The 2010 Medicare physician payment rule advocacy effort continues full steam. The letters from Congress to HHS now total about 25% of Congress, with many very prominent members. That is impressive. HHS has got to be feeling the pressure. Ex-CMS Administrators Gail Wilensky, Nancy Ann DeParle (now in the White House), and Mark McClellan have been briefed by me on the debacle, and are in my view genuinely concerned that this doesn’t make sense. Their conversations with the Administration will be felt.

I also had a chance to share our concerns with leaders of the investment banker world this week in NYC with Harvard economist David Cutler (Obama’s health advisor), Leslie Norwalk (former Deputy HHS Secretary), Dana Goldman (Rand health economist), and several consumer group leaders at a Warburg Pincus briefing. The briefing was about how health reform would affect the economic viability of the health system -- but it was amazing how the potential of a 27% cut for CV practices caused great consternation about how their investments (devices, pharma, hospitals) will fare. And look for more major coverage in the media in the next two weeks on how the Rule will hurt seniors and health care -- it is serious, and we have to prevail somehow. We’re working ALL fronts.

The Golden Rule
My hope is that CMS will delay the implementation of the Rule until they can fairly evaluate the practice cost data -- and validate that this proposed approach is absurd. But hope isn’t enough. ALL PRESSURE must be kept on. The AHA data that reveals the 27% reduction in morbidity and mortality over the past decade in CV care should not be reciprocated with a 27% cut in practice reimbursement that will literally KILL outpatient and community cardiology and access to care for 60% of non-urban patients. Instead of implementing this proposed Rule, the CMS needs to be reminded of the Golden Rule -- to do unto cardiology as has been done by us to improve the well being and survival of the American public during this past decade.

We sent several communications to the Congress, the White House, and to the AMA about our concerns on the proposed Rule last week. I sent a letter, and ACC SVP for Advocacy Jim Fasules, M.D., F.A.C.C., sent a thoughtful memo this week to cardiologist and AMA President Jim Rohack. The letter highlighted our concerns with AMA’s survey data, which of course was used to inform the proposed Physician Payment Rule.

Dr. Fasules emphasized in great detail our concerns about survey data irregularities, process problems and — ultimately — practice impact. He also underscored the College’s respect for the AMA and its leadership, as well as our understanding of the many competing pressures in regards to this process. He writes:

“In the long run, it is far better to have data reflect the true costs of caring for patients whether being seen for health maintenance or with complex problems. The ACC hopes we can work with the AMA and CMS to improve the process and data analysis allowing long term policy decisions based on precise realistic measurements.”

We will not relent on our advocacy on this issue until it is fixed.