Payment Band Aid Sticks for Six

by Jack Lewin December 20, 2007 14:30

As most of you already know, there is news from Capitol Hill — not great news, but news. Before they recessed for the holidays, the Senate and House voted to approve a six-month Medicare payment update and extension of incentive funds for PQRI. As a result of CV societies’ collective efforts, the legislation does not include imaging cuts or policy. The fix replaces the scheduled 10 percent cut with a .5 percent update from Jan. 1 to June 30, 2008. The legislation does not pay down the cost of the update, making the cost of future fixes even higher. 

They got most of the money by borrowing from the Medicare Trust Fund, which is really “funny money” supposedly allocated for future boomer Medicare costs. They didn’t tap Medicare Advantage insurers so that Mr. Bush will sign the big domestic spending bill in which this fix was embedded.  The PQRI program was not terminated, so theoretically a 1.5% payment for participation continues for the first six months of 2008.

So, what’s next? The ACC will continue to fight the payment battle in the hopes of achieving a long-term solution rather than perpetuating the series of short-term band aids. The College sent a letter to Senate Finance Committee Chair Max Baucus (D-Mont.) and Ranking Member Charles Grassley (R-Iowa) expressing disappointment in the temporary nature of the fix.

Congress fully agrees with us that the current system is unsustainable, and they frankly hate this SGR formula mess as much as we do. But they can’t agree on how to fund our way out of it. It is critical that we together craft a long-term strategy. As irritating as this is, it is far better to delay the cuts for now, and go after more help during the election year when Congress doesn’t want to have embarrassing battles that could alarm patients — aka voters. We don’t think any real long-term reform in payment fairness will occur until 2009. But something will have to happen then. We’ll be ready.

Keep Calling!

by Jack Lewin December 17, 2007 20:45

The “chatter” coming from Capitol Hill regarding Medicare physician payment changes every few hours. We’re encouraged they will stay in session through this week, but we’re very concerned they will split without reversing the cuts. The disagreement is over the size of the package and where to find money.

The ACC has sent letters to key committee leaders and once again shared our concerns with House and Senate leadership and rank and file members. Our membership has placed more than 400 calls through ACC’s grassroots hotline.

The calls to reverse the cuts are critical still. Use the ACC’s Grassroots Hotline number: (800) 210-7193. We will update you as developments occur.

Guidelines Get Nip-Tuck

by Jack Lewin December 17, 2007 20:44

The ACC has had another remarkable week. The College has posted focused updates to the Guideline for Percutaneous Coronary Intervention and the Guideline for the Management of Patients with ST-Elevation Myocardial Infarction. Kudos to the writing committees.

We’ve also established two exciting new Guideline Focus Centers on Cardiosource. These Focus Centers include the full text of each update, plus interviews with writing committee members, slide sets, and a very handy “10 Points to Remember” summary. I encourage you to go to Cardiosource and peruse the outstanding resources we’ve gathered there for these two updated documents. Click here to see the STEMI focus center, or click here to go to the PCI focus center.

CLAIMing a Position

by Jack Lewin December 11, 2007 20:43

The issue of claims data continues to rear its head. We just learned that Senators Kennedy, Clinton, Gregg and Enzi plan to move their “Wired for Healthcare Quality Act” (S. 1693) this week. The legislation is intended to promote widespread HIT use, but it also includes a section that allows the public release of reports based on federal health care data, including physician-identified Medicare claims data.

Over the past few months, the ACC and several other physician organizations have met repeatedly with congressional staff to discuss concerns with claims data-based reporting based and urge significant modifications to the legislation. While these discussions have contributed to a number of positive changes in the public reporting section of the bill, many questions still remain. 

As the ACC continues its discussions around public reporting, we need to be aware that a number of our research members are currently engaged in using claims data for certain legitimate research purposes. We will also likely be using claims data for certain NCDR "trending" purposes, such as tracking frequency of use of certain procedures or diagnostic studies. When developing a stance on this bill (or potentially others) we need to not to be so strident against claims data that Congress interprets our position to be that claims data has no appropriate uses or value. This could hurt our credibility and limit our ability to influence changes. Rather, we need to continue to make clear that claims data cannot be effectively applied to clinical outcomes measurement. We are firm in this regard for good reason.

Down To The Wire

by Jack Lewin December 10, 2007 20:42

We’re down to the wire! There is a strong possibility that Congress could adjourn this year without stopping cuts to Medicare. Congress is banking on the assumption that the cuts won’t cause physicians to change their practices and limit Medicare patients. However, I think this will happen this next year if the cuts proceed.

It’s critical that you contact your members of Congress and encourage them to put pressure on House and Senate leadership to ensure that these cuts do not go through. Call now using the ACC’s toll-free grassroots hotline at 800-210-7193.

Call Now!

by Jack Lewin December 3, 2007 21:49

As of a meeting last Friday with other specialties, large states and AMA, it was anticipated that the Senate Finance Committee would introduce a package early this week addressing Medicare physician payment cuts. Our imaging accreditation and appropriateness criteria pilot may be included in the package. The pilot would include parallel tracks employing both ACC’s and ACR’s appropriateness criteria, since we don't have agreement with radiology on a unified set of criteria, even though staff are meeting to discuss this. We are also working to address concerns over accreditation and appropriateness criteria raised by other societies. 

These issues aside, we need to get the calls going to your members of Congress NOW. There is some concern that Congress will let the cuts go through, and come back to fix them in February or March. Congress is banking on the assumption that the cuts won’t cause physicians to change their practices and limit Medicare patients. Despite our tireless staff efforts here on the Hill, more folks need to start letting their members of Congress know how bad things are getting. Not to mention, Friday's New York Times implied that Medicare is wasting money on oxygen and other payment factors, which ironically could hurt our cause. There's no excuse for Congress not to get this fixed now. They've cut physicians for six years running. The funding for the reversal would probably have to come from cuts in Medicare Advantage insurance payments, which are 12 – 18 percent above regular Medicare. MedPAC even suggested cuts there. But, no matter how they fund reversing the cuts, we need to get the calls going this week — please.

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About the Authors

The ACC in Touch Blog is primarily co-authored by current ACC President John Gordon Harold, MD, MACC, and Board of Governors Chair David May, MD, PhD, FACC.

Harold John Gordon Harold, MD, MACC, became ACC president in March 2013. Dr. Harold is a clinical professor of Medicine at the Cedars-Sinai Heart Institute in Los Angeles.

May David May, MD, PhD, FACC, began as the chair of the Board of Governors in March 2013. Dr. May currently works as a managing partner at his private practice, Cardiovascular Specialists, PA (CVS) in Lewisville, Texas.

Learn more about Drs. Harold and May.

Statements or opinions expressed on the Blog reflect the views of the contributor, and do not reflect the official views of the ACC, unless otherwise noted.

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