If you would like to submit a Bulletin Board topic for consideration for our listing, please contact Deloris Green via info@msacc.org. December 29, 2009 Cardiology Advocacy Alliance, are seeking a preliminary injunction against the implementation of the 2010 fee schedule rates for cardiologists and asking the court to rule it invalid and order HHS to use more reliable data that is available or commission a new practice expense survey. Read the complaint! It will make you even more determined to work with us until we prevail. The lawsuit is filed. What's next? We hope the court will schedule a hearing on the College's motion for a preliminary injunction prior to Jan. 15, before any 2010 Medicare payments are actually issued. We also hope the court will grant our motion for expedited discovery of CMS and others involved in the development and analysis of the PPIS. Of course, the court may decide not hear our motions prior to implementation of the fee schedule and/or not grant either motion. Should the government try and have our right to bring this suit blocked by the court we will vigorously contest that effort. While the probability of success in any legal action can be difficult to gauge, the College would not have taken this action, if we did not believe strongly in the legitimacy of our claims. We can confidently say that we have fully pursued all regulatory and legislative options in an attempt to reach a reasonable compromise before having to resort to a lawsuit to protect practice viability and access to cardiovascular care. Unfortunately, despite the best efforts of many in Congress, there is no sign of a reprieve before the Jan. 1, 2010 deadline. Our expectations are realistic, and we are aware that the Federal courts' general inclination to defer to the executive agencies in the implementation of their statutes and regulations with certain laws that protect aspects of the Medicare law from judicial involvement. But, we believe these do not preclude our challenge to the use of the PPIS. Also, should our legal efforts not succeed rest assured that the College will continue its legislative and regulatory efforts. Thanks to the tremendous grassroots efforts of the entire house of cardiology, we have made great strides in building a strong framework for fighting these cuts in 2010. We will continue to work with Congress, CMS and the Obama administration to resolve this issue and find a reasonable solution that minimizes the impact to other specialty societies, while addressing the unjustified and unreasonable cuts to cardiology. We understand that the Medicare cuts are already having irreparable effects on cardiology practices across the country. On behalf of our patients and the future of cardiology, we will not give up until this injustice is rectified. For more on ACC's efforts, go to the Campaign for Patient Access Web site. December 23, 2009 As the end of the year quickly approaches, I wanted to take this time on behalf of your ACC Board of Trustees to update you on where we stand with the 2010 Medicare Physician Fee Schedule. I also want to thank you for your tireless efforts over the past six months to preserve the private practice of cardiology. Despite the unprecedented advocacy efforts of the entire house of Cardiology, it is virtually certain that the payment cuts to cardiology services announced in the final rule will take effect as of Jan. 1. We certainly knew this was the most likely possibility. That being said, we have made tremendous headway, particularly in Congress, in terms of developing a strong framework for continuing to fight this battle in 2010. In addition, we still have a legal card to play in 2009. As you will see below the best timing for this option, which we had hoped to avoid, is now. As you know, the College has had a four-prong strategy working with our chapters, other cardiovascular specialty societies, the Cardiology Advocacy Alliance and others. This "Campaign for Patient Access" has been focused on fighting the cuts at all levels -- regulatory, legislative and legal. In addition, we have undertaken a massive communications and fundraising effort that has resulted in thousands of personal letters and phone calls from patients and practices alike about the impacts of these cuts. These stories have made, and continue to make, headlines in newspapers across the country. Legislative: The College, thanks to your help, has made great strides on the legislative front. While there was no final legislation passed this year, your efforts to influence legislation were not wasted. In the House, there are 55 (and counting) cosponsors to legislation introduced by Rep. Charles Gonzalez (D-TX) on Dec. 16. The bill (H.R. 4371) would continue using 2009 Medicare practice expense relative value units for certain cardiology services. In addition, Reps. Henry Waxman (D-CA), Charles Rangel (D-NY) and Pete Stark (D-CA) sent a letter to CMS Acting Administrator and CEO Charlene Frizzera regarding the 2010 physician fee schedule and the drastic cuts for nuclear cardiology. On the Senate side, Sen. Bill Nelson (D-FL) is leading a sign-on letter to Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KY) regarding the cuts. Also in the Senate, Sen. Arlen Specter's (D-PA) amendment to delay the elimination of payments for consultations provided in office and hospital settings is still in play. Meanwhile, both houses have passed a two-month freeze on the 21.5 percent reduction in overall Medicare physician payment initially slated for Jan. 1, 2010. These SGR cuts are independent of the practice expense and other cuts included in the 2010 Medicare physician fee schedule. Regulatory: The College's leaders and staff have been hard at work demanding changes to the final rule from CMS officials and Health and Human Services (HHS) Secretary Kathleen Sebelius herself. In particular, the College has asked for a phase-in of the 36% cuts slated for nuclear cardiology as of Jan. 1. We have also strongly opposed the new consultation policy and, of course, continue to argue against the use of the flawed PPIS survey used to determine the practice expense cuts. Secretary Sebelius has the authority to make these changes and we will not let up. The continued pressure from Congress on these issues is key, especially since CMS very rarely makes changes to rules once they are final. Legal: The College's legal strategy has been running in parallel to its regulatory and legislative actions. With Jan. 1 fast approaching, and no final action by Congress or CMS to stop the cuts, legal action is the next step. Barring any imminent regulatory action from HHS Secretary Sebelius, the ACC will be forced to file a lawsuit against CMS. We anticipated this might be necessary and have spent the last several months preparing for a legal challenge. Such a challenge needs to be timed when the court can be convinced that the damage caused by the rule is truly imminent. We're at that point. The time to correct this error is now -- before practices are forced to make irreversible decisions regarding support staff and the provision of important patient services. Our expert law firm is now working on the timing of the action and we will report back to you in full detail as soon as it happens. Stay tuned to the Campaign for Patient Access Web site and "The Advocate" for updates on the legal front. Our profession is engaged in a fight for survival. Every cardiologist in the United States must continue to be personally involved in the fight to protect patient access. With the viability of outpatient cardiology and hence patient access to quality cardiovascular care at extreme risk, we cannot afford to stand silent. Many of you are asking what you can do. The College has prepared a Practice Survival Toolkit to help navigate the new coding changes, assess your practice options and determine the impacts of the rule on your practice. In addition, the Campaign for Patient Access Web site makes it easy to donate to the campaign and/or the ACC's Political Action Committee to help subsidize the costs associated with these multifaceted advocacy efforts. In addition, the campaign Web site makes it easy for you to contact your members of Congress and share your stories. December 17, 2009 December 17, 2009 Fifty-five ... That;s the number of original cosponsors on the Gonzalez legislation (H.R. 4731)! Thank you to everyone who called, emailed and/or met with their congressional members urging them to sign on to this bill. Rep. Charlie Gonzalez (D-TX) introduced the legislation in the House last night. With the House now in recess, the next stop is the Senate. As noted previously in "The Advocate," the legislation would keep cardiology payments at current 2009 practice expense levels while allowing other specialties' payments to be based on the Physician Practice Information Survey. Click here for more information on the bill. Additional phone calls and emails are encouraged asking those members who have not signed on to lend their support. Phone calls to the Senate urging similar legislation are also needed. Click here to take action. House passes short-term SGR fix! The House of Representatives on Wednesday approved a roughly $636 billion defense appropriations bill that includes a provision delaying the 21.5 percent reduction in overall Medicare physician payment initially slated for Jan. 1, 2010. The bill, which now goes to the Senate, would delay the cuts for two months. The SGR cuts are independent of the practice expense and other cuts included in the 2010 Medicare physician fee schedule. Your ACC, working with the AMA and other specialty societies, succeeded in getting a Senate amendment to delay implementation of new Medicare consultation policy. Sen. Arlen Specter (D-PA) this week introduced the amendment, which would delay the elimination of payments for consultations provided in office and hospital settings. This new policy, which was included in the final Medicare rule, is set to start on Jan. 1, 2010 and would decrease payments to varying degrees for consultation services. Under the Specter amendment, the new policy would be delayed until 2011 and the Secretary of Health and Human Services would be required to work with the CPT Editorial Panel to modify or establish new consultation service codes that will minimize coding errors. Your ACC strongly opposes the consultation policy because of inadequate physician education about the policy change and the need to more carefully weigh its impact. It is not clear whether the amendment will be brought up for a floor vote. For more information on the consultation code changes, click here. There's still time to participate in the 2009 Physician Quality Reporting Initiative (PQRI) using measure groups. Your ACC has partnered with CECity to offer you an easy online tool you can use to participate in the 2009 PQRI and earn a 2 percent incentive payment on all Medicare Part B professional services for the entire year. Using the PQRIwizardSM, an online, subscription-based CMS qualified reporting program, you can participate in the 2009 PQRI using one of these measure groups: Diabetes Mellitus Preventative Care Rheumatoid Arthritis Back Pain Chronic Kidney Disease Coronary Artery Bypass Graft (CABG) Perioperative Care The deadline for data submissions is February 21, 2010 (data submissions must be for patient visits within 2009 calendar year). For more information or to register for PQRIwizardSM, visit http://acc.pqriwizard.com. Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org. Update your ACC and Cardiosource eNewsletter preferences here. Unsubscribe to this eNewsletter here. American College of Cardiology . 2400 N Street NW . Washington DC 20037 December 14, 2009 A lot happened last week! We had an outstanding fly-in, with more than 80 members from around the country visiting Washington, D.C., to encourage their lawmakers to cosponsor the bill Rep. Charlie Gonzalez (D-Texas) will introduce this week. We also had hundreds of calls and emails from members who couldn't make it to Washington, and we ran ads in key Capitol Hill publications aimed at the Obama Administration and Congress. However, "hundreds" is not enough! We are up against a number of other forces, including other medical specialties, and misinformation is spreading like wildfire. If we have any hope of mitigating the impacts of the final rule by Jan. 1, action is required from everyone NOW! You can easily contact your legislator by calling the ACC's toll-free grassroots hotline (800-210-7193) or going to the College's Campaign for Patient Access website (www.campaignforpatientaccess.org). Message to the House: Rep. Gonzalez's legislation would keep cardiology payments at current 2009 practice expense levels while allowing other specialties' payments to be based on the Physician Practice Information Survey. Click here to view the "Dear Colleague" letter from Rep. Gonzalez. Ask your representative to be an original co-sponsor of this bill. Interested members of Congress should contact Julie Hart in Rep. Gonzalez's office at 202-225-3236 by COB today! Click here to act now. Message to the Senate: The Senate is very preoccupied with health care reform. It is absolutely critical for each and every member to call, visit and/or write their senators NOW asking them to support legislation similar to Rep. Gonzalez's bill! More information and sample talking points are available at the Campaign for Patient Access Web site. With the end of the year quickly approaching, it is crucial that senators understand the impacts of the cuts on cardiovascular patients in their states. The Medicare cuts are slated to take effect on Jan. 1. This is crunch time and we need everyone's support. Practices and/or physicians interested in getting patient's involved should send them to the Guarding Hearts Alliance Web site. Issue briefings and sample letters to Congress designed for patients are available here. December 10, 2009 What a week! More than 80 cardiovascular professionals flew in from all over the country to meet with their congressional delegations asking them to sign on as cosponsors of legislation sponsored by Rep. Charlie Gonzalez (D-TX). The legislation, which will be introduced in the next couple days, would hold cardiology at current 2009 practice expense values, while allowing other specialty practices to operate at 2010 physician practice information survey (PPIS) values. ACC Past President Douglas Weaver had this to say about the meetings: "Staffers were not just polite, they were genuinely interested in our message ... I found a willingness from both sides of the aisle to help. Now it's whether or not we can get something done." Follow up is critical! Those members who attended face-to-face meetings with members of Congress are strongly encouraged to fill out ACC's online feedback form, so that the College's legislative team can follow up with lawmakers on these visits. In addition, personal emails to congressional offices thanking them for their time also are strongly encouraged. For help with these emails, contact Molly Nichelson (mnichels@acc.org). News from the front. In addition to all of the face-to-face meetings, your ACC ran print ads in key Capitol Hill papers over the course of the week and have reached out to national and local media about the impacts of the cuts. ACC media campaigns are having an impact all across the nation, with efforts underway in Denver, Colorado Springs, Birmingham and Chicago. The Chicago media effort focuses on private practice cardiologists from the South Side to the Northwest who will be forced to cut important services for cardiovascular patients. "Hospitals don't have the capacity to absorb the amount of patients we handle, and it's unrealistic to think that they can respond that quickly," said Dr. John Giardina of DuPage Medical Group. For an updated list of your ACC's media efforts, visit the Campaign for Patient Access newsroom. The week is still not over. We can still use calls and emails to members of Congress. The ACC's toll-free grassroots hotline (800-210-7193) connects you directly with congressional offices. In addition, the Campaign for Patient Access site makes it easy to contact your entire congressional delegation via email. As you call and write your lawmakers, keep in mind that personal stories like the ones below are key. "The anticipated cutbacks have already led to a 15% layoff of our workforce and we expect that there will be more employees let go." -- Beverly Hills, CA "Our cardiology practice serves many patients through our 4 separate offices ... The cuts will definitely force us to not only close one or two of our offices b December 8, 2009 Breaking news from Capitol Hill: Rep. Charlie Gonzalez (D-TX) is expected later this week to introduce legislation holding cardiology at 2009 practice expense values at the current rates, while allowing other specialty practices to operate at 2010 physician practice information survey (PPIS) values. While we still have an uphill battle to save the private practice of cardiology, the goal now is to get as many original cosponsors for the bill as possible. We are asking everyone, as part of the "Take Action for Access Week," to contact their representatives and ask them to call Julie Hart in Rep. Gonzalez office (202-225-3236) by Friday to be an original cosponsor of the bill. If Rep. Gonzalez is your member, please take time to personally thank him for sponsoring this bill. The Centers for Medicare and Medicaid Services (CMS) issued a devastating blow to patient access with its 2010 Medicare fee schedule. This legislation will go a long way towards mitigating the impacts of this rule. However, we need everyone to act now! We've made it as easy as possible for you to take action. The College's toll-free grassroots hotline (800-210-7193) will connect you directly with your members of Congress. The Campaign for Patient Access Web site also provides easy access to your lawmakers via email. Sample letters and talking points, as well as materials for you and your patients, are readily available. We've also made it easy to donate to the campaign and to share your stories with each other and the media. Please act now to save your profession and your patients' access to care! December 7, 2009 Take action for access! That's the theme of this week. A bill to hold cardiology at 2009 practice expense RVUs, while allowing other specialties to have 2010 PPIS values, will be dropped in the coming days. While it still will be an uphill battle to get this legislation passed, this week's goal is to generate as many visits, calls and letters to members of Congress as possible urging their support. We'll be storming Capitol Hill over the next three days. More than 80 cardiovascular professionals from across the country will meet face-to-face with members of Congress in Washington, D.C. In addition, we are running ads in several Capitol Hill newspapers over the course of the week that target the Obama administration and Congress. The ads highlight the consequences of the rule and question whether policymakers are prepared to be responsible for the health and material costs associated with cuts. We also have several practices across the country making local news headlines about the impacts of the cuts on Medicare patients in their states. For those who can't make it to D.C., in-district meetings and phone calls are just as important. We are making it as easy as possible. The College's toll-free grassroots hotline (800-210-7193) will connect you directly with your members of Congress. The Campaign for Patient Access Web site also provides easy access to your lawmakers via email. Sample letters and talking points, as well as materials for you and your patients, are readily available. We've also made it easy to donate to the campaign and to share your stories with each other and the media. Your ACC understands that the survival of private practice cardiology is at stake. We have all done our jobs at improving cardiovascular care and reducing mortality, and we will continue to do all that is necessary to defend these accomplishments and not allow the infrastructure we have spent decades building to be destroyed in the name of cost savings. At the same time, we would be doing a disservice by not recognizing that the health care environment is changing. Our other job is to make sure that any changes protect the ability of cardiovascular professionals to provide patients with the care they need in a timely and appropriate manner. We are working hard to ensure that practices have the tools necessary to best survive and thrive in light of these changes. The most recent examples of these efforts are the ACC's new Practice Survival Toolkit and this week's all-member call regarding the pressing coding changes for nuclear cardiology SPECT-MPI, Cardiac Computed Tomography and Cardiac Magnetic Resonance. As a reminder, this member-only call will take place on Dec. 8 at noon ET. Click here to register. The ACC is a powerful and respected organization because of its 60-year history in education, science and advocacy. We have reached this point because of the dedication and efforts of cardiovascular professionals like you. We have a challenging future ahead, but there is real opportunity for the ACC and its members to continue to lead and shape that future. By taking part in this week's activities, we are taking steps to do just that. December 2, 2009 We are stepping up our efforts to stop bad government policy! We've heard from several members of Congress this week about in-depth conversations they've had with cardiologists in their states about the impacts of the cuts on local communities and patient services. We're being heard and we must not let up. We are working with our partner cardiovascular societies on legislative language that is slated to be dropped next week. We also continue to meet with CMS about phasing in the massive cuts to nuclear imaging. ACC President Alfred Bove and President-Elect Ralph Brindis have meetings with key CMS officials and members of Congress as part of next week's "Take Action for Access" activities. We are also continuing to reach out to consumer groups and others about the serious patient access issues posed by the rule. We'll also be running ads in three Capitol Hill-based papers next week. Links to the ads will be included on the "Campaign for Patient Access" Web site and in the next edition of The Advocate. Get Online! Check out the ACC's new "Campaign for Patient Access" Web site for daily updates on what's happening now, quick access to your members of Congress and easy opportunities to share your stories about the cuts' impacts on your patients and your community. The site also contains background information on the issues and resources for both patients and practices. This site is designed for you, so your feedback is appreciated. Ready. Set. Go. We're going to need each and every member to visit, call and write members of Congress as part of next week's "Take Action for Access" grassroots effort. We have a good-sized contingent of people coming to Washington, D.C., December 7, 8 and 9 for face-to-face meetings with their congressional delegations. Those still interested in coming to D.C. should contact ACC's grassroots team as soon as possible for help with scheduling meetings and briefing materials. For those who can't make it to D.C., your ACC stands ready to help schedule in-district meetings and provide you with easy ways to call and write your members of Congress asking them to support our legislation. More information on this virtual effort will be posted in the coming days on the "Campaign for Patient Access" site. We're committed to helping you navigate the coding changes included in the 2010 rule. Your ACC is hosting two Webinars just for members over the next two weeks. The first call will take place on Tuesday, December 8 at noon (ET) and will walk practices through the most pressing CPT changes for cardiology, including the new nuclear cardiology SPECT-MPI, Cardiac Computed Tomography, and Cardiac Magnetic Resonance codes. The call will also address the most up-to-date information on Medicare changes to provider consultations. To register for this call, click here. The second call will take place on December 14 at 1 p.m. (ET). This call will feature a national health insurer panel with representatives from AETNA, CIGNA, WellPoint and UHC. The panel will discuss their respective plans for proper coding implementation, as well as their changes regarding provider consultations. Stay tuned for more information on how to register for this call. Speaking of new coding changes, don't forget about the new Practice Survival Toolkit! The toolkit contains a wealth of information on not only the coding changes, but all of your practice options. Our goal is to help you make the best choices for your practice and your patients in light of the challenging health care environment. Again, this is a resource designed for you, so your feedback on what tools will help you both now and moving into the future is encouraged. November 20, 2009 We'll be coming to you more often, now that we are in the next phase of our campaign to protect patient access to quality CV care. We will have specific requests, provide you with specific tools and keep you informed of our progress every step of the way. Your ACC leaders are in constant conversations with key White House, HHS, Congressional, media and consumer groups to make clear the consequences of this bad government policy. We are detailing the suspect nature of the data used to make payment policy; and we are painting a disturbing picture of disrupted services, blocked patient access, increased disparities and increased Medicare Part B costs caused by shifting services to hospitals. We have willing legislative sponsors for bill language to stop the cuts that should be introduced in the coming days. The introducing members of Congress are checking with CMS to verify technical details over the next several days. Watch this space for a bill number that you can push for. We're not stopping with legislation. We are vetting high-profile law firms and putting the final touches on a strategy to pursue a legal injunction. We are seeking partners in this legal effort from our CV society colleagues, CAA, interested Chapters and other affected specialty societies. We need to continue the pressure on lawmakers during this critical time. The coming weeks present a terrific opportunity for you to meet with your representatives while they are home. Please contact ACC's Grassroots staff at grassroots@acc.org to set up in-district meetings. You will want to illustrate for them the devastating impact the rule will have on your practices and your patients. Your ACC stands by ready to help you get to those offices and make the strong case against this debilitating rule. If you have already arranged meetings on your own, please let us know about them so we can keep a tally of activities. Go to acc.org and get involved with this campaign. You will see links to issue briefs with details about the negative consequences of the rule. You can access a practice expense calculator to specifically define the effects on your practice so that you can deliver the message in your community and to your elected officials. You can access materials for your patients to get them involved in the effort. And you can get complete information about how to contact the lawmakers representing your area. Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org. November 17, 2009 Thanks for dialing in! More than 550 members took advantage of ACC's all-member call last Thursday to learn more about the final 2010 Medicare Physician Fee Schedule and hear from ACC President Fred Bove and ACC CEO Jack Lewin about member resources and next steps. For those of you who could not make the call, slides are available. A recording of the call will be available in the coming days. So what is next? Many of you are asking what you can do. The short-term answer is simple: assess the impacts on your practice. Not only do you need to assess the impacts in order to know how best to plan for the coming year in terms of staffing, negotiating with health plans and meeting the needs of your patients, but you need this information for your members of Congress. We now need to prove to Congress and to CMS that these cuts will in fact impact access to care. We're asking everyone to take advantage of ACC's practice expense calculator to gauge the initial impacts. From there, you are strongly encouraged to send these results to advocate@acc.org, where ACC's media and grassroots team stand ready to help you use these results in messages to Congress, to patients and to your local media. Speaking of media, your ACC is launching a "media blitz" designed to put faces on the cuts at the state and local level. If your office is forced to lay off staff, or you have patients that will need to drive hours to the closest hospital for a test they used to get at your office, we are ready to help make sure these staff and patients are heard. The ACC media team can work with you on op-eds in local papers, radio interviews and even local television interviews. For more information, contact advocate@acc.org. Survey says. As a result of the recent CMS ruling, a new ACC member survey indicates that many practices will need to take action to protect the viability of their practice. The majority of practices report staff layoffs (42%), elimination of service lines (33%), limiting office hours (14%) or not accepting Medicare (13%). Only one-quarter report no action and those which will not change practice patterns tend to be in academia or work in hospitals. Patient Impact: Patients seeing solo practitioners (100 patients seen on a weekly basis) will feel the effect of the ruling the hardest with anticipated cuts across the board in staff, service lines, Medicare payment and office hours. Medicare patients will also be extremely inconvenienced, as 13% of practices (17% of private practices) anticipate a need to reduce the number of Medicare patients or stop accepting Medicare payment. Cardiovascular practices report that about 50% of their patient volume is Medicare patients. Taking that into account, calculations reveal that 14% of the Medicare population receiving cardiovascular care (or 7% of all cardiovascular patients) would be directly impacted by the anticipated cuts. The survey also shows a clear trend toward hospital migration, especially given the 2010 CMS Medicare cuts. Almost one-in-five (18%) of active, practicing cardiologists in the U.S. have already migrated to another practice or hospital and 28% say that a practice merge is on the horizon. When you look at practice type, private practices which expect to be hit the hardest by the recent ruling are more likely to consider integration into a hospital system (39%), although remaining in private practice (32%) is also planned. We will be coming to you in the coming days and weeks with specific ways you can help influence regulatory and legislative efforts to minimize aspects of the rule. Remember that there could be cuts no matter what. However, we are exploring every single option to mitigate the cuts that we believe are based on flawed and unvalidated data and/or are excessive to the point that the consequences to important patient services like medical imaging are devastating. A sample letter to Congress asking members to stop the cuts by any means necessary is currently posted at www.acc.org/can. Information on coding changes and how to work with health plans as you transition to the new codes is available at www.acc.org/practicemanagement. November 12, 2009 We are engaged in a fight for survival. Every cardiovascular professional in the United States must get personally involved in the fight to protect patient access. The CMS Final Rule is bad government policy and it can not stand. The viability of outpatient cardiology and hence patient access to quality cardiovascular care is at extreme risk. Because of your efforts to date, we have succeeded in buying a little time. Since the rule phases in some of the cuts to cardiology over four years, we have mitigated the damage a bit. But these cuts, whether immediate or spread out over time are simply unacceptable. Your ACC is working hand-in-hand with the Cardiology Advocacy Alliance (CAA) and the other cardiovascular societies. We ARE working together and we will do whatever it takes to win. The odds against stopping the cuts completely are high, particularly by Jan. 1, 2010, but that only makes us redouble our efforts. We will need your tireless support during this battle. In the short-term we need you to continue to spread the message within your community and with your elected officials about the specific impacts of these cuts on your practice and your patients. ACC's new practice expense calculator can help. We also need your stories and your patients' stories to put the unintended consequences of these cuts in human terms. Send these stories to advocate@acc.org. As mentioned in previous issues of The Advocate we are exploring all legislative, legal and regulatory options. As we pursue specific strategies in the coming weeks ahead, we will give you specific instructions on how you can help. (Watch this space!) Keep in mind that we will provide as much detail about these strategies as is possible, but we need to be cautious about giving intelligence to those in the house of medicine who would oppose our efforts. On the regulatory front, we have made a specific request to CMS to phase in the 36 percent cut to nuclear imaging. Again, the cuts are unacceptable but we need to buy a little time here as with the other proposed cuts. On the legislative front, our goal is to turn back this bad government policy by building on the goodwill and support created by your efforts to date, and at the same time minimizing opposition. We want to win here, not just feel good about our efforts. The requests for your support will be specific and we will need your full-throated response. If we hit a dead-end with one strategy, we will move on to the next and ask for your support again. If we have a success, we will build on it with additional strategies. On the legal front, we have retained high level legal counsel with experience in challenging this kind of bad policy. Our legal strategy will run in parallel with our regulatory and legislative efforts. Be engaged and get involved. You can start today! Don't forget to join today's all member call with ACC CEO Jack Lewin, M.D., and President Alfred Bove, M.D., Ph.D., F.A.C.C., from 4:00 to 5:30 p.m. (EST) to discuss the rule. To RSVP, click here. Slides are also available at: http://qualityfirst.acc.org/advocacy/Documents/AllMemberCall2010RuleSlides.ppt. In addition, the ACC is ramping up its practice management Web site to help you assess the initial impacts of the cuts and provide FAQs on key components of the rule. Visit www.acc.org/practicemanagement for these and other resources. Finally, there is no better time to contribute to the ACC's Political Action Committee (www.accpacweb.org). October 29, 2009 It's crunch time and we're not letting up! Your ACC's efforts to stop the proposed Medicare payment cuts continue on all fronts. ACC leaders and staff understand the very real impacts these cuts will have on your practices, your staff and your patients and are working around the clock to fight the implementation of these cuts until a rigorous review is conducted of the practice expense survey data. We're appealing directly and publicly to the president to step in and stop this tragedy. Your ACC, working with the Cardiology Advocacy Alliance, today placed an open letter in the nation's flagship newspapers, calling upon President Obama to stop the cuts that will drastically reduce access to cardiovascular care and greatly impact the health of the nation. The print ads ran in today's "A Sections" of The Washington Post, USA Today, The New York Times, and the president's hometown newspaper, The Chicago Tribune. Take a look, and please let others know about these advertisements. Over the past four months, we have worked together to fight this nightmare scenario, in which patients will be forced to battle heart disease without the necessary and critical treatments from their cardiac care providers. To date, approximately 120 members of Congress have written letters to Health and Human Services Secretary Kathleen Sebelius on behalf of the ACC asking for clarification and intervention. In addition, you have made more than 19,000 e-mails, calls and visits to members of Congress. Your ACC remains completely focused on saving cardiology practices and stopping these cuts, but only President Obama can step in and prevent this looming disaster. The final rule is expected by Nov. 2. The ACC is preparing for all scenarios and will communicate with you as soon as we have any information. In the meantime, plan on joining ACC President Alfred Bove and ACC CEO Jack Lewin for an all-member call about the final rule on Nov. 12 from 4:00 to 5:30 p.m. (EST). To RSVP for the call, click here. For more on ACC's efforts regarding the proposed rule, visit: qualityfirst.acc.org.gress about the benefits of appropriate use criteria and clinical guidelines to ensure that the right tests are delivered at the right time to the right patients. We're still at the table (or at least in the garden) when it comes to health care reform. Just this week, ACC CEO Jack Lewin represented the ACC at a special White House event in the Rose Garden with physicians from all 50 states. The ACC was the only specialty group in attendance. Click here <http://emessaging.vertexcommunication.com/ct/5331759:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> to read the ACC's statement. To read the president's remarks, click here <http://emessaging.vertexcommunication.com/ct/5331760:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> . Note his intention to fix the SGR! Check out the president's plan. President Obama's health plan is actually quite pragmatic and includes all of the basic elements that your ACC has been lobbying for over the past few years. There's not much in there we couldn't get behind, particularly as compared to all the controversies in the major bills. The plan primarily targets insurers, and the president has made it clear he's not 100 percent dependent on a public option. He's also open to discussion about the MedPAC idea. If we want to be at the table when really tough decisions are being made over the next 2-3 months, it may be in our best interest to align ourselves with this moderate approach now. The cardiovascular community, by virtue of our past experience and leadership, has some very real insights into payment and delivery system reforms that could add a lot of value as we get into the details. To view the president's principles, go to: http://www.whitehouse.gov/issues/health_care/plan/ <http://emessaging.vertexcommunication.com/ct/5331761:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> . Don't miss this. CMS has finalized its proposal to eliminate blanket noncoverage of MRI for blood flow determination and will allow local carriers to determine coverage policies for this service. The ACC worked with Society of Cardiovascular Magnetic Resonance and the American College of Radiology to request that CMS consider current evidence on MRI blood flow determination and reverse its decision on noncoverage. Removal of the restriction on coverage will permit local carriers to cover blood flow determination performed with cardiac MR studies. In addition, a CPT coding change to be implemented in January 2009 will enable correct reporting of services. October 7, 2009 Full steam ahead! Your ACC's efforts to stop the proposed Medicare payment cuts continue on all fronts. Approximately 25 percent of Congress has sent letters to Health and Human Services expressing concern about the cuts' impacts to the practice of cardiology. Our hope is that the Centers for Medicare and Medicaid Services (CMS) will delay implementation of the cuts until it can fairly evaluate the practice cost data. But hope isn't enough. We must keep the pressure on. The significant decreases in cardiovascular-related mortality over the past decade should not be reciprocated with a 27 percent cut in practice reimbursement that will literally KILL outpatient and community cardiology. The Wall Street Journal <http://emessaging.vertexcommunication.com/ct/5331757:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> agrees. The paper ran an editorial this week, titled "The War on Specialists." The editorial highlights the impacts of the proposed CMS cuts on specialties like cardiology and oncology and criticizes the process used to get there, saying "HHS justified its decision with a flimsy survey whose data it won't release and whose results can't be replicated." ACC CEO Jack Lewin is also quoted, saying the cuts "will cause a horrible disruption that will force many community and independent practices to close their doors, lay off staff or make senior patients wait days or weeks for tests and services." Your ACC continues to take this message to lawmakers, the White House and the media. You can too! Talking points, sample letters to Congress and patient materials are all available at www.acc.org/can <http://emessaging.vertexcommunication.com/ct/5331758:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> . We won one for imaging. The awful imaging amendment by Reps. Anthony Weiner (D-NY) and Bruce Braley (D-IA) to eliminate the ability of physicians to provide advanced diagnostic imaging services in their offices beginning in 2013 was fortunately withdrawn. Special thanks to all of the ACC members who have contacted their representatives on the Energy and Commerce Committee asking them to oppose this amendment. ACC staff and leaders continue to meet regularly with members of Congress about the benefits of appropriate use criteria and clinical guidelines to ensure that the right tests are delivered at the right time to the right patients. We're still at the table (or at least in the garden) when it comes to health care reform. Just this week, ACC CEO Jack Lewin represented the ACC at a special White House event in the Rose Garden with physicians from all 50 states. The ACC was the only specialty group in attendance. Click here <http://emessaging.vertexcommunication.com/ct/5331759:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> to read the ACC's statement. To read the president's remarks, click here <http://emessaging.vertexcommunication.com/ct/5331760:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> . Note his intention to fix the SGR! Check out the president's plan. President Obama's health plan is actually quite pragmatic and includes all of the basic elements that your ACC has been lobbying for over the past few years. There's not much in there we couldn't get behind, particularly as compared to all the controversies in the major bills. The plan primarily targets insurers, and the president has made it clear he's not 100 percent dependent on a public option. He's also open to discussion about the MedPAC idea. If we want to be at the table when really tough decisions are being made over the next 2-3 months, it may be in our best interest to align ourselves with this moderate approach now. The cardiovascular community, by virtue of our past experience and leadership, has some very real insights into payment and delivery system reforms that could add a lot of value as we get into the details. To view the president's principles, go to: http://www.whitehouse.gov/issues/health_care/plan/ <http://emessaging.vertexcommunication.com/ct/5331761:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> . Don't miss this. CMS has finalized its proposal to eliminate blanket noncoverage of MRI for blood flow determination and will allow local carriers to determine coverage policies for this service. The ACC worked with Society of Cardiovascular Magnetic Resonance and the American College of Radiology to request that CMS consider current evidence on MRI blood flow determination and reverse its decision on noncoverage. Removal of the restriction on coverage will permit local carriers to cover blood flow determination performed with cardiac MR studies. In addition, a CPT coding change to be implemented in January 2009 will enable correct reporting of services. September 21, 2009 Our ACC storms the Hill. Thanks to the relentless efforts of you and your patients, nearly 60 members of Congress signed on to a letter from Charles Gonzales (D-TX) and Mike Rogers (R-MI) to Department of Health and Human Services Secretary Kathleen Sebelius condemning the proposed CMS cuts. This does not count the many other letters that individual senators and representatives sent to Secretary Sebelius themselves. You are being heard! We stand firm as we deliver formal comments to CMS. The ACC's formal response to CMS decries the use of the American Medical Association's (AMA) flawed Physician Practice Information Survey to calculate practice expense relative value units (RVUs). The AMA data have not been reviewed for precision or accuracy, and as you well know, the ACC is strongly urging CMS and Congress not to finalize the proposal without further examination. Our formal response is available online. Our Legislative Conference had record-breaking attendance with more than 350 FACCs meeting personally with their congressional delegations in Washington, D.C., last week. The conference brought together members from nearly every state to learn more about current issues facing the cardiovascular community, including the proposed 2010 Physician Fee Schedule, health care reform, medical malpractice and state advocacy. On the final day of the conference, attendees made hundreds of visits to offices on Capitol Hill, reaching lawmakers and their staff on these very important issues. For those of you who couldn't make it to D.C., updates on key sessions, posts from attending members, polls, videos and more are posted on the The Lewin Report blog. Slides and briefing materials are also available on the Legislative Conference Web site. You can also send an email letter or fax to your members of Congress from www.acc.org/can. We are keeping up the pressure with advertising. In addition to the Hill meetings and educational sessions, ACC print and online ads timed to coincide with the Legislative Conference ran in National Journal, Politico, CongressDaily, www.politico.com and www.rollcall.com. To view the ad, go to: qualityfirst.acc.org. Support for the PAC is helping to open doors. Special thanks go to everyone who supported the ACC PAC during the Legislative Conference. Donors gave more than $60,000 to help further the cardiovascular message on Capitol Hill during this critical time. For more information on the ACC PAC visit www.accpacweb.org, or contact Kaycee Smith at ksmith@acc.org. While we're fighting the cuts, we're also seeing health reform bills take shape. Finally, there is a bill out of the Senate Finance Committee that includes some things we like, such as some attempts to address medical liability reform and a few ways to test new payment structures. But the bill falls far short with only a one-year fix to the SGR and not enough heft in long-term payment reform. Our statement on the bill can be found at qualityfirst.acc.org. Click here to read the Finance Committee release. The shortage in cardiologists is growing, according to a report from The ACC Board of Trustees Workforce Task Force. The report finds that an estimated doubling of the CV workforce is necessary between 2000 and 2050 to adequately meet patient need. The report also issues several recommendations for relieving the shortage. The chair of the Task Force, former Texas Chapter Gov. George Rodgers, is featured in the ACC's The Lewin Report as part of the 2009 Legislative Conference coverage. To read the report, click here. Bless you! CMS has released information regarding billing for the Influenza A (H1N1) Vaccine. In the event that it is necessary for Medicare beneficiaries to receive both a seasonal flu vaccination and an H1N1 vaccination, Medicare will pay for both. CMS also will pay for earlier-than-normal seasonal flu vaccinations. More information from CMS is available here. Also, more information and resources regarding pediatric influenza immunization can be found at: www.preventchildhoodinfluenza.org. Are you ready for ICD-10? CMS has issued a fact sheet clarifying differences between the current International Classification of Diseases-9 (ICD) and the ICD-10 system that must be implemented by Oct. 1, 2013. The fact sheet is available online. While implementation is still four years away, the ACC encourages practices to take steps to begin to prepare for the transition. Practices should inquire with their vendors about ICD-10 compliance so they can make budget plans for the coming years. Physicians also should begin familiarizing themselves with the codes. For more information, visit the ICD-10 section of the CMS Web site. August 26, 2009 We've been making significant progress on our Congressional sign-on letter to get the proposed cuts in the Medicare rule reversed. Advocacy staff and ACC leaders have been meeting with members of Congress back in their districts to encourage them to sign on. As we reach the end of the comment period for the rule, we'll need to continue to push hard to win congressional support for our cause. To date at least 4,000 letters from patients and cardiovascular specialists have been sent to Congress. If you have not contacted your Congressional representative about the proposed cuts, please do so right now. Margo Minissian, chair of the CCA Chapter Liaison Working Group and co-chair of the Cardiovascular Team Council, advocates for how important it is for the entire cardiovascular team to contact their lawmakers on ACC's blog, The Lewin Report. For more information, sample talking points and patient materials go to: www.acc.org/can. The comment deadline for the CMS rule is Aug. 31. Your ACC is preparing detailed comments, which will be posted at www.acc.org once completed. The final rule is expected at the end of October. We're making news. Hundreds of cardiologists descended on downtown Orlando as part of a rally organized by the ACC Florida Chapter last week to draw attention to the effects of the CMS cuts. In Oregon, ACC Chapter President Michael Widmer was featured in an opinion piece in the Oregonian where he says the proposed cuts will "lead to reduced access and quality care for patients with cardiovascular disease," as well as limit free care provided to the uninsured. Meanwhile, Iowa Chapter President Craig Clark was featured as a guest columnist in the Des Moines Register. Clark discusses the importance of focusing on the patient in designing reform because if we "focus on patients, we will simultaneously increase quality and reduce expenses, making our system viable in the long term, so we can provide access to quality care for all Americans." Read more at qualityfirst.acc.org. Your ACC is working closely with the Cardiovascular Advocacy Alliance on a PR campaign designed to draw attention to the impacts of the proposed cuts and the resulting need for health reform. We'll keep you posted on this important effort. In other news, ACC's video team hit the road last week to meet with a practice in Culpeper, VA, that would be forced to close its doors if the CMS cuts go through. Stay tuned for the video and keep stories like these coming. What are they thinking? "Fair" and "accurate, those are the words the American College of Physicians (ACP) is using to describe the CMS cuts. ACP's vocal support of the rule is surprising and disappointing, especially considering that many of its cardiovascular members will be forced to make drastic decisions about their practices should the cuts go through. The ACC fully understands the need for primary care physicians to receive fair reimbursement and increased funding for practice viability and workforce pipeline enhancement. To that end, the College has been working to get the medical home and primary care reimbursement increased in a truly major way. We would all be better off working together on such efforts. The small increase proposed by CMS for primary care physicians will not fix internal medicine, family practice or pediatrics. We aren't surprised other specialties that would benefit from the rule are working against us, but ACP and ACC have been historic colleagues on these types of issues. Not this time. We believe the ACP needs to rethink its position and have let them know. If you are an ACP member you should do so as well. Looking for an easy way to improve patient safety and your liability protection? Your ACC has worked with the FDA, American Medical Association, state medical societies and liability carriers to bring you a free service that delivers FDA-mandated drug alerts immediately online. The Health Care Notification Network (HCNN) is free for ACC members. HCNN is precluded from selling, or in any way re-disclosing any of the information provided to it by the users of the service. The registration form is secure and registrants' privacy is protected by the iHealth Alliance. Registration only takes only a few minutes. More information is available at www.hcnn.net or via email at info@hcnn.net. Trying to decide what integration to have with your local hospital system? Your ACC is hosting a Practice Alignment Symposium in Washington, DC, from Nov. 5-6, to assist you in making decisions on what management model to use. The symposium will provide you with the information you need to help your practice thrive in this challenging environment, and is designed to address your specific questions and concerns about the practice alignment process by connecting you with those who are currently working through the alignment process. The Practice Alignment Symposium also will help you cut back on costs during integration by supplying you with the information and understanding you need to budget your expenditures. Registration information is coming soon. August 13, 2009 Now we're rolling! Reps. Charles Gonzalez (D-TX) and Mike Rogers (R-MI) are circulating a letter to HHS Secretary Kathleen Sebelius, expressing concerns regarding the 2010 CMS Proposed Rule and its drastic cuts for cardiovascular and oncology-related services. Click here to see a copy of the letter. Your ACC is asking each and every one of you to contact your respective representative and ask him/her to sign on to this critical letter. Click here to act now. Over the next week, a list of lawmakers who have signed on to the Gonzalez/Rogers letter will be posted at www.acc.org/can. A sample thank you letter to those members will also be provided. In addition, your ACC staff and leaders continue to work to find Senate sponsors for a similar letter. If you have close ties to a specific senator (or senators) and would like to help in this effort, contact Molly Nichelson (mnichels@acc.org). More than 1,500 - that's the total number of emails, faxes, letters and phone calls that have been made to congressional offices across the country from ACC members. More than 80 - that's the total number of visits to key congressional offices and CMS that have been made by your ACC staff and leadership alone. Three - that's the number of op-eds that have been placed to date regarding the payment cuts and their impacts on quality and patient access. One wine tasting - that's the creative way the Ohio Chapter is planning to educate its members about the payment cuts and the overarching need for real health reform later this month. These numbers don't include the incredible efforts of each and every ACC Chapter to send letters to their entire state congressional delegations; schedule face-to-face meetings with members of Congress while they're home on August recess; and host "Cardiologist for a Day" events. Keep up the good work! The CMS comment deadline is quickly approaching. Public comments on the proposed rule are due to CMS at the end of this month. The ACC is crafting a detailed response, but ACC members who wish to write CMS to voice their opinion regarding the proposed rule may do so by clicking here. Don't forget to explain how your practice and your patients will be impacted and what you will do if the cuts are implemented. A recent survey of ACC members shows that 95 percent of you in private practice would be significantly affected by these cuts, with staff layoffs and service limitations listed as the primary impacts. CMS and Congress need to hear this information. If the payment cuts were not enough, we need to make certain the Weiner-Braley imaging amendment is not incorporated into the House health care reform bill (H.R. 3200) when Congress returns in September. Energy and Commerce Committee Chair Henry Waxman (D-CA) has promised to hold an expedited hearing on the amendments not voted on prior to the August recess. Amendments that survive the hearing will be included in broader discussions around a final House package. The ACC position: Let's use appropriate use criteria and science to improve the effectiveness of imaging, not limit who and where imaging is performed. Your ACC Board of Trustees met last week for its annual retreat. Beyond tuning up our strategic plan to reflect the changing health care environment, the Board spent significant time discussing the College's policy positions in the rapidly changing face of system reform, and how we can redouble our efforts to positively influence the final proposal. This all leads up nicely to our major Legislative Conference in September. To register for the conference, click here. Registration closes this Friday! Victory! You may recall that earlier this year the ACC worked with the American College of Radiology (ACR) and the Society for Cardiovascular Magnetic Resonance (SCMR) to request that CMS change its National Coverage Determination (NCD) on MRI to eliminate language that prohibited coverage of blood flow studies with MR. Patients whose physicians recommended a cardiac MR study with blood flow faced a situation in which the entire service was not paid for because of overly restrictive coverage language. We formally requested that CMS reopen the NCD, eliminate the problematic language and return decision-making authority for coverage of cardiac MR blood flow studies to local contractor discretion. CMS recently published a draft decision in which it proposes to do exactly what we requested. Now if they'll only listen to us on the proposed rule. July 8, 2009 Lawmakers are scrambling to put health reform ideas on the table. Key House and Senate Committees have released their respective proposals, with the goal of passing the bills before the August congressional recess. The ACC has submitted detailed comments on the proposals and continues to work with leaders in the Senate and House to be sure your interests are protected. Meanwhile, President Obama on June 15 addressed the economic imperative for health care reform in a speech to attendees of the AMA's annual meeting in Chicago. To view the ACC's congressional comments, as well as a statement reacting to President Obama's speech, go to qualityfirst.acc.org. You can also share your thoughts on health care reform and related issues via the ACC's online forum, The Lewin Report. Watch this space for more detailed information. Under the headline "The Right Care at the Right Time Saves Lives," the ACC has launched an aggressive Capitol Hill ad campaign to let policymakers know that cardiologists and their patients must be directly involved in health care reform. The ads will run in Capitol Hill publications, including CongressDaily AM, Roll Call, National Review, National Journal and Politico, over the next several months while Congress considers health care reform options. The ad also will run in Cardiology and the Journal of the American College of Cardiology. To view the ad, visit the Quality First Web site. Chalk one up for the good guys. We applaud the Senate action late last week to pass the "Family Smoking Prevention & Tobacco Control Act." The bill gives the Food and Drug Administration (FDA) the authority to restrict tobacco marketing and sales to youth; requires detailed disclosure of ingredients; allows FDA to require changes to tobacco products; and requires larger, more specific health warnings. The ACC has been a long-time leading advocate for this legislation, working hand-in-hand with the Campaign for Tobacco Free Kids. Special kudos go to FACCs in Alaska who stepped up to secure co-sponsorship of the legislation from Senator Murkowski. As part of our efforts to help you prepare for widespread adoption and use of electronic health records, the College last week sent a paper to HHS National Coordinator for Health Information Technology David Blumenthal, M.D., with our recommendations for defining meaningful physician use of health IT. By law, practices can begin receiving bonus payments for "meaningful use" of health IT starting in 2011. However, what constitutes meaningful use has yet to be defined, so we are sending in our two cents. To view the paper and for more information on how to choose the best EHR for your practice, visit the ACC's Health IT Web site. Cardiac cath lab procedures have fallen by 111 percent over the past two years, according to a recent report by market research firm IMV Medical Information Division. Total patient cases accommodated by U.S. cath labs declined to 3.75 million in 2008, a drop from 4.21 million in 2006. This is in contrast to IMV's 2006 report, which identified a gradual 9 percent increase in patient cases from 3.85 million in 2002. When are expert witnesses a little too "expert?" When they have become "professional expert witnesses" and make their entire living testifying as medical experts. The testimony of these hired guns may not always be objective and unbiased, and they may function as advocates rather than scholars. Part of the reason these folks have a market for their services is because physicians have been reluctant to testify as expert witnesses. It's understandable--physicians may have a distrust of lawyers, uneasiness with the legal system and the process of testifying, or fear of being censured by other physicians. And yet the ACC and other professional associations have all made strong recommendations that it is the duty of physicians to act as expert witnesses in their areas of expertise. With the availability of adequate numbers of physicians willing to act as expert witnesses, the use of the professional expert witness will decrease. If you are directly involved in a case with one of these professional witnesses there is also an ACC process for you to make a report. Check out the following link to the expert witness testimony guid If you don't read another edition of this publication, read this one. Then read it again and get ready to join the ACC's fight for the viability of your practice! CMS late last week proposed mind-boggling cuts to cardiology that could be 30 percent or higher beginning in 2010. Taken together with the payment cuts cardiology already has experienced, this wrongheaded proposal represents a real threat to your practice and to the patients you serve. Let's break down the horrible numbers. The proposed rule slashes Medicare payments by more than 11 percent for the average cardiology practice as a result of a badly managed practice expense survey. Out of thousands of cardiology practices solicited this survey is based on input from approximately 50. Somehow this small sample size showed that CV practices have experienced a 30 percent reduction in practice costs. Does that match up to the numbers in your practice? Of course not. This survey has no credibility and CMS chose to disregard the standards it previously put in place to ensure the quality of practice expense data. We believe this is a significant departure from previous policy and may be a violation of the law. It is ironic that the agency that purports to support an evidence-based approach to medicine is making major decisions based on shoddy and incomplete data. It gets worse! As if the 11 percent were not bad enough, most of the core cardiology services face cuts ranging from 20 to 40 percent. Add in the regularly scheduled SGR cuts of more than 20 percent and practices could see possible payment cuts ranging from 25 to almost 50 percent. This is not what we meant by putting quality first. The timing couldn't be worse. Just as we're moving forward with real proposals for health care reform that would improve quality, reduce waste, slow spending and improve the viability of CV practices, along comes this CMS hatchet job. Arbitrary price controls do not equal reform and will only lead to greater disparities in health care. That's the bad news. The good news is that this proposal is subject to revision. Your ACC is fighting this change at all levels through CMS, Congress and the Administration. ACC President Fred Bove, and your elected officers and Washington-based staff are all over this crisis on your behalf. Working closely with our partner cardiovascular societies we are developing a detailed response to CMS and working the halls of Congress to bring political pressure to bear on the agency. We are reaching out beyond cardiology to engage other specialties like oncology that also face daunting cuts that will inevitably impact patient diagnosis and treatment. On the regulatory side, ACC staff is working closely with the Advocacy Steering Committee and the CV RUC to prepare a substantive analysis and response to this proposed rule. We anticipated this action from CMS and have identified technical expert consultants who can assist us with our analysis and help propose alternatives. We have been rocked by this proposal and now it's time to roll! Here are four key ways you can get involved: The ACC has launched a grassroots campaign to get Congress involved. Go to www.acc.org/can and send a letter to your members of Congress explaining in detail how 20 to 40 percent cuts will impact your ability to practice medicine. Take part in a video campaign that can be shared with members of Congress, regulatory officials and the public. Upload a 30-40 second video about the impacts of large-scale cuts on your ability to provide patients with the right care at the right time. Email Molly Nichelson at mnichels@acc.org to have it posted for you on ACC Advocacy's YouTube" site. Don't own a video camera? Submit your story via the ACC's online forum, "The Lewin Report." Take part in the ACC's "Cut the Cuts Roadshow" and volunteer to give your own or facilitate an ACC-taped presentation on the implications of the cuts on cardiology to your hospital or practice group. Email qualityfirst@acc.org for more information Get involved with your local Chapter's efforts: this could include volunteering your practice to host a "Cardiologist for a Day" event, writing op-eds and more. Go to www.acc.org/chapters for contact information or email qualityfirst@acc.org Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org or 202-375-5407. elines, as established by our Ethics Committee: www.acc.org/qualityandscience/clinical/consensus/ethics/taskforce5.cfm. June 17, 2009 Lawmakers are scrambling to put health reform ideas on the table. Key House and Senate Committees have released their respective proposals, with the goal of passing the bills before the August congressional recess. The ACC has submitted detailed comments on the proposals and continues to work with leaders in the Senate and House to be sure your interests are protected. Meanwhile, President Obama on June 15 addressed the economic imperative for health care reform in a speech to attendees of the AMA's annual meeting in Chicago. To view the ACC's congressional comments, as well as a statement reacting to President Obama's speech, go to qualityfirst.acc.org. You can also share your thoughts on health care reform and related issues via the ACC's online forum, The Lewin Report. Watch this space for more detailed information. Under the headline "The Right Care at the Right Time Saves Lives," the ACC has launched an aggressive Capitol Hill ad campaign to let policymakers know that cardiologists and their patients must be directly involved in health care reform. The ads will run in Capitol Hill publications, including CongressDaily AM, Roll Call, National Review, National Journal and Politico, over the next several months while Congress considers health care reform options. The ad also will run in Cardiology and the Journal of the American College of Cardiology. To view the ad, visit the Quality First Web site. Chalk one up for the good guys. We applaud the Senate action late last week to pass the "Family Smoking Prevention & Tobacco Control Act." The bill gives the Food and Drug Administration (FDA) the authority to restrict tobacco marketing and sales to youth; requires detailed disclosure of ingredients; allows FDA to require changes to tobacco products; and requires larger, more specific health warnings. The ACC has been a long-time leading advocate for this legislation, working hand-in-hand with the Campaign for Tobacco Free Kids. Special kudos go to FACCs in Alaska who stepped up to secure co-sponsorship of the legislation from Senator Murkowski. As part of our efforts to help you prepare for widespread adoption and use of electronic health records, the College last week sent a paper to HHS National Coordinator for Health Information Technology David Blumenthal, M.D., with our recommendations for defining meaningful physician use of health IT. By law, practices can begin receiving bonus payments for "meaningful use" of health IT starting in 2011. However, what constitutes meaningful use has yet to be defined, so we are sending in our two cents. To view the paper and for more information on how to choose the best EHR for your practice, visit the ACC's Health IT Web site. Cardiac cath lab procedures have fallen by 111 percent over the past two years, according to a recent report by market research firm IMV Medical Information Division. Total patient cases accommodated by U.S. cath labs declined to 3.75 million in 2008, a drop from 4.21 million in 2006. This is in contrast to IMV's 2006 report, which identified a gradual 9 percent increase in patient cases from 3.85 million in 2002. When are expert witnesses a little too "expert?" When they have become "professional expert witnesses" and make their entire living testifying as medical experts. The testimony of these hired guns may not always be objective and unbiased, and they may function as advocates rather than scholars. Part of the reason these folks have a market for their services is because physicians have been reluctant to testify as expert witnesses. It's understandable--physicians may have a distrust of lawyers, uneasiness with the legal system and the process of testifying, or fear of being censured by other physicians. And yet the ACC and other professional associations have all made strong recommendations that it is the duty of physicians to act as expert witnesses in their areas of expertise. With the availability of adequate numbers of physicians willing to act as expert witnesses, the use of the professional expert witness will decrease. If you are directly involved in a case with one of these professional witnesses there is also an ACC process for you to make a report. Check out the following link to the expert witness testimony guidelines, as established by our Ethics Committee: www.acc.org/qualityandscience/clinical/consensus/ethics/taskforce5.cfm. Welcome to the first edition of the ACC Advocate The biweekly newsletter dedicated to the viability of your CV practice. We know you get a lot of stuff from the ACC, but we thought the time was right to give you regular updates about our day-to-day efforts to protect your ability to give the best care to your patients. The Advocate comes in two flavors--email and fax. If you'd like one but not the other, let us know. If you would like neither, let us know. In fact, let us know about anything at all--questions, answers, successes in your practice or your community, topics you want us to cover, things that keep you up at night. Email us at: advocate@acc.org. Fax us at: 202-375-6848. Call us at: 202-375-5407. Speaking of faxes, we don't have that many numbers, especially from practice administrators. Send us yours, please. In the Advocate you'll find coverage of the battle to give you fair reimbursement for your services. And what's more we will send you the latest tips and techniques on practice management to keep more of what you earn. We'll cover the fight on Capitol Hill and in the states to stop wrongheaded attempts by other specialties and lawmakers to restrict your ability to provide appropriate diagnostic services. As soon as we know about coding changes and other regulatory maneuvers, we'll let you know. And we'll give you recommendations on how to make the best of them. We'll cover tort reform, but more than that, we will let you know effective new strategies you can use to reduce your risk. In short, if the College is out there advocating on your behalf, you will hear about it here. So let's get started. Your ACC (again) helped put the brakes on the FTC's new Red Flags rule that classifies doctors as "creditors" because they regularly defer payment for goods and services. If it stands, the rule would require you to develop and implement a written program to protect consumers by identifying potentially suspicious "red flags" that may signal identity theft. The rule is now delayed until August 1, a reprieve that will allow us to continue the fight to exempt your practice. If you want to be extra careful, we recommend you take a look at sample Red Flags Rule documents developed by MGMA (Red Flags Rule Resource Center) and AMA (Red Flags Rule Physician Resources). For more information from your ACC, contact Gretchen Wyatt at gwyatt@acc.org. We've made a request to CMS for coverage for PTA of the carotid artery concurrent with stenting. In a letter cosigned by SCAI and SVM, we urged CMS to expand its coverage policy to allow carotid artery stenting (CAS) in patients who are at increased perioperative risk for carotid endarterectomy (CEA) complications due to currently defined anatomic and comorbid factors and who have either symptomatic carotid artery stenosis of 50-99% or asymptomatic carotid artery stenosis of >/-80%. We expect a decision by July. We'll keep you in the loop. Here is a coding alert. The NCCI removed its restriction on billing the echocardiography "add-on" codes (CPT 93320 and 93325) together. The NCCI accepted your ACC's recommendation to retroactively remove the coding edit and permit medical providers to bill these codes with the appropriate echocardiography CPT code during the same visit on the same day. + 93320 - Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to code for echocardiographic imaging); + 93325 - Doppler echocardiography color flow velocity mapping (List separately in addition to code for echocardiographic imaging) We advise you to resubmit any claims on or after Jan. 1, 2009, denied for using both CPT 93320 and 93325 together. These codes can still be used with congenital, stress, fetal and transesophageal echocardiography. The first real salvo in the national health care reform debate comes from the Senate Finance Committee. Their proposal addresses payment reform options and infrastructure investments to support delivery system reform. This is early in the game, and we won't burden you with pages of minute details here. (Details are available at qualityfirst.acc.org.) Suffice it to say your ACC is going over all proposals with a fine-tooth comb to ferret out any efforts to threaten the viability of your practice. Stay tuned for specific requests for your comments to lawmakers. Take a look at a great article from ACC BOG Chair John Harold in ACC's online forum, The Lewin Report. Dr. Harold writes eloquently about the vital importance of your involvement in state advocacy and gives a terrific example from his home Chapter of California of how partnerships can lead to legislative victories. Read the post in full. If you prefer the "hands-on" approach to advocacy, save the dates of Sept. 13-15 for the ACC's 2009 Legislative Conference at the Fairmont Hotel in Washington, D.C. There is no one better than you to help educate lawmakers about the impact of their policy decisions on your patients and your practice. For more information go to www.acc.org. Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org or 202-375-5407.