If you would like to submit a Bulletin Board topic for consideration for our listing, please contact Deloris Green via info@msacc.org. March 3, 2010 SGR reprieve for one more month. The U.S. Senate last night passed the "Temporary Extension Act of 2010," which includes a provision delaying the 21.2 percent Medicare payment reduction to physicians until April 1. The House of Representatives passed the legislation last week. Discussions are still underway in the House and Senate on the next steps. We are hearing that proposals under consideration would only temporarily stop the cuts for anywhere from 90 days, to seven months, or through the end of the year. Your ACC, along with the entire house of medicine, continues to press for a permanent solution to the flawed sustainable growth rate (SGR) formula and an end to the yearly band-aid fixes. Please continue to contact your members of Congress urging them to stop these cuts once and for all. The longer we wait, the more costly a true fix becomes. Medicare participation deadline approaching. Physicians have until March 17 to change their Medicare "participating" or "non-participating" status for 2010. It is unclear whether that deadline will be extended in response to upcoming congressional action. The American Medical Association has updated its guidance document, "Medicare Participation Options for Physicians (PDF)," to address important considerations for physicians when making their 2010 participation decision. Health reform, now what? As we reported last week, President Obama held his bipartisan Health Reform Summit. Enough key members of both parties showed, and everybody got a chance to express their view. While it's anyone's guess what will happen, Democrats in both the House and the Senate are trying to muster the votes to get a reconciliation process going in order to pass legislation. In addition, President Obama announced that he has added Republican ideas to his health reform proposal. This is an extremely fluid state of affairs and we will continue to keep you posted. Your ACC's advocacy staff will be analyzing the new issues and prepare a review of the direct and indirect effects on cardiology. Stay tuned. In the absence of overarching health reform legislation, there are a number of things we can be doing in the short term with other participants in the health sector. This includes proposing payment reform options that reward outcomes and quality. We might also get Congress to move ahead with a number of other smaller pieces of reform for which significant support exists, including tort reform. In addition, insurance reform remains a popular issue on both sides of the aisle. In fact, ACC leaders were invited to attend a White House briefing on insurance reform today. To watch the briefing, click here. Do you do imaging? The FOCUS Radionuclide Imaging Performance Improvement Module (PIM) is now available here. This PIM provides a web-based quality improvement tool for tracking adherence to appropriate use criteria (AUC) and helping to improve AUC patterns over time. Please join the FOCUS Innovation Community as they work to identify order patterns and develop local solutions to AUC implementation. For more information or to join, please visit the FOCUS Web site or email focus@acc.org with questions. Two studies were published last week on the safety and efficacy of carotid artery stenting. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), a randomized clinical trial of surgery vs. stenting in 2,502 patients at more than 100 hospitals in the U.S. and Canada, showed comparable safety and efficacy for the two methods. Meanwhile, a European trial of 1,713 patients showed a much higher incidence of stroke, heart attack and death in the first 30 days following stenting than in the first 30 days following endarterectomy. Your ACC's NCDR CARE Registry can provide needed additional data on these procedures. The registry assesses the characteristics, treatments and outcomes of stenting and endarterectomy procedures, performed by a variety of specialties. As the Centers for Medicare and Medicaid Services moves toward potential reimbursement decisions for these procedures, it is imperative to have the most accurate and complete data on safety and efficacy to form the basis for those decisions. More coverage of the studies is available online from the New York Times. More on EHR incentives ... The Office of the National Coordinator for Health Information Technology (ONC) recently released the last in a series of rules pertaining to the electronic health record (EHR) incentive program created as part of the American Recovery and Reinvestment Act of 2009 (ARRA). ARRA requires that those receiving incentive monies be using certified EHRs. This proposed rule addresses the process of certifying those EHR solutions. The interim final rule containing the EHR certification standards was released late last year, as was the proposed structure and criteria for the EHR program itself. Your ACC is in the process of reviewing the proposals and will provide you with information regarding the program as more information becomes available. In related news, your ACC is hosting a Health Information Technology (IT) Spotlight Session as part of ACC.10 in Atlanta on Sunday, March 14. The spotlight will feature practical advice for practices interested in implementing health IT, among many other topics. For more details, visit the health IT section of ACC.org. February 25, 2010 President Obama held his much-discussed "Bipartisan Meeting on Health Reform" today. The event was attended by senior Obama Administration officials, as well as House/Senate leadership and the chairs and ranking members of key committees overseeing health reform. (For the complete list of invitees, click here.) The Summit was, in the President's own words, intended to: "get the relevant parties together" and identify ways to "best achieve the most effective reform possible." While we will have to wait and see what the ultimate outcome of this meeting will be, your ACC is monitoring the coverage and reactions to both the Summit and the President's own health care reform proposal. Your ACC has provided detailed feedback to both the House and Senate on their respective bills and we continue to advocate at all levels for a means of involving physicians and other professionals in helping to design a new payment system, as well testing innovative new models for rewarding the delivery of quality, cost-effective care. Share your thoughts on the Summit via the ACC's Lewin Report blog. Extending the extension. House and Senate leaders have agreed to move a 30-day extension of the SGR freeze, which was set to expire on Feb. 28. We are still awaiting a formal vote, so stay tuned to "The Advocate" for final updates. In the meantime, thank you to everyone who called their members of Congress urging them to intervene. Physicians face a 21.5 percent cut as a result of the flawed SGR should Congress fail to act. Ninety-three and counting. The large-scale campaign by your ACC and local Chapters to encourage in-district visits to members of Congress while they were home for the President's Day recess appears to have paid off. At last count, 93 representatives had signed on as cosponsors to the Gonzalez legislation aimed at mitigating the impacts of the 2010 Medicare cuts. Our goal is 150 by the end of April. Stay tuned for information on what you can do over the next congressional recess at the end of March. In the meantime, ACC Advocacy staff is available to help schedule congressional meetings both in D.C. and/or in-district. Contact grassroots@acc.org for more information. We are hearing from many of you about the increasing number of challenges being posed by payers when it comes to medical imaging. Your ACC is addressing the individual situations as they arise, while also working on a larger-scale strategy that can be presented to health plans as an alternative to radiology benefit managers (RBMs) and preauthorization programs. Most recently, your ACC joined other specialty society leaders for a meeting with the medical directors from Aetna and MedSolutions to further discuss concerns with Aetna's plans to nationally expand its radiology management program and preauthorize both outpatient stress echocardiography and diagnostic left heart catheterization. The College will continue to seek a delay to this expansion. In the meantime, please use the College's "Payer Hassle Form" to report any imaging-related issues. In addition, please consider being a part of the College's new FOCUS initiative, aimed at optimizing ways to implement appropriate use criteria at the point of care. For more information on FOCUS, including upcoming webinars and resources like the new Performance Improvement Module for Radionuclide Imaging (RNI), go to: www.acc.org/focus. Keep your eyes open. This is just a reminder that over the next several weeks, many of you will be receiving email requests to participate in surveys as part of the Relative Value Scale Update Committee (RUC) process. The RUC -- which is a joint effort of the American Medical Association and medical specialty societies like your ACC -- makes recommendations on revising and updating the resource-based relative value scale used by Medicare and many private payers. These surveys ask physicians to evaluate the work of services performed by cardiologists. Information, such as the time it takes a cardiologist to perform certain services for patients, is critical to ensure appropriate valuation. These surveys are sent on a routine basis but a large number of cardiology services are being reviewed as part of this process at this time. The ACC strongly encourages members who receive these surveys to take the time to complete them. Save these dates: MGMA's 2010 "Cardiovascular Specialties Practice Management Conference" will take place May 2-4 in Chicago. For more information and/or to register, click here. Also, if you haven't already registered for ACC.10 in Atlanta there is still time. Don't miss this opportunity to catch up on the latest science and attend sessions designed to help cardiovascular professionals deliver the highest quality, evidence-based care to patients with heart disease. Learn more and register today! February 18, 2010 Do NOT Delete ... Over the next several weeks, many of you will be receiving email requests to participate in surveys as part of the Relative Value Scale Update Committee (RUC) process. The RUC -- which is a joint effort of the American Medical Association and medical specialty societies like your ACC -- makes recommendations on revising and updating the resource-based relative value scale used by Medicare and many private payers. These surveys ask physicians to evaluate the work of services performed by cardiologists. Information, such as the time it takes a cardiologist to perform certain services for patients, is critical to ensure appropriate valuation. These surveys are sent on a routine basis but a large number of cardiology services are being reviewed as part of this process at this time. The ACC strongly encourages members who receive these surveys to take the time to complete them. Referral policy delayed again! The Centers for Medicare and Medicaid Services (CMS) has delayed yet again, a policy of non-payment for services ordered or referred by physicians not enrolled in the Medicare program. The new implementation date for this policy is Jan. 3, 2011. Your ACC has opposed the changes to the ordering/referring policy and sent a joint letter to CMS citing the numerous problems in the implementation of the policy, both legal and practical. The College continues to monitor CMS' activities with respect to this new policy to ensure minimal effects on practitioners who receive referrals. In the meantime, CMS has created a file listing all of the practitioners eligible to order and/or refer for Medicare services. This list can also be used by practices receiving orders and/or referrals to determine if services furnished by their referral sources will be paid. Cardiovascular practices whose main referral sources are not listed in this file, should remind them to update their enrollment information with Medicare. Your ACC has prepared a sample letter for contacting those referral sources. Thank you! If the news stories and additional cosponsors to the Gonzalez legislation are any indication, our efforts to educate the public and Congress about the value of cardiovascular professionals and the impacts (both immediate and future) of continued Medicare cuts are working. Recent newspaper articles, blog posts and TV broadcasts in San Antonio, South Bend,Kansas City and New York have focused on the 2010 Medicare cuts and what they mean for local practice viability and patient access to care. Meanwhile, we've been hearing all week from those of you who have taken advantage of the Congressional recess to visit with your senators and representatives while they are home. As always, your ACC stands ready to help schedule congressional meetings and work with you on op-ed and other media outreach as appropriate. Simply email advocate@acc.org. Complete media coverage, as well as easy access to your members of Congress, is available on the Campaign for Patient Access Web site. When talking to your members of Congress, be sure to: * Emphasize the increased costs of shifting services from an office-based to hospital-based settings. * Detail how your practice serves "X number" of patients and employs "X number" of people in the member's district/state. * Arm yourself with the ACC's practice expense calculator and provide hard numbers about the impacts of the cuts on your practice viability. (The calculator and other tools are available on the Campaign for Patient Access site under "Practice Tools.") Are you ready for Atlanta? ACC.10 in Atlanta is fast approaching and your ACC has prepared a number of sessions designed to help you meet the challenges of today's health care environment. Don't miss the following sessions below. For additional practice management-related sessions check Special Topic and Quality pathways in your Final Program. Register now for ACC.10 and the i2 Summit. * Health IT Spotlight Session: This day-long session begins at 8 a.m. on Sunday, March 14 and will address the hottest topics in health IT. David Blumenthal, M.D., the national coordinator for health IT for Health and Human Services and Aneesh Chopra, U.S. Chief Technology Officer are featured keynote speakers. * What's Happening to My Profession?: Sponsored by the ACC, MedAxiom and MGMA, this session will take place from 10:30 a.m. to 2:30 p.m. on Sunday, March 14 and will cover everything from "meaningful use" of health IT to the ACC's Hospital to Home program. * Evolving Models of Cardiovascular Practice - What To Do After A Merger: This session will take place from 12:15 to 1:45 p.m. Sunday, March 14 and will address profitable, beneficial post-merger relationships for physicians and their new practice or hospital employer. * Lab Accreditation - What Practices Need to Know to Comply with CMS Rules: This session, which will take place from 2:30 to 3:30 p.m. Sunday, March 14, will discuss why accreditation is necessary, the process of becoming accredited and how practices can get started. * Practice Innovation - How to Reduce Costs and Increase Quality: This session takes place Monday, March 15 from 2 to 3:30 p.m., and will provide an overview of the powerful resources the College offers to help you deliver higher quality care and save money. * Expert Lunches: Both the "Optimizing Your Practice - What's the Code for That?" and "Preparing Your Practice for Quality-Based Payment - An ACC Roadmap to Success" expert lunches will take place on Tuesday, March 16 from 12:15 to 1:45 p.m. Learn about practical use of coding to minimize lost revenue and improve compliance with regulatory requirements or get a look at the future of payment and how you can prepare. February 4, 2010 Marching orders are here! Your members of Congress will be home February 15-19 and March 29-April 9 for two separate congressional breaks. During these times every member of the cardiovascular community should grab a patient and schedule in-district meetings with members of the House and Senate while they are home. Your ACC's Advocacy team stands ready to assist with scheduling, simply email advocacy@acc.org. In addition, your ACC's Communications team can help coordinate op-eds and other media coverage as appropriate. Simply email advocate@acc.org. Why in-district meetings? Not only do you save on travel costs and time away from your patients, but in-district meetings break through the clutter of the myriad other interests and votes competing for your congressional member's attention in Washington, D.C. In-district meetings also mean you have a much better chance of meeting directly with your member and you can more easily bring patients, key support staff and/or other practice partners with you to drive home the impacts of the Medicare cuts on your practice and the local community. The following messages are critical when speaking to your lawmakers: Preserve patient access to quality, cost-effective cardiovascular care. The 2010 Medicare cuts for cardiovascular services are having very real impacts on patient access to care, particularly patients living in rural or underserved communities. Practices across the country are laying off staff, limiting services, selling to hospitals, or closing their doors all together. To make matters worse, these cuts are occurring at the same time the number of people at risk for heart disease is increasing and the number of cardiovascular professionals trained to treat them is decreasing. [House] Support H.R. 4371, introduced by Rep. Charlie Gonzalez to mitigate the 2010 Medicare cuts to cardiology. The Gonzalez legislation currently has more than 80 cosponsors and your ACC's goal is to double this number. If your representative has already signed on to the H.R. 4371, please send a letter thanking him/her for the support. To see if your member is a cosponsor, click here. [Senate] Introduce legislation to mitigate the impacts of the 2010 Medicare cuts for cardiovascular services. Ask your senators to support legislation similar to H.R. 4371 in the House. In addition, ask for mitigation of the 36 percent cut for nuclear imaging and the use of accurate date to determine future payments. As you know, as of Jan. 1 the billing for myocardial perfusion imaging (SPECT and planar) has changed. Practices must use CPT codes (78451-78454) to report these procedures. If your practice is experiencing problems with using the new codes and receiving correct reimbursement, please let the College know via the ACC's Payer Hassle Factor Form. For more on the new 2010 codes, click here. Your ACC has also prepared a series of tips to help you review provider contracts, as provisions within these contracts may affect reimbursement. Some things too look for: Is there language in the contract that governs the fee schedule? Is this language linked to a specific year? Does the contract automatically incorporate CMS changes, or does it require advance notice of any fee schedule changes? Is reimbursement tied to Work RVUs only, or are practice expenses and practice liability insurance also included? For more information go to www.acc.org/practicemanagement and click on "Working With Health Plans." All cardiology practices providing advanced diagnostic imaging services must be accredited by 2012 by one of three organizations recently announced by CMS. The three approved accreditation organizations are the Intersocietal Accreditation Commission, The Joint Commission and the American College of Radiology. Your ACC is urging practices to familiarize themselves with the requirements for accreditation and begin steps to implement. More information and resources will also be available in the coming months to help with this process. In addition, your ACC is holding a special session at ACC.10 in Atlanta on the topic. The session, which takes places Sunday, March 14 from 2:30-3:30 p.m., will discuss why accreditation is necessary, the process of becoming accredited and how practices can get started. Register now for ACC.10 and i2 Summit! Refer to this file! CMS recently released a file of all practitioners who have current enrollment records in Medicare. This file will assist cardiovascular practices in determining which practitioners are enrolled in Medicare and eligible to refer patients and to order tests for them. Last fall, CMS announced that it would no longer pay for services ordered or referred by practitioners not eligible to refer. The policy, originally scheduled for implementation on Jan. 1, was delayed until April 5 because of the efforts of your ACC and other physician organizations. For those cardiovascular practices whose main referral sources are not listed in this file, you should remind them to update their enrollment information with Medicare. Your ACC has prepared a sample letter for you to use when contacting those referral sources. Update your ACC and Cardiosource eNewsletter preferences here. Unsubscribe to this eNewsletter here. Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org. January 27, 2010 The health care reform debate continues. The National Coalition on Health Care (NCHC) -- of which the ACC and a number of other specialty societies and consumer groups are members -- held a press conference on health care reform at Heart House. Ralph G. Neas of NCHC, ACC CEO Jack Lewin, Ron Pollack of Families USA, Mary Andrus of the Consortium for Citizens With Disabilities, Terry Gardiner of the Small Business Majority, Mary Wilson of the League of Women Voters, and Richard Kirsch of Health Care for America Now were the featured speakers. The press conference was in keeping with the College's ongoing efforts to work with multiple stakeholders to enact health care reform that protects patient access, addresses tort reform, improves quality/coordination and reduces disparities in care. The ACC had the opportunity to highlight the cardiology community's concerns with the current legislation and urge the elimination of provisions that have reduced public trust and increased partisan rancor. Even more importantly, it also placed us front and center with key consumer groups who have the ability to help us not only with crucial elements of reform, but with mitigating the impacts of the 2010 Medicare cuts. ACC leadership was also able to individually educate the media in attendance on the impacts of the CMS Medicare cuts on the practice of cardiovascular medicine and patient access to quality care. Your ACC continues to navigate a critical path through the reform quagmire that truly meets the needs and goals of the cardiology community, while also protecting the patient-physician relationship. Click here to read the ACC's recent letter from ACC President Alfred Bove to House and Senate leaders outlining both the College's areas of support and areas of concern. In addition to health care reform, the ACC continues its efforts to fight the cardiology payment cuts included in the 2010 Medicare Physician Fee Schedule. Please take a few minutes to call or write your representatives urging them to cosponsor legislation (H.R. 4371) introduced by Rep. Gonzalez (D-TX). Help us reach our goal of 100 more cosponsors by contacting your member today. It will take less than five minutes. To see if your member is already one of the 77 cosponsors and to say thank you, click here. ACC staff is working on generating similar legislation in the Senate. For more on ACC's efforts related to Medicare payment reform, go to www.campaignforpatientaccess.org. Did you submit your 2009 PQRI data? Feb. 21 is the last day to submit data for the 2009 Physician Quality Reporting Initiative (PQRI) using measures groups. Data submissions must be for patient visits within the 2009 calendar year. Participants who successfully participate in the program will earn a 2 percent incentive payment on all Medicare Part B professional services for 2009. The ACC has partnered with CECity to offer PQRIwizardSM, an online subscription-based program, to assist you with your participation. For more information, or to register for the PQRIwizard, go to: http://acc.pqriwizard.com. What about 2010 PQRI participation? The 2010 PQRI program includes new measures groups for coronary artery disease (CAD) and heart failure (HF). These measures groups require physicians to report on only 30 patients instead of 80 percent of eligible patients to qualify for a 2 percent bonus. The patients also no longer need to be consecutive. In addition to the measures groups, there are five new individual measures for 2010 that can be reported through a registry: * CAD: Symptom and Activity Assessment * CAD: Drug Therapy for Lowering LDL Cholesterol * HF: Left Ventricular Function (LVF) Assessment * HF: Patient Education * HF: Warfarin Therapy for Patients with Atrial Fibrillation The ACC's PINNACLE Registry (formerly the IC3 Program) is a certified registry for PQRI reporting. In addition, the ACC has partnered with CECity to offer ACC members an easy online tool, PQRIwizardSM, to participate in the 2010 PQRI measures groups. For more detailed information about the 2010 measures and measures groups, click here. But wait there's more ... CMS will re-run 2007 PQRI data for eligible professionals who did not receive a bonus for submissions from July 1-Dec. 31, 2007. CMS will re-run the data for those participants based on new analytics, and they may become eligible for an incentive payment based on the new data. Eligible professionals who received a bonus based on the initial report will not receive a new report. The 2007 re-runs will be issued separately from the 2008 feedback reports and incentive payment distributions. Initial 2007 feedback reports are available through the end of this month at: http://www.qualitynet.org. Update your ACC and Cardiosource eNewsletter preferences here. Unsubscribe to this eNewsletter here. January 21, 2010 Health care reform is back in the spotlight -- especially given Scott Brown's victory in the race to fill Sen. Ted Kennedy's Senate seat. Brown has pledged to oppose the health care package. As House and Senate members attempt to reconcile the two bills passed before the holidays, we sent a letter this week to Senate Majority Leader Henry Waxman (D-CA) and House Speaker Nancy Pelosi (D-CA) outlining certain provisions of the bills affecting the practice of cardiology. Below are the highlights of the letter: What we support ... Your ACC strongly supports initiatives in both bills that would expand coverage to the nearly 50 million uninsured and underinsured by promoting the availability of more coverage options and through steps to promote wellness, increase comparative effectiveness research and address workforce shortages. Specifically, the College supports the House version of a national exchange for insurance coverage, which would allow administrative simplification, better portability for the insured and greater competition in the insurance market. The College also supports efforts by the House and Senate to ensure the quality of care, including the national quality strategy, testing of accountable care organizations and the Center for Medicare and Medicaid Services (CMS) Innovation Center. The College also supports initiatives in both proposals that aim to address medical liability by authorizing grants to states to pursue alternative reforms, including certificates of merit and early offers. Now for our concerns ... Your ACC has some real concerns with several policies included in the reform proposals, including the lack of a permanent fix to the sustainable growth rate (SGR) formula and an increase in the imaging equipment use rate for advanced imaging. The effect of numerous already-implemented policy changes on imaging should be assessed before additional changes are enacted so continued patient access to these diagnostic services can be ensured. Despite proposed improvements to the physician quality reporting initiative (PQRI), including an appeals process, more timely feedback, and maintenance of certification as a participation option, the College strongly opposes the penalties for unsuccessful PQRI participation included in the Senate proposal. The College also is concerned about moving forward with public reporting based on Medicare claims/administrative data as included in the Senate proposal. The ability of physicians to be aware of reports and able to address inconsistencies should be safeguarded. Your ACC had also hoped that the Independent Payment Advisory Board (IPAB) concept would offer an opportunity to break down the silos of parts A and B in Medicare and provide modernization of the program, unfortunately the IPAB as currently designed raises serious concerns. Specifically, the ACC is concerned by the authority granted to an independent body of un-elected officials to determine payment cuts for only physicians. Physicians are already subject to an expenditure target and other potential payment reductions as the result of the Medicare physician payment formula. Both the House and Senate proposals include a provision banning new physician-owned facilities and placing restrictions on current facilities. Your ACC opposes this ban, especially since studies have shown that physician-owned hospitals, especially in the cardiovascular setting, provide higher quality care and better patient outcomes than other facilities. What you can do: Your ACC is asking you contact your members of Congress with two specific asks. 1) Urge them to oppose the inclusion of medical imaging payment cuts in health reform. 2) Ask them to include H.R. 3961, "The Medicare Physician Payment Reform Act of 2009," in final health reform legislation. H.R. 3961 would permanently repeal the SGR. Click here to contact your members of Congress now. January 12, 2010 Case closed. Just as the ACC's attorneys, witnesses and staff were about to board flights to Florida for tomorrow's scheduled hearing on the preliminary injunction and expedited discovery motions related to the Medicare 2010 Payment Rule, we learned that the U.S. District Court Southern District of Florida had denied our motions. Basically, the judge refused to hear our case on jurisdictional grounds, finding that statutory language governing the Medicare program precludes judicial review of the relative value units and the methods for determining the RVUs in the Medicare fee schedule. While we are obviously very frustrated by the court's decision, there is no denying that this was going to be an uphill battle given the traditional hesitancy of any court to take on the federal government. We are certainly not sorry that we undertook this important step and we are grateful to the Florida ACC Chapter, the American Society of Nuclear Cardiology, the Association of Black Cardiologists, the Cardiology Advocacy Alliance and others who supported this effort. Suffice it to say, we are not done. We will not allow the bogus data and process to go unchallenged! While we didn't win in court we did discover just how little CMS knew about the practice expense survey data used to determine the most drastic portion of the 2010 Medicare cuts. (Your ACC's responses to the government's request to dismiss the lawsuit outline these arguments.) This information will be extremely useful as we move forward with CMS, Congress and, to the extent possible, the public to develop and implement a fair and just payment methodology that protects not only the private practice of cardiology, but patient access to timely and cost-effective care. A blow to physicians everywhere, today's court decision only serves to emphasize the precedent that CMS can set physician payment in whatever manner it chooses regardless of impact and/or level of analysis. Other medical specialty societies who have been actively opposing our efforts to stop these cuts should be wary. While they may benefit from this particular rule, what happens the next time? We should all be working together to fight for fair and reasonable reimbursement, not continuing to play this zero sum game every year. How we actually get paid needs to be a very important and seriously undertaken consideration for the profession over this coming year. Your ACC is committed to getting this conversation started. Stay tuned for more information in the coming weeks on how you can get involved in this effort as well. January 6, 2010 Our New Year's resolution is to apply all means necessary to turn around the 2010 Medicare Payment Rule. It is bad policy. Not only will it hurt access to care, particularly for disadvantaged populations, but it will dramatically increase Medicare costs by shifting services to the hospital setting. At the same time we will also be working with multiple stakeholders to develop and implement a new and better payment philosophy and methodology so we don't have to go through this again! We're already making headway in the lawsuit. The U.S. District Court in Florida has granted our request for an expedited hearing on our motion for a preliminary injunction. This hearing is scheduled for early January and we are in an expedited discovery phase. As you know, the College on Dec. 28 filed a complaint, as well as motions for a preliminary injunction and expedited discovery, against Health and Human Services (HHS) Secretary Kathleen Sebelius. For more on the lawsuit, including expert witness testimony and a new FAQ to help answer your basic questions, click here. We have a very compelling case, and of course we are letting the media know. Check out the major article that recently ran in USA Today about the lawsuit. Fox News also covered it live with an interview with ACC's Janet Wright. Your ACC's Campaign for Patient Access Web site includes additional coverage of the lawsuit and rule impacts as well. We'll continue to keep you updated on the lawsuit as it moves forward. A New Year also means new opportunities to make headway on the legislative and regulatory fronts . Rep. Charlie Gonzalez (D-TX) has introduced legislation holding cardiology at current 2009 practice expense values. We'll continue to urge continued support for this bill, as well as seek similar legislation in the Senate. Also, before heading home for the holidays Congress approved a temporary freeze on implementing the scheduled 2010 SGR cuts. They will need to act by February to stop these cuts for another year - or even better for good. On the regulatory front, we'll continue to work with CMS to seek changes to the 2010 rule, while also advocating major changes in the proposed 2011 rule. It's hard to believe, but we only have a narrow window to influence the proposed 2011 rule. We'll keep you posted on these efforts. Unfortunately, minus a reprieve from Congress or CMS before Jan. 1, the cuts included in the final rule are for now official. Your ACC has developed a series of documents to help you navigate the biggest changes, including cardiology coding changes and the new consultation policy. The College has also developed a "Practice Survival Toolkit" to help you make important decisions regarding management of your practice. Do you image? Your ACC has developed a new initiative designed to help practices best use appropriate use criteria (AUC) and help to make our case for the appropriate use of imaging in the outpatient setting. This new effort, called FOCUS, will provide interested practices with an online forum to share challenges and successes with using AUC, as well as educational tools and resources. For more information and/or to register, visit http://www.acc.org/auc. A special kick-off Webinar will take place on Jan. 19 from 2-3 pm (ET). 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 but also require us to let several of our employees go, contributing to the unemployment problems in our area." -- Falls Church, VA "In our practice, with 28 cardiologists, we are looking at layoffs and staff reductions of up to 20 full-time employees if the current cuts are realized." -- Sandusky, OH Obviously we have a very tough road ahead of us! However, if this week is any indication, we are making headway. We must not let up. Now is the time to share your stories and make sure that Congress, the media and patients know about the very real impacts of these cuts on access to cardiovascular care. 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 24, 2009 Thank you. The efforts of individual members and chapters in unprecedented numbers are building momentum for a solution to the unbelievable mess created by CMS payment policy. Your concerns are being felt in the White House, in Congress, at HHS and in particular at CMS. If you haven't had the chance to get involved yet, now is a good time to start. Go immediately to acc.org and click on the Campaign for Patient Access button, or go directly to www.acc.org/patientaccess. You'll be able to access an explanation of the rule and learn about the cuts to cardiology services. You can see videos about how the rule will block patient access, learn more about your ACC's efforts to stop the cuts and download a variety of tools to help you and your patients engage in the campaign. We're organizing a flurry of activity Dec. 7 - 11. The "Take Action for Access" week will feature a flood of letters, calls and visits to key lawmakers urging them to stop the rule and prevent the patient access disaster that will inevitably ensue when it goes into effect. We need your help more than ever! On Tuesday, Dec. 8, your ACC invites you to come to Capitol Hill to meet with your federal legislators. If you are willing to fly to D.C. to conduct a face-to-face visit, we will arrange the meetings and provide you with materials to inform your discussions. If you can't make the trip to Washington, your ACC can assist you with arranging an in-district visit with your lawmakers as part of a "virtual fly-in." Either way, if you're interested, contact the ACC grassroots team at grassroots@acc.org. Look for more details in this space about additional activities during this week-long communications blitz. CMS cuts have been long in coming. The imaging cuts, bundling proposed for echo and now the nuclear studies have been developing over the past three to four years at the urging of CMS and MedPAC. The philosophy is simple even if it lacks elegance: "cut payment on the machines and devices that doctors use." This meat-axe approach to cost containment ignores far better methods developed by your ACC such as appropriate use criteria, which base cost decisions on clinical necessity. Learn more about the cuts from www.acc.org/patientaccess. The government severely underestimates the impact of these cuts. Because of the four-year phase-in, CMS calculates the "average" CV private practice will face total payment reductions in 2010 of 8 percent, including all changes to RVUs and other policy mischief in the rule. Not so. Practices providing valued imaging services with a typical outpatient volume of stress testing and echo - which means most practices - will be hit much harder. In addition, the elimination of the consultation payments could be much bigger than the 1 percent "average" impact estimated by CMS. For many practices, this particular decision could reduce revenues by 8 percent or more. Your ACC is working with a coalition of specialty societies to combat the consultation changes. November 24, 2009 Thank you. The efforts of individual members and chapters in unprecedented numbers are building momentum for a solution to the unbelievable mess created by CMS payment policy. Your concerns are being felt in the White House, in Congress, at HHS and in particular at CMS. If you haven't had the chance to get involved yet, now is a good time to start. Go immediately to acc.org and click on the Campaign for Patient Access button, or go directly to www.acc.org/patientaccess. You'll be able to access an explanation of the rule and learn about the cuts to cardiology services. You can see videos about how the rule will block patient access, learn more about your ACC's efforts to stop the cuts and download a variety of tools to help you and your patients engage in the campaign. We're organizing a flurry of activity Dec. 7 - 11. The "Take Action for Access" week will feature a flood of letters, calls and visits to key lawmakers urging them to stop the rule and prevent the patient access disaster that will inevitably ensue when it goes into effect. We need your help more than ever! On Tuesday, Dec. 8, your ACC invites you to come to Capitol Hill to meet with your federal legislators. If you are willing to fly to D.C. to conduct a face-to-face visit, we will arrange the meetings and provide you with materials to inform your discussions. If you can't make the trip to Washington, your ACC can assist you with arranging an in-district visit with your lawmakers as part of a "virtual fly-in." Either way, if you're interested, contact the ACC grassroots team at grassroots@acc.org. Look for more details in this space about additional activities during this week-long communications blitz. CMS cuts have been long in coming. The imaging cuts, bundling proposed for echo and now the nuclear studies have been developing over the past three to four years at the urging of CMS and MedPAC. The philosophy is simple even if it lacks elegance: "cut payment on the machines and devices that doctors use." This meat-axe approach to cost containment ignores far better methods developed by your ACC such as appropriate use criteria, which base cost decisions on clinical necessity. Learn more about the cuts from www.acc.org/patientaccess. The government severely underestimates the impact of these cuts. Because of the four-year phase-in, CMS calculates the "average" CV private practice will face total payment reductions in 2010 of 8 percent, including all changes to RVUs and other policy mischief in the rule. Not so. Practices providing valued imaging services with a typical outpatient volume of stress testing and echo - which means most practices - will be hit much harder. In addition, the elimination of the consultation payments could be much bigger than the 1 percent "average" impact estimated by CMS. For many practices, this particular decision could reduce revenues by 8 percent or more. Your ACC is working with a coalition of specialty societies to combat the consultation changes. 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. 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. ACC Partnering with Chapters Please go to this link to see important information from Dr. John Gordon Harold, Chairman of the Board of Governors: http://lewinreport.acc.org/post/ACC-Partnering-With-Chapters.aspx 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.