD. The Finance Committee could begin work as soon as this week on a $30-$40 billion Medicare provider payment package, Reuters Health reported. The Medicare reform bill passed by the House in July—the "Medicare Modernization and Prescription Drug Act of 2002," H.R. 4954, which the ACC endorsed—would provide an approximate 6 percent increase in Medicare physician payments, a 2 percent increase each year from 2003 to 2005, at a cost of approximately $30 billion.

Surveys Reveal Medicare Dilemma Facing Congress
In related news, the results of two polls released last week further highlight the sticky situation facing members of Congress with regard to Medicare legislation. First, an online survey conducted by the AMA found that 24 percent of physicians have either placed limits on the number of Medicare patients they treat or plan to institute limits in the next six months because of the Medicare fee reductions. In addition, when asked if they would continue to sign Medicare participation agreements if there were additional Medicare payment cuts, 42 percent of physicians surveyed said they would not. Meanwhile, in a survey released last week by the Alliance for Retired Americans, nearly half of seniors asked said a prescription drug benefit was their top priority. Congress, however, has been unable to reach a compromise on Medicare prescription drug benefit legislation. Several prescription drug bills died in the Senate prior to the August congressional recess, and questions still remain about the political ramifications if Congress passes legislation on provider Medicare payments without passing a prescription drug benefit. "We're not going to stand aside and … let the money go to other issues without insisting that prescription drugs be addressed," AARP Policy and Strategy Director John Rother told National Public Radio. [Note: hotlink is for audiofile that requires RealPlayer]

Further Medicare Fee Cuts Would Worsen Existing Access Problem, Study Finds
Medicare beneficiaries and people over the age of 50 with private insurance are currently experiencing significant problems with access to care, including specialty care, according to a new study released last week. The problem could be measurably exacerbated if further cuts in physicians' Medicare fees are not averted, concluded the study from the Center for Studying Health System Change (HSC). Roughly half of Medicare seniors must wait at least three weeks for a checkup with a specialist, the study found, and almost three in four must wait more than a week to see a specialist for a specific illness. "The question for Congress is what's the tipping point for compromising physicians' willingness to care for Medicare patients," said HSC President Paul B. Ginsburg, PhD. "Additional Medicare cuts of the magnitude expected over the next few years are likely to increase beneficiaries' access problems, especially in markets where private insurers pay significantly more than Medicare for physician services."

ACC Comments on 2003 Fee Schedule Highlight Access to Care, SGR Formula Concerns
Further cuts in physicians' Medicare fees could "adversely affect Medicare patients' access to quality health care," ACC President Bruce W. Fye, MD, MA, stressed in comments submitted to CMS Administrator Tom Scully on the proposed rule outlining the Medicare physician fee schedule update for 2003. In the letter, Dr. Fye noted the ACC's agreement with the CMS's plan to broaden the measure of productivity used in the sustainable growth rate formula to an economy-wide multifactor productivity adjustment. He added, however, that "there are numerous other variables in the sustainable growth rate formula that can and should be adjusted," including a change to compensate for the CMS's over-estimate of the number of Medicare beneficiaries that would leave Medicare fee-for-service for Medicare managed care plans. "Now that the actual (lower) numbers are known," the comments stressed, "the CMS should adjust the formula to make it more accurate and to stop penalizing physicians for the failures of Medicare managed care plans."

Drug-Eluting Stent To Be Reviewed by FDA Advisory Committee
The FDA Circulatory System Devices Panel will review Johnson & Johnson's (J&J) sirolimus-eluting Cypher stent at its Oct. 22 meeting. According to a Health News Daily report, a favorable vote by the committee could mean the FDA will approve the device by the end of the year. Eight-month angiographic follow-up data from the SIRIUS study presented earlier this year showed virtually no in-stent late lumen loss in patients treated with the Cypher stent, according to a J&J press release. The findings mirrored the six-month findings from two other sirolimus-eluting stent studies, RAVEL and FIM. Although the FDA has yet to grant marketing approval to a drug-eluting stent, the CMS in August included a new, higher-paying DRG (526) for drug-eluting stents in the 2003 final hospital inpatient payment rule released in August. Implementation of the new DRG is contingent upon FDA approval of a device.

Member Assistance Needed for Medical Liability Study
With Congress expected to consider medical liability reform legislation this fall, the ACC and the American Medical Association are jointly conducting a study to assess physicians' recent experiences with the professional liability system. The study findings will be used in the College's efforts to urge members of Congress to support liability reform legislation that's been introduced in the House and Senate, the HEALTH Act of 2002. A random sample of physicians will be selected to participate in the study. Members should be on the look out in late September for a postcard or email notifying them that they have been selected to participate in the study. Those who are selected to participate are urged to respond to help ensure the success of this study. In related news, the House Judiciary Committee's markup of the HEALTH Act (H.R. 4600) that was scheduled for last week was delayed. It is likely to be rescheduled for this week. For more information on tort reform efforts at the state and federal level, visit the ACC Medical Liability Reform Resource Center on the ACC Web site.

Ohio Physicians Call for Liability Reform
Physician groups in Ohio, including the ACC Ohio Chapter, are waging an all-out campaign in support of legislation to reform the medical liability system in the state. Ohio is one of the 13 states identified as experiencing a liability "crisis." Physicians from across the state rallied at the state capital building in Columbus last week to urge lawmakers to support a tort reform bill that would, among other things, cap noneconomic damages at $300,000. In addition to advocating for reform legislation, the ACC Ohio Chapter has joined with the Ohio State Medical Association to support two Republican candidates for the Ohio State Supreme Court—candidates who are in favor of tort reform. The court, which has a Democratic majority, has twice overturned tort reform laws, most recently in 1996.

Calif. Lawmakers Pass Malpractice History Bill
The California state legislature has approved a bill that would allow patients to obtain information on physicians' malpractice settlements from the state medical board Web site. According to a Los Angeles Times report, physicians would have to have a certain amount of settlements to trigger disclosure. Physicians in low-risk specialties would have to have three or more settlements of $30,000 or more in a 10-year period to trigger disclosure, while higher-risk specialists would have to have four or more settlements. Only future settlements are covered under the bill.