If you would like to submit a Bulletin Board topic for consideration for our listing, please contact Deloris Green via info@msacc.org. August 18, 2010 Defining "meaningful use:" Numerous studies have demonstrated the advantages of electronic health records (EHRs) over paper records, including increased quality of patient care. Despite these studies, many physicians have been reluctant to make the necessary capital investments in EHRs for a number of reasons, including cost. To help overcome some of these hurdles, the federal government has developed an EHR incentive program to encourage physicians to purchase and use EHR programs. The final regulations for the program were issued on July 13. Your ACC has developed a new detailed analysis and tools that focus on the requirements for physicians who primarily practice in an outpatient setting. The resources address questions to consider before participating; eligibility requirements; reporting requirements; meaningful use definitions; EHR certification criteria; and more. Read the complete analysis. ACC research panel explores current state of cardiology. The intersection of a growing elderly population, high rate of uninsured Americans, weakened economy and changes in the CMS reimbursement structure has created a perfect storm that is testing the limits of the U.S. health care system and physician practice models. Check out the latest findings from over six months of research with 350 cardiologist panel members on topics ranging from the future of private practice, EMR adoption challenges and more. Read the complete issue. Don't miss the claims submission deadline for the UnitedHealth Group Settlement. Over $350 million is available as part of the settlement to any and all providers who submitted "non-network" claims to UnitedHealth Group between 1994 and 2010. Your ACC has teamed up with the Managed Care Advisory Group (MCAG) to help members in obtaining data, identifying eligible claims and submitting all necessary paperwork to the settlement administrator by the October 5 deadline. Given the 15-year window for eligible claims, providers must contact MCAG by Sept. 21. As part of the ACC/MCAG partnership, ACC and American Medical Association (AMA) members will receive discounts on MCAG services. It is important when contacting MCAG to let them know that you are an ACC and/or an AMA member to receive the discounted rates. The MCAG phone number is 800-355-0466. For more information on MCAG click here. Register now for the next Evolving Models of Cardiovascular Practice Symposium. The two-day conference will be held at the Ritz-Carlton Naples Golf Resort in Naples, Fla., from Nov. 5-6. The conference looks to help physicians and/or practice administrators make the best decisions for their respective practices given the changing health care environment. Participants will learn about various practice alignment and integration models from experienced managing physicians and practice administrators, legal and governance experts and will receive critical information on policies, proposals and the practical implications of change. Learn more and register August 11, 2010 Don't delay! ACC members have until Sept. 21 to utilize a professional service to help meet the final Oct. 5 claims submission deadline for the United Health Group Settlement. The settlement: After years of efforts with courts and regulators, UnitedHealth Group has settled claims that it used a flawed database operated by Ingenix (a UnitedHealth Group subsidiary) to determine out-of-network payment rates, increasing insurer profits at the expense of patients and providers. Over $350 million is available as part of the settlement to any and all providers who submitted "non-network" claims to UnitedHealth Group between 1994 and 2010. Providers who wished to be excluded from the settlement must have opted out as of July 27. This is the only opportunity for providers to obtain any retribution for lost revenue. For this reason -- and given the fast-approaching submission deadline -- your ACC is teaming up with the Managed Care Advisory Group (MCAG) to help members in obtaining data, identifying eligible claims and submitting all necessary paperwork to the settlement administrator by the October deadline. Given the 15-year window for eligible claims, providers must contact MCAG by Sept. 21. How it works: MCAG retains a small percentage of the money recovered as payment for services. As part of the ACC/MCAG partnership, ACC and American Medical Association (AMA) members will receive discounts on MCAG services. It is important when contacting MCAG to let them know that you are an ACC and/or an AMA member to receive the discounted rates. The MCAG phone number is 800-355-0466. For more information on MCAG, click here July 29, 2010 Last chance to register for your ACC's 2010 Legislative Conference, Sept. 12-14 in Washington, D.C.! With the passage of health care reform legislation earlier this year, this year's Legislative Conference couldn't come at a better time. It's especially important that members of Congress understand the current "state of cardiology" as they move forward with implementing the health reform law. It's also important they know the many ways the cardiovascular community is working to reduce costs and ensure the most appropriate, evidence-based care. Registration closes Friday, Aug. 5. Hospital to Home (H2H) on Capitol Hill. Your ACC last week hosted a congressional briefing on the College's Hospital to Home (H2H) initiative, which is focused on reducing cardiovascular-related hospital readmissions. The briefing was held in cooperation with Rep. Lois Capps (D-CA) and Rep. Todd Platts (R-PA), co-chairs of the Congressional Heart and Stroke Coalition, and featured an appearance by Sen. Byron Dorgan (D-ND). Mary Norine Walsh, M.D., F.A.C.C., member of the H2H Steering Committee and director of the Heart Failure and Transplantation Program at the St. Vincent Heart Center of Indiana, provided an overview of the national quality improvement initiative, as well as early lessons learned in terms of reducing hospital readmissions. Read more on the H2H program. Take advantage of group discounts on the ACC's PQRIwizard! As part of ACC's PINNACLE Network, practices of 10 or more providers can receive group discounts on the PQRIwizard. Similar to online tax preparation software, the PQRIwizard is an online tool that allows users to collect and report quality measure data under the Centers for Medicare and Medicaid Services' Physician Quality Reporting Initiative (PQRI). The PQRIwizard is powered by the CECity Registry. Learn more about the PQRIwizard and the group discount program. Looking at practice options? Health care reform, managed care, declining revenues, increased overhead expenses, and additional administrative and regulatory burdens, have caused physicians in solo or smaller private practices to consider alternatives. While remaining committed to the preservation of individual autonomy wherever possible, physicians are increasingly looking for opportunities to develop strategic alliances with one another and with their hospitals. However, there are significant regulatory constraints, which must be considered prior to affiliation. Check out the following PINNACLE Network fact sheets, which provide an overview of the regulatory constraints, as well as a comparison chart of the different practice options. Nominate your next ACC leaders. The deadline to submit your recommendations to the Nominating Committee for the slate of officers and trustees for the American College of Cardiology (ACC) and the American College of Cardiology Foundation (ACCF) is July 31. These officers and trustees will be elected at the Annual Business Meeting in March 2011 in New Orleans. Review the procedure and guidelines for submitting recommendations. You can also contact Carissa Maguire (202-375-6246) with any questions. July 22, 2010 Medical isotope update: Your ACC and the American Society of Nuclear Cardiology (ASNC) this week sent a letter to Sen. Christopher Bond (R-MO) urging action on H.R. 3276, the American Medical Isotope Production Act of 2009. According to the letter, "the legislation is beneficial in restraining the immediate threats arising from the lack of access to a reliable, consistent supply of medical isotopes that thousands of American patients rely on every day." To read the full letter, click here. Where will you be in September? Don't miss the ACC's 2010 Legislative Conference, Sept. 12-14 in Washington, D.C. A great agenda is in the works, as are special events hosted by the ACC Political Action Committee. Don't miss this opportunity to learn more about the key issues facing the practice of cardiology and, more importantly, meet directly with your members of Congress and/or their staff. Registration closes on August 6. For more information, click here. Are you ready for ICD-10? Medical coding in U.S. health care settings is slated to transition from ICD-9-CM to ICD-10 as of Oct. 1, 2013. Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition, not just those who submit Medicare or Medicaid claims. The compliance dates are firm and not subject to change. Practices not ready by the deadline will not have their claims paid. The ACC is encouraging practices to ask their clearinghouse, billing service or software vendor what needs to happen to be ready for ICD-10. For more information about ICD-10 Implementation, go to CardioSource.org. In addition, a MLN Matters Special Edition article is available on the CMS website. ARBs and cancer risks? In a notice posted on its website last week, the U.S. Food and Drug Administration (FDA) said it is conducting a review of angiotensin receptor blockers (ARBs) after a recently published study in Lancet Oncology suggested they may be associated with a small increased risk of cancer. According to the notice, the FDA plans to review the available data on these medications, and evaluate additional ways to better assess a possible link between use of ARBs and cancer. The agency will update the public when this review is complete. In the meantime, the FDA recommends that ARBs continue to be used as recommended in their approved labels. Your ACC is on top of this issue. In fact, Jeffrey Anderson, M.D., F.A.C.C., chair-elect of the ACC/American Heart Association Task Force on Practice Guidelines and Vice Chair of the 2010 UA/NSTEMI Focused Update, discusses the issue in a recent ACC in Touch blog post. Stay tuned to The Advocate and Cardiology magazine for continued updates. Attention MRA/MRI providers! All physicians, providers and suppliers submitting claims to Medicare contractors for Magnetic Resonance Angiography (MRA) services should note the following change. As of June 3, Medicare contractors now have the discretion to cover or not cover all indications of MRA (and magnetic resonance imaging (MRI)) that are not specifically nationally covered or nationally non-covered. Existing national coverage for both MRI and MRA will be maintained. Read the complete article. July 14, 2010 Over the last year, your ACC has been working with the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) to provide feedback on the new federal electronic health record (EHR) program. The program will provide physicians who demonstrate "meaningful use" of EHRs through the Medicare program with annual payment incentives starting in 2011 and ending in 2015. In particular, we have focused on providing input about what constitutes "meaningful use," given that early proposals have included exceedingly difficult and complex requirements that would make it challenging, if not impossible, for physicians and hospitals to participate in the program. The wait is now over. Yesterday, CMS released the final rule defining "meaningful use," which includes several of the College's recommendations, such as a phased-in approach to the program to allow for technological advances. CMS reduced several onerous provisions, such as the number of core requirements, the number of quality measures and whether specialty-specific quality measures need to be reported; decision support requirements; and the extent of computerized physician order entry (CPOE) use. Eligible professionals who want to become "meaningful users" of health IT will need to meet 15 core requirements and five out of 10 optional requirements. One of these requirements is using CPOE to order medication for at least 30 percent of patients who have at least one medication in their medication list. In addition, those wishing to participate in the program will need to report on six quality measures: a core set of three quality measures, three alternatives and three more that can be selected by the physician. Additional requirements will be outlined in future issues of "The Advocate," and you can read the ACC summary online. Beginning in January 2011, cardiovascular professionals can register to participate in the EHR Incentive Program. The reporting period for a clinician's first year of participation is 90 days, so for 2011, providers will be able to begin attesting to success in April. CMS anticipates making the first payments the following month. Next steps: Your ACC is working with the ONC and CMS to help physicians who can participate to do so. In addition, there will be opportunities throughout the various stages of the program to continue to press for changes that would make participation easier. Stay tuned to "The Advocate," Cardiology and www.CardioSource.org for more detailed analysis of the rule, as well as additional tools and resources. Speaking of resources... The ACC has developed a comprehensive EHR Toolkit to help cardiovascular professionals select and implement the right system for their individual practice environment. The toolkit includes case studies, selection criteria and access to ACC-approved EHR selection consultants. In addition, CMS has developed a comprehensive website that includes FAQs and other information about meaningful use and the federal incentive program in general. July 8, 2010 Good news for women! Your ACC has heard that the Senate HELP Committee this month is expected to take up the HEART for Women Act (S. 422). Your ACC signed on to a letter with approximately 50 other groups in support of this important legislation that aims to raise awareness among women and their health care providers about heart disease, as well as provide screening for low-income women. Learn more and read the letter. The new Medicare ordering/referring policy is now in effect. As of July 6, individuals ordering or referring Medicare patients for "specialist services" must be in the Medicare provider enrollment database. The Centers for Medicare and Medicaid Services (CMS) last week did issue a small clarification to say that it will not automatically reject claims submitted by providers that have attempted to enroll in PECOS. CMS has also said that "until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid." Your ACC continues to request that CMS issue additional guidance and instructions as soon as possible to allow for the education of physician practices and their staff and any changes in claims submission that must occur. The letter's in the mail! CMS this month will begin general outreach to enrolled physicians, non-physician practitioners and independent diagnostic testing facilities (IDTFs) about the need to become accredited to continue to provide advanced diagnostic imaging services to Medicare beneficiaries as of Jan. 1, 2012. Providers that have furnished advanced diagnostic imaging procedures within the last six months will receive the first of five letters starting this month urging them to begin the accreditation process as soon as possible in order to meet the Jan. 1, 2012 deadline. The accreditation process can take up to nine months to complete. Your ACC has developed an "Accreditation FAQ" to help answer any questions about the process. Patient copay update: Your ACC has received word from the Office of Inspector General (OIG) that physicians will not have to charge their patients additional copay amounts as a result of the recent CMS technical corrections to the 2010 Medicare Physician Fee Schedule. While this is good news, we are still waiting for guidance on when the adjusted payments from Medicare contractors will start. For more information on the new OIG policy, click here. New leader for CMS! President Obama this appointed Institute for Healthcare Improvement CEO Donald Berwick to be the Centers for Medicare and Medicaid Services (CMS) Administrator. "For all the talk about health care in recent months, not many people truly understand the ins and outs of our nation's health care system. But Don understands the nuances, complexities and difficulties of our health care system and he has long worked side-by-side with physicians to increase the quality of health care while also lowering the cost of its delivery," ACC CEO Jack Lewin said in a statement. June 28, 2010 The proposed rule is out! The Centers for Medicare and Medicaid Services (CMS) late Friday released its proposed 2011 Medicare Physician Fee Schedule, which includes both payment and payment policy proposals for all physician services. Overall, the rule does not include any egregious policy proposals on the scale of those included in the 2010 rule. That being said, while there were some positives, cardiovascular professionals will continue to feel the downstream impacts of policies that were finalized in the 2010 rule. As in past years, increases and cuts for cardiovascular services are dependent on the services provided by the practice. The following is a high-level overview of provisions in the rule effecting cardiology: Practice Expense: CMS estimates the aggregate impact on cardiology to be negative 2 percent as a result of the second year phase-in of the cuts associated with the AMA Physician Practice Information Survey (PPIS). This was an expected reduction and there are no other provisions with major negative effects. Nuclear Imaging: In the 2010 Medicare Physician Fee Schedule, CMS substantially reduced the payment for myocardial perfusion imaging by reducing both the physician work value and the practice expense value. To make matters worse, because there was a new code for the service, CMS did not apply the four-year transition of the practice expense cuts and instead used the fully implemented value. In the proposed 2011 rule, CMS did not respond to requests from your ACC or members of Congress to phase-in the cuts over four years, so the proposed RVU is nearly identical to that for this year. Practice Expense and Malpractice RVUs: CMS has proposed some changes to the technical underpinnings of the RVUs, including reallocating the shares of total physician fee schedule payments for each of the RVU components -- physician work, practice expense, and malpractice expense. Under the proposal, all practice expense and malpractice RVUs would be adjusted slightly upward to reflect data showing that practice expenses and malpractice expenses have grown relative to physician earnings. Since the entire payment pool must remain budget neutral, this would require a downward adjustment to work RVUs, but CMS proposes instead a small decrease to the conversion factor in order to maintain stable work RVUs. CMS projects that the effect of the reallocation will be neutral for overall cardiology payments. We will be examining this proposal and its impact on individual cardiology services closely. Equipment utilization: The Affordable Care Act (ACA) requires that CMS establish the equipment utilization rate for CT, MR and PET at 75 percent. CMS had previously set the equipment utilization rate for this equipment at 90 percent, phasing in reduced payments over four years. This may result in minor changes to payment rates for cardiac CT and MR services. Stark changes: The ACA requires that physician practices furnishing PET, CT or MRI under the in-office ancillary services exception to the physician self-referral (Stark) law provide a notice to patients referred for such services of their ability to obtain those services elsewhere. The notice must include a list of other sources of the services. Under the law, CMS also has the discretion to include other radiology services. The good news is that CMS is not interested in expanding this provision to services beyond the three explicitly mentioned in the statute. In addition, despite the provision's statutory effective date of Jan. 1, 2010, CMS has determined that it cannot be effective without a regulation. Thus, the notice and disclosure requirement will not go into effect until the final Medicare physician fee schedule is implemented in January 2011 and will not apply to services furnished at any point during 2010. This eliminates concerns that the regulations would somehow be made retroactive to services furnished as early as January 2010. SGR: The proposed rule includes CMS's estimate of the 2011 conversion factor based on current law and does not reflect the six-month patch signed into law last week. Congress will have to act again to prevent next year's SGR-based cut, currently estimated at 6 percent on top of the 21.5 percent cut that must be averted before December 1. A more detailed analysis, along with next steps, will follow once ACC Regulatory Staff has reviewed it more closely. Keep in mind that there is a 60-day public comment period before the final rule is released in November. The College, as always, will submit detailed comments and meet with CMS staff as needed. Stay tuned to The Advocate, CardioSource.org and Cardiology for more information. For questions, please contact advocacydiv@acc.org. June 25, 2010 House applies latest SGR Band-Aid: The House of Representatives last night passed legislation (H.R. 3962) that would provide a 2.2 percent Medicare fee schedule update for physician services through November. This update would replace the 21 percent cut currently in effect, and be applied retroactively to claims for services provided on or after June 1. The Senate approved this bill last Friday. This just in from CMS ... The agency has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors' claims processing systems. CMS expects to begin processing claims at the new rates no later than July 1. Claims for services rendered prior to June 1, will continue to be processed and paid as usual. Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. If you submitted claims containing June dates of service with charges less than the 2.2 percent update amount you will need to contact your local Medicare contractor to request an adjustment. Enough is enough! The entire House of Medicine is fed up with these continued temporary patches. Ultimately patients are the ones that suffer, whether it's through higher co-pays, longer wait times or the reduced access to services. Your ACC continues to urge Congressional leaders to find a permanent solution to the current SGR formula before it's too late. Educating Congress about the real-life impacts of these cuts is one such way. Your ACC provides several ways to facilitate interaction with members of Congress, including through the ACC Political Action Committee (ACCPAC), local Chapters and/or through the annual Legislative Conference. Speaking of Legislative Conference ... Registration is now open for the 2010 Legislative Conference to be held at the Fairmont Hotel in Washington, D.C., from Sept. 12-14. This is a great opportunity to meet face-to-face with members of Congress. A limited number of scholarships are available for FITs, CCAs and Practice Administrators. In addition, the ACCPAC has a number of events planned including its annual Texas Hold Em Tournament, a special luncheon featuring political strategist Karl Rove, and a happy hour for FITs, CCAs, and Practice Admins. Email pac@acc.org for more info. Are you enrolled? Beginning July 6, physicians furnishing services to Medicare patients that require a written order or referral from non-Medicare enrolled physicians will not be paid for those services. Your ACC is awaiting additional guidance on the particular types of services affected by this new rule and will let you know as soon as it's available. In the meantime, cardiovascular practices are advised to closely examine Medicare remittances for informational messages that may indicate a problem with payment on or after July 6. If you see these messages on your claims forms, contact your Medicare contractor for additional guidance. For more on Medicare enrollment policies, click here. Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org. June 18, 2010 SGR Update: This week has been frustrating for any physician in the United States, and perhaps even worse for cardiologists trying to run small businesses. Congressional gridlock is at its best. That being said, the Senate this afternoon by unanimous consent passed a six-month patch that would give doctors a 2.2 percent payment update through November. The agreement will now go to the House, which has adjourned for the week and will not consider it until at the earliest Tuesday of next week. On the CMS front, the claims hold expired yesterday (June 17). Because legislation was not signed into law before the weekend, contractors have been instructed to begin processing Medicare claims for physician services provided in June at rates that reflect the 21.3 percent cut. Once the House and Senate act to avert the cut, claims will be processed as follows: (1) where the submitted charge is higher than the new rate, the contractor will automatically reprocess the claim; and (2) if the submitted charge is lower than the new rate, the physician should call the contractor. According to the AMA, no one is going to be reviewing the limiting charge for the period that the cut was in place because CMS assumes Congress will ultimately make the fix retroactive. Finally, the OIG and CMS are close to releasing a document to waive patient co-pay requirements for situations such as the retroactive increases that were made to the geographic practice cost index (GPCI) increases. CMS will share that document once it is available. June 16, 2010 Senate fails to move SGR patch. The Senate this afternoon failed to advance legislation that would stop Medicare physician payment cuts related to the sustainable growth rate formula (SGR) for 19 months. A 21.2 percent cut originally scheduled for Jan. 1, 2010 went into effect on June 1. However, the Centers for Medicare and Medicaid Services (CMS) has been holding claims through June 17 to give Congress time to act. We will continue to keep you apprised of any new updates, including whether CMS will extend the claims hold beyond tomorrow. Stay tuned to "The Advocate" and CardioSource.org for updates. Take a peek at PECOS! While more details on the new federal EHR incentive program are expected this month in an impending final rule, CMS has announced that Provider Enrollment, Chain and Ownership System (PECOS) records will be used to verify Medicare enrollment prior to making any Medicare EHR incentive payments. If you plan to participate in the EHR incentive program, your enrollment information must be in PECOS as soon as possible. Physicians enrolled in Medicare before November 2003 and who have not updated their Medicare enrollment information since then, must enroll in PECOS. For instructions, go to www.cms.hhs.gov/MedicareProviderSupEnroll and click on "Tips to Facilitate the Medicare Enrollment Process" under "Downloads." Physicians enrolled in Medicare after November 2003, or those that have updated Medicare enrollment information since November 2003, are already in the PECOS system. Unsure? Check "Ordering Referring Report" on the CMS website. Click here for more enrollment information, including changes as a result of the new health reform law. Quality improvement works! An editorial correspondence piece in the June 14 issue of Archives of Internal Medicine looks at trends in race-based door-to-balloon (D2B) times since the advent of several national initiatives, including the ACC's D2B Alliance, that have focused on improving D2B times to meet the guideline-recommended time of 90 minutes or less. According to the data analyzed, national performance on D2B times improved dramatically over the last four years, and "these improvements were accompanied by a marked narrowing of racial disparities in D2B times." Access the full article (subscription required). Check out ACC's new home on the web! The ACC's new CardioSource.org website launched this week. Don't forget to bookmark this new site and take advantage of its many new features, including "CardioSource Communities," which allow you to share your thoughts and interact with your colleagues. June 2, 2010 We need to blitz Congress. Congress is expected to vote any day on new legislation that could provide up to a three and a half year fix to the Sustainable Growth Rate (SGR) formula and stop the 21 percent cut slated for June 1. Act now! The fate of this bill is far from certain, particularly in the Senate where leadership is still working to muster up enough votes. Call your members of Congress at (800) 210-7193 or via email using the ACC grassroots website. Tell them to support H.R. 4213. In other news, the Federal Trade Commission's (FTC) "Red Flags" identity theft rules are slated to take effect on June 1. In an effort to address the growing risk of identity theft, the FTC released rules in November 2007 requiring all financial institutions and "creditors" (including health care providers) to develop and implement a written program to protect consumers by identifying potentially suspicious "red flags" that may signal identity theft. Your ACC, the American Medical Association (AMA) and other medical associations have strongly opposed the inclusion of physicians as creditors and have repeatedly been able to delay the rule's implementation date. Most recently, the AMA, the American Osteopath Association (AOA) and the Medical Society of the District of Columbia filed a lawsuit on this point. Your ACC will keep you informed regarding any late-breaking developments in this area. However, given the fast-approaching deadline, the ACC strongly recommends that practices prepare a written identity theft detection and prevention program. The AMA and MGMA have developed Red Flags Rule guidance documents and sample policies that can be modified, which can be accessed at: MGMA Red Flags Rule Resource Center and AMA Red Flags Rule Physician Resources. Are you eligible? An interim final rule released by the Centers for Medicare and Medicaid Services (CMS) this month, revisits an issue regarding ordering and referring providers that was included in the 2010 Medicare Physician Fee Schedule. CMS last summer issued changes requiring an individual ordering or referring an imaging or laboratory service to be a physician or other health care professional able to enroll in Medicare and permitted to order or refer for the service. According to CMS, claims that did not contain the name of an enrolled ordering or referring provider would not be paid beginning in January 2010. However, based on concerns raised by the ACC and others, CMS had agreed to push the implementation date to January 2011. The new rule makes several changes to the previously announced policy, including moving the implementation date forward from January 2011 to July 6, 2010. It also requires that individuals ordering or referring patients for "specialist services" be enrolled. Read more about these changes and what you can do to ensure you are enrolled. Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org. May 26, 2010 We need to blitz Congress. Congress is expected to vote any day on new legislation that could provide up to a three and a half year fix to the Sustainable Growth Rate (SGR) formula and stop the 21 percent cut slated for June 1. Act now! The fate of this bill is far from certain, particularly in the Senate where leadership is still working to muster up enough votes. Call your members of Congress at (800) 210-7193 or via email using the ACC grassroots website. Tell them to support H.R. 4213. In other news, the Federal Trade Commission's (FTC) "Red Flags" identity theft rules are slated to take effect on June 1. In an effort to address the growing risk of identity theft, the FTC released rules in November 2007 requiring all financial institutions and "creditors" (including health care providers) to develop and implement a written program to protect consumers by identifying potentially suspicious "red flags" that may signal identity theft. Your ACC, the American Medical Association (AMA) and other medical associations have strongly opposed the inclusion of physicians as creditors and have repeatedly been able to delay the rule's implementation date. Most recently, the AMA, the American Osteopath Association (AOA) and the Medical Society of the District of Columbia filed a lawsuit on this point. Your ACC will keep you informed regarding any late-breaking developments in this area. However, given the fast-approaching deadline, the ACC strongly recommends that practices prepare a written identity theft detection and prevention program. The AMA and MGMA have developed Red Flags Rule guidance documents and sample policies that can be modified, which can be accessed at: MGMA Red Flags Rule Resource Center and AMA Red Flags Rule Physician Resources. Are you eligible? An interim final rule released by the Centers for Medicare and Medicaid Services (CMS) this month, revisits an issue regarding ordering and referring providers that was included in the 2010 Medicare Physician Fee Schedule. CMS last summer issued changes requiring an individual ordering or referring an imaging or laboratory service to be a physician or other health care professional able to enroll in Medicare and permitted to order or refer for the service. According to CMS, claims that did not contain the name of an enrolled ordering or referring provider would not be paid beginning in January 2010. However, based on concerns raised by the ACC and others, CMS had agreed to push the implementation date to January 2011. The new rule makes several changes to the previously announced policy, including moving the implementation date forward from January 2011 to July 6, 2010. It also requires that individuals ordering or referring patients for "specialist services" be enrolled. Read more about these changes and what you can do to ensure you are enrolled. Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org. May 21, 2010 The House of Representatives is expected to vote early next week on new legislation that would provide a three and a half year fix to the Sustainable Growth Rate (SGR) formula and stop the 21 percent cut slated for June 1. The SGR formula would resume in 2014. Specifically, the package, called the "American Jobs and Closing Tax Loopholes Act" (H.R. 4213), includes: * A 1.3 percent update, effective June 1 * A 1 percent update in 2011 * Updates for 2012 and 2013 established under two expenditure targets with a floor of zero While this provision is not ideal and does not repeal the current SGR formula, your ACC believes it will provide physicians with some payment stability over the next three and a half years, while buying time to continue working with Congress and other medical societies to develop and implement true payment reform and eliminate the need for the SGR. To be clear, we want the SGR repealed. However, Congress must not allow the current SGR cuts to go through on June 1. Act now! Your ACC is asking all members to call their representative and senators urging them to support H.R. 4213. The fate of this bill is not a given, particularly in the Senate where leadership is still working to muster up enough votes. Call your members of Congress at (800) 210-7193 or via email using the ACC grassroots website. On a different note ... Your ACC has been meeting with health plans and advocating for more efficient and less burdensome alternatives to existing prior notification and approval programs for cardiac imaging. Just last week, the College sent a letter to Sen. Rockefeller supporting his investigation into inappropriate pre-authorization denials for cardiac stress testing by Blue Cross Blue Shield of Delaware and MedSolutions. In addition, the College is developing an alternative plan to radiology benefit managers (RBMs) based on use of appropriate use criteria. The alternative solution would transparently reduce inappropriate imaging, while limiting hassles for doctors and reducing costs to health plans. Stay tuned for more information on these efforts. In the meantime, several large health plans are expanding their existing prior notification and approval programs to new cardiac diagnostic modalities beginning this summer and fall. The affected modalities include echocardiography, nuclear cardiology, diagnostic cardiac catheterization, and electrophysiological device implantations (ICD and pacemakers). The requirements vary by insurer, member plan and service market and ACC members are strongly encouraged to familiarize themselves with the requirements in order to ensure proper payment. Programs that will be expanded include: * AETNA: As of May 15, all outpatient elective stress echocardiography and diagnostic cardiac catheterization require prior authorization. * Anthem BCBS (WellPoint): All outpatient elective echocardiography will require prior authorization. This will take effect Sept. 1 (CT, CO, NV, GA, NH, ME), Nov. 1 (OH, IN, KY, MI, WI) or is not yet determined (CA). * Highmark BCBS (PA): Starting Sept. 1, all outpatient, non-emergency imaging procedures (nuclear cardiology and stress echocardiography) will require prior authorization. * UnitedHealthCare (UHC): UHC will expand its prior notification program to include all outpatient, inpatient and emergent diagnostic cardiac catheterization and EP implantation procedures beginning July 1 (FL, MO, NC, OH, WI) or at a yet-to-be determined date. Rest assured, your ACC will continue to work with these plans to advocate for less-burdensome alternatives. Please continue to use your ACC's imaging hassle form to report any issues with pre-authorization so we can better advocate on your behalf.etitive. May 7, 2010 Breaking News: CMS Correction Means Increased Payments for MPI, CT and Cardiac Cath The Centers for Medicare and Medicaid Services (CMS) today released a technical correction to the 2010 Medicare Physician Fee Schedule, which results in payment increases for myocardial perfusion imaging (MPI) codes, cardiac CT codes, and cardiac catheterization codes, retroactive to Jan. 1, 2010. The correction notice also includes a minor increase in the Medicare conversion factor (from 36.066 to 36. 0791) effective June through December 2010. The corrections to MPI and CT codes address errors made in incorporating RUC recommendations on direct practice expenses (e.g., medical supplies, equipment time) for these services. The errors included incorrect practice expense values for CPT codes 75571-75574 and 78451-78454. For example, the corrected national average payment for 78452 (SPECT MPI, multiple) is $439, compared to the $379 published in the November Final Rule. The American Society of Nuclear Cardiology, the Society of Nuclear Medicine and the American Medical Association identified the errors in the SPECT codes. Society of Cardiovascular Computed Tomography (SCCT) and ACC worked with CMS to correct errors in the cardiac CT codes. The correction notice also includes changes to malpractice RVUs for cardiac catheterization services. In the Final Rule for the 2010 Medicare Physician Fee Schedule, CMS agreed with ACC, SCAI, and the AMA that cardiac cath services should be assigned malpractice RVUs based on the higher surgical risk factor. However, the published RVUs and payment rates did not correctly reflect that policy change. With this notice, CMS has corrected its error. The payment changes -- for example, an increase from $235 to $253 for 93510-26 (Left heart catheterization, professional component) -- reflect the higher risk associated with invasive procedures. Your ACC continues to apply pressure to CMS to address the other imaging cuts included in the 2010 Medicare rule. Most importantly, we continue to press for a phase-in of the bundled nuclear codes and are working with members of Congress and CMS to help them understand the extent of the cuts, their impacts on practices and the need for a formal policy that phases in cuts of a certain magnitude over time. In the meantime, stay tuned for more information as it relates to notifying payers of these new corrections. May 5, 2010 Did you know? Previously, practitioners had three calendar years from the date of service to file Medicare claims. Under the new health reform law, all claims for services must be filed within one calendar year after the date of service, unless an exception is made by CMS. For services furnished before Jan. 1, 2010 where claims have not yet been filed, those claims must be filed no later than Dec. 31, 2010. Read more about this and other health care reform law provisions. The Advocate will continue to feature regular updates on key elements of the health reform law that impact the practice of cardiovascular medicine. Don't forget to send us your questions and comments as well. Before you sign ... The Centers for Medicare and Medicaid Services (CMS) recently issued a clarification for providers outlining new and revised signature requirements for medical review purposes. Medicare requires that services provided/ordered be authenticated by the author using a "legible identifier" in the form of a handwritten or electronic signature. The new clarification revises these requirements and includes e-Prescribing language. It is important to review these changes to ensure your claims are reviewed and paid properly. Read the complete update. We are now nearing 120 co-sponsors on our Gonzalez legislation! "Congress is beginning to realize they have to do something," writes ACC CEO Jack Lewin in a recent Lewin Report blog post. "The dilemma is how to propose a longer-term solution that Congress will buy into." Read the complete post and share your thoughts. Register now for the following ACC webinars: * On May 13, the ACC will hold its third "Imaging in FOCUS" Webinar starting at 4:00 p.m. (ET). The one-hour Webinar will address how to set FOCUS goals related to the implementation of appropriate use criteria at the point of care. Register now. * On May 19, the ACC will hold a Webinar on the new TAD Guidelines from 2:00 3:30 p.m. (ET). Register now. The ACC "Practice Census" is coming. Check your email over the coming days for the ACC's 2010 Practice Census. The goal is to use the information from this survey to help educate Congress and other health policy leaders at the state and national level about the realities of running a cardiovascular practice in the current health care environment. For scientific validity the Practice Census will be sent to one representative per practice. If you receive this survey, please make the time to take part in this important effort! Your ACC is celebrating National Nurses Week by waiving the $25 application fee for nurses who apply for Cardiac Care Associate membership. Also, special discounts will be given to practices interested in group membership for the entire team. April 29, 2010 The devil's in the details, and your ACC is working to make sure that the details of the new health reform law do not place additional burdens on your ability to provide quality patient care. In particular, the Patient Protection and Affordable Care Act of 2010 (PPACA) includes several near-term requirements that have the potential to increase the burden on physician practices that provide imaging services. Your ACC this week sent a letter to CMS urging the agency to implement several of these requirements in a manner that minimizes the costs and administrative burdens on cardiovascular practices. The letter provides specific recommendations on the following:The PPACA requires the creation of a protocol for physicians to self-disclose violations of the physician self-referral (Stark) law. Given that most Stark law violations are typically inadvertent and constitute merely technical violations of the law, the College is urging CMS to develop a disclosure protocol that provides "leeway for those who have attempted to comply; believed to a reasonably degree of certainty that they were, in fact, in compliance; and reasonably seek to remedy the situation when they determine a violation has been committed."The PPACA requires physicians making self-referrals for MR, CT and PET services to inform their patients at the time of referral about their ownership or other financial interest in imaging equipment, as well as provide them with the option of obtaining the service elsewhere. Physicians will need to provide a written list of other imaging centers that provide the service in the area in which the patient lives. The ACC is urging CMS to create a standardized notice with information on how physicians should disclose ownership interests and how lists of alternate providers are to be compiled. The ACC believes it is critical that the list of alternate sources be for the same service for which the patient has been referred, and that CMS develop a standardized, consistent method for providing accurate information to patients. Last chance to participate in the online survey to help understand the impacts of the CMS decision to eliminate the use of consultation codes. Your ACC is working with the American Medical Association (AMA) and other specialty societies to modify the policy and the survey will help inform this effort. The deadline for participation is this Friday, April 30. E-prescribing update: The Drug Enforcement Agency (DEA) recently released an interim final rule that permits e-prescribing of controlled substances, provided it is allowed under state law. Some states do not permit e-prescribing of controlled substances and the DEA rule would not override those prohibitions. The publication of this rule may have implications on the widely anticipated final rule on meaningful use for electronic health records, which is likely to include provisions that would require individuals to achieve a minimum level of e-prescribing of all prescriptions legally permitted to be electronically prescribed. Read more information about the DEA requirements. Have you signed the SGR petition? Your ACC has partnered with the Texas Medical Association (TMA) on a petition drive to fight the flawed SGR formula and preserve patient access. The petition urges an end to the Band-Aid approach over the last several years and the development of a permanent solution that allows physicians to continue providing quality care to their patients. Help us reach our goal of 1 million signatures. To sign the online petition, go to: www.meandmydoctor.com. April 22, 2010 Your help is needed in overturning a decision by the Centers for Medicare and Medicaid Services to eliminate the use of consultation codes. The 2010 Medicare Physician Fee Schedule eliminated the use of consultation codes as of Jan. 1. Physicians are now required to bill for these services using the "most appropriate" remaining evaluation and management codes. While your ACC continues to work to overturn this decision, we are also working with the American Medical Association (AMA) and other specialty societies to modify the policy. To gather data for this effort, the ACC, AMA and other societies have designed a short survey that takes approximately 10 to 15 minutes to complete. Your participation in this survey will help us to understand and quantify how this policy affects physicians. This online survey is open through close of business April 30. Results will be collated for individual specialties and across all specialties. Radiation safety comments are in! Your ACC last week submitted comments to the Food and Drug Administration (FDA) on radiation exposure from medical imaging. The comments outline our support for a "pragmatic approach to radiation safety, balancing the intended benefits of the procedure against the radiation risk" and for the "principle of 'as low as reasonably appropriate' with respect to radiation levels used during such procedures." They also stress the need for the ordering physician and imaging laboratory to work together to ensure appropriate patient selection and for the physician and patient to work together as a care team. In addition, they highlight opportunities for increased collaboration between the provider community and the device industry to develop data recording fields that would allow the operator to better determine the radiation dose and the appropriateness of the procedure. More information on the radiation safety topic is also included in the latest issue of Cardiology magazine. ACC members can access this issue online by logging into the "Member Center" and then clicking on "Cardiology magazine." Have you signed the SGR petition? Your ACC has partnered with the Texas Medical Association (TMA) on a petition drive to fight the flawed SGR and preserve patient access. We are the first specialty society to partner with the TMA on this critical campaign. The goal of the campaign is to gather 1 million signatures from health care providers and their patients and share them with Congress and the president. To sign the online petition, go to: www.meandmydoctor.com. Reminder: Your ACC has developed several practice management resources to help you navigate Physician Quality Reporting Initiative (PQRI) and e-prescribing requirements. Changes to both federal programs have made it easier to participate and earn incentive bonuses. In addition, we have developed a "Practice Survival Toolkit" that contains information and resources for assessing practice options and maintaining practice viability in the current health care environment. Register now for the "Evolving Models of Cardiovascular Practice Symposium," June 3 4 at the Venetian in Las Vegas. This program is designed to help practices prepare for hospital or health system integration by providing tools and real-world experiences necessary to make better and smarter decisions before and during the integration process. Attendees will discover the ins and outs of several integration models from legal, governance and integration experts as well as experienced managing physicians and practice administrators. For more information, go to: www.acc.org/practiceopportunities. April 16, 2010 Another reprieve ... President Obama last night signed H.R. 4851, the Continuing Extension Act of 2010, into law, following on the heels of votes in both the House and Senate. The law reinstates Medicare physician payments to where they were on March 31 and again postpones the 21.3 percent Medicare Physician Payment cuts related to the flawed sustainable growth rate (SGR) formula until the end of May. What does this mean for April Medicare claims? The Centers for Medicare and Medicaid Services' (CMS) temporary hold on the processing of physician claims filed as of April 1 officially expired yesterday. However, with Congressional action so imminent, it is unlikely many claims were actually processed at the lower payment rates. However, CMS has said that any claims paid that reflected the 21.3 percent cut will be reprocessed automatically without any action required from physicians. Contact Congress NOW! The continuous Band-Aid approach to the SGR is clearly not working. Your ACC is urging all members to contact their members of Congress and urge them to find a permanent solution to the SGR using the toll-free grassroots hotline (800-210-7193) or via email (click here for the House and click here for the Senate). In addition, ACC members are encouraged to sign on to a petition to Congress, urging them to stop the SGR cuts. You can sign your name by clicking here. PQRI participation made easier. Changes included in the 2010 Medicare Physician Fee Schedule have made participation in the Physician Quality Reporting Initiative (PQRI) less burdensome and more likely to be successful than the previous method of claims submission. In the 2010 PQRI program, new measures groups for coronary artery disease and heart failure are available for reporting and require physicians to report on only 30 patients instead of 80 percent of eligible patients to qualify for a 2 percent bonus but these measures groups may not be reported through claims. Your ACC has partnered with CECity to offer an online tool, PQRIwizard to facilitate the submission of these PQRI measures groups. Similar to online tax preparation software, the PQRIwizard provides a simple, cost-effective way for eligible professionals to collect quality data and submit the results to CMS for payment. For more information on how to get started, go to: http://acc.pqriwizard.com. The FDA this week issued a letter to health care providers following up on its request to suppliers of unapproved nitroglycerin sublingual tablets that they cease manufacturing and distribution of the products. Pfizer's Nitrostat (nitroglycerin tablets, USP) received FDA approval in 2000 and is currently the only brand of nitroglycerin sublingual tablets on the market. According to the letter, Pfizer has accelerated production of all three strengths of Nitrostat and now has additional inventory to meet the increased demand. For the complete letter, click here. April 7, 2010 Congress must act immediately next week to stop the sustainable growth rate formula (SGR) cuts that went into effect on April 1. Congress failed to address the SGR prior to its spring recess, and as a result the 21.3 percent Medicare physician payment cut is now a reality. The Centers for Medicare and Medicaid Services has instructed its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule for the first 10 business days of April in case Congress acts, but time is of the essence. Your ACC strongly supports moving the current Medicare physician payment system away from a volume-based system and toward a value-driven system. If you haven't already, please go to www.acc.org/can and tell your members of Congress to stop the SGR cuts and provide stable, positive updates and cover the increase in the cost of providing care. Pens with a purpose! Your ACC has partnered with the Texas Medical Association (TMA) on a petition drive to fight the flawed SGR and preserve patient access. We are the first specialty society to partner with the TMA on this critical campaign. During one of the seven rallies held Monday across Texas to launch the campaign, TMA President William H. Fleming III, M.D., said: "We need more than Band-Aids. We need more than sutures. We need a complete transplant. This is all about Medicare patients' access to physicians' care. Congress created this problem, and only Congress can fix it." The goal of the campaign is to gather 1 million signatures from health care providers and their patients and share them with Congress and the president. To sign the online petition, go to: www.meandmydoctor.com/. You can "bet" you'll come away from the "Evolving Models of Cardiovascular Practice Symposium" this June in Las Vegas with the tools and real-world experiences you need to make better and smarter decisions regarding the hospital or health system integration process. The symposium, which will take place June 3-4 at The Venetian Hotel, will explore the ins and outs of several integration models from the perspectives of legal, governance and integration experts as well as experienced managing physicians and practice administrators. Register today at www.acc.org/practiceopportunities. Read all about "IT." The April issue of Health Affairs explores the world of health information technology (IT) since passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) one year ago. The issue addresses important reasons to aggressively move forward with health IT, as well as reasons to tread carefully. Topics range from defining meaningful use to the effect of health IT on quality. For a complete table of contents and abstracts click here. For ACC health IT resources, including comments on meaningful use, tips for choosing an electronic health record and practice case studies, go to www.acc.org/healthit. March 30, 2010 Congress leaves without fixing SGR. Congress failed to address the flawed sustainable growth rate (SGR) formula used to set Medicare physician payment rates prior to the Spring District Work Period, and as a result, a 21.3 percent Medicare physician payment cut will take effect on April 1 when the current short-term Medicare payment freeze expires. Your ACC needs your help in urging Congress to act immediately upon its return the week of April 12 to permanently repeal the SGR. The College strongly supports moving the current Medicare physician payment system away from a volume-based system and toward a value-driven system. Go to www.acc.org/can and tell your members of Congress to provide stable, positive updates that cover the increase in the cost of providing care. CMS issues 10-day hold on claims. The Centers for Medicare and Medicaid Services (CMS) has instructed its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule (including anesthesia services) for the first 10 business days of April in order to allow Congress time to pass a fix. This hold will only affect claims with dates of service April 1 and forward. The hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. A new leader for CMS? Obama Administration officials this past weekend announced that the president is expected to nominate Dr. Donald Berwick, a pediatrician and president of the Institute for Healthcare Improvement (IHI), to head CMS. While the nomination still awaits Senate confirmation, the timing couldn't be better. Not only will Dr. Berwick be critical in implementing the new health reform law, your ACC also is looking forward to working with him on issues like payment reform and quality improvement. In his position at IHI, the College worked with Dr. Berwick on quality improvement initiatives like the D2B Alliance and most recently Hospital to Home. Delaware denials make headlines. Over the last several days, Blue Cross Blue Shield (BCBS) of Delaware, MedSolutions and Aetna have made headlines for denying certain patients cardiac stress tests in cases where physicians have said they are warranted. In one case, a denial was almost fatal, while in another, a patient had to pay out of pocket for her diagnostic test. For the past year, the Delaware Chapter of the ACC has been advocating for the state's insurers to permit appropriate imaging testing for its members based upon current appropriate use criteria and not allow MedSolutions to dictate major clinical decisions for medical providers and patients. As a result of these recent articles, both the Delaware Insurance Commissioner and Sen. Jay Rockefeller (D-WV) have launched investigations of BCBS of Delaware and MedSolutions' pre-authorization practices. ACC members in Delaware are strongly encouraged to notify the Delaware ACC Chapter if patient coverage has been denied. The Chapter plans to present these cases to the Delaware Insurance Commissioner. At a national level, your ACC is working with Sen. Rockefeller's staff to identify opportunities to assist with the congressional investigation process. Current laws in nearly 30 states limit damages in medical liability cases, but recent state Supreme Court decisions in Illinois and Georgia that overturn medical liability caps could potentially nullify the great strides medicine has made to increase competition among medical liability insurers, lower premium rates and provide greater access to care. In February, the Illinois Supreme Court ruled that the state's 2005 law limiting damages to $500,000 for physicians and $1 million for hospitals violated the state Constitution's separation of powers between the legislature and the judiciary. Just last week, the Georgia Supreme Court unanimously ruled that a $350,000 cap on noneconomic damages, including compensation for a plaintiff's pain and suffering, violated the right to a jury trial as guaranteed under the Georgia Constitution. The recent trend of states overturning constitutional malpractice caps is disturbing, especially in light of the effectiveness of these actions in curbing medical costs in the states. Your ACC, working with its state chapters, is committed to both promoting and defending effective liability reforms. Stay tuned for more opportunities to get involved. March 23, 2010 Survey responses urgently needed. Over the last several weeks your ACC has been informing you about the importance of completing RUC surveys if you receive them in your e-mail. These surveys are critical to ensuring accurate and fair valuation of diagnostic cardiac catheterization services. Thank you to everyone who has completed a survey to date. We still need more cardiologists, however, to complete a survey on injections associated with diagnostic cardiac catheterization. If you perform diagnostic cardiac catheterization, it is imperative you fill out this critical survey at: https://www.formrouter.net/forms@JMMS/93X18-Svy.pdf. Please note, this link will only work for PC users. Mac users should email advocate@acc.org to have a survey emailed to you. Please include "RUC Survey" in the subject line. Health reform update: President Obama this morning signed H.R. 3590, the "Patient Protection & Affordable Care Act" in to law. The Senate is expected to take up the House-passed reconciliation bill that includes a separate package of amendments as early as today. Stay tuned for next week's "Advocate" and an overview of the health reform landscape and your ACC's next steps as they relate to short-term asks and long-term permanent solutions. As we mentioned yesterday, now the real work begins and there will no doubt be much debate over implementation. We stand poised to lead in this effort! The FDA has been busy ... The agency has ordered Glenmark Generics of Mahwah, N.J., and Konec Inc. of Tucson, Ariz., to stop marketing unapproved nitroglycerin tablets. The tablets are placed under the tongue to relieve chest pain or to stop a heart attack and are marketed in 0.3 mg, 0.4 mg, and 0.6 mg dosages. The FDA does not anticipate a supply problem for these products, nor do they anticipate a change in pricing. Pfizer Inc. markets FDA-approved sublingual nitroglycerin tablets in the same strengths and is able to supply the market with approved products. For more information, click here. Black box warning: The FDA has also notified health care professionals and patients that a Boxed Warning has been added to the prescribing information for Plavix (clopidogrel). For Plavix to work, enzymes in the liver (particularly CYP2C19) must metabolize the drug to its active form. In patients who are poor metabolizers of the drug, Plavix has less effect on platelets, and therefore less ability to prevent heart attack, stroke and cardiovascular death. According to the FDA, it is estimated that 2 to 14 percent of the population are poor metabolizers; the rate varies based on racial background. The Boxed Warning in the drug label will include information to: Warn about reduced effectiveness in patients who are poor metabolizers of Plavix. Poor metabolizers do not effectively convert Plavix to its active form in the body. Inform health care professionals that tests are available to identify genetic differences in CYP2C19 function. Advise health care professionals to consider use of other anti-platelet medications or alternative dosing strategies for Plavix in patients identified as poor metabolizers. It would be irresponsible of your ACC to officially endorse a particular treatment strategy or offer other guidance on clopidogrel at this time, given the lack of definitive data. Randomized clinical trials are underway that will help address the change in treatment issue based on platelet response to clopidogrel, and we await these important results. Our clinical documents team is examining the issue to determine how appropriately to address it. For more information, click here. Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@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 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 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 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 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 b December 8, 2009 Breaking news from Capitol Hill: Rep. Charlie Gonzalez (D-TX) is expected later this week to introduce legislation holding cardiology at 2009 practice expense values at the current rates, while allowing other specialty practices to operate at 2010 physician practice information survey (PPIS) values. While we still have an uphill battle to save the private practice of cardiology, the goal now is to get as many original cosponsors for the bill as possible. We are asking everyone, as part of the "Take Action for Access Week," to contact their representatives and ask them to call Julie Hart in Rep. Gonzalez office (202-225-3236) by Friday to be an original cosponsor of the bill. If Rep. Gonzalez is your member, please take time to personally thank him for sponsoring this bill. The Centers for Medicare and Medicaid Services (CMS) issued a devastating blow to patient access with its 2010 Medicare fee schedule. This legislation will go a long way towards mitigating the impacts of this rule. However, we need everyone to act now! We've made it as easy as possible for you to take action. The College's toll-free grassroots hotline (800-210-7193) will connect you directly with your members of Congress. The Campaign for Patient Access Web site also provides easy access to your lawmakers via email. Sample letters and talking points, as well as materials for you and your patients, are readily available. We've also made it easy to donate to the campaign and to share your stories with each other and the media. Please act now to save your profession and your patients' access to care! December 7, 2009 Take action for access! That's the theme of this week. A bill to hold cardiology at 2009 practice expense RVUs, while allowing other specialties to have 2010 PPIS values, will be dropped in the coming days. While it still will be an uphill battle to get this legislation passed, this week's goal is to generate as many visits, calls and letters to members of Congress as possible urging their support. We'll be storming Capitol Hill over the next three days. More than 80 cardiovascular professionals from across the country will meet face-to-face with members of Congress in Washington, D.C. In addition, we are running ads in several Capitol Hill newspapers over the course of the week that target the Obama administration and Congress. The ads highlight the consequences of the rule and question whether policymakers are prepared to be responsible for the health and material costs associated with cuts. We also have several practices across the country making local news headlines about the impacts of the cuts on Medicare patients in their states. For those who can't make it to D.C., in-district meetings and phone calls are just as important. We are making it as easy as possible. The College's toll-free grassroots hotline (800-210-7193) will connect you directly with your members of Congress. The Campaign for Patient Access Web site also provides easy access to your lawmakers via email. Sample letters and talking points, as well as materials for you and your patients, are readily available. We've also made it easy to donate to the campaign and to share your stories with each other and the media. Your ACC understands that the survival of private practice cardiology is at stake. We have all done our jobs at improving cardiovascular care and reducing mortality, and we will continue to do all that is necessary to defend these accomplishments and not allow the infrastructure we have spent decades building to be destroyed in the name of cost savings. At the same time, we would be doing a disservice by not recognizing that the health care environment is changing. Our other job is to make sure that any changes protect the ability of cardiovascular professionals to provide patients with the care they need in a timely and appropriate manner. We are working hard to ensure that practices have the tools necessary to best survive and thrive in light of these changes. The most recent examples of these efforts are the ACC's new Practice Survival Toolkit and this week's all-member call regarding the pressing coding changes for nuclear cardiology SPECT-MPI, Cardiac Computed Tomography and Cardiac Magnetic Resonance. As a reminder, this member-only call will take place on Dec. 8 at noon ET. Click here to register. The ACC is a powerful and respected organization because of its 60-year history in education, science and advocacy. We have reached this point because of the dedication and efforts of cardiovascular professionals like you. We have a challenging future ahead, but there is real opportunity for the ACC and its members to continue to lead and shape that future. By taking part in this week's activities, we are taking steps to do just that. December 2, 2009 We are stepping up our efforts to stop bad government policy! We've heard from several members of Congress this week about in-depth conversations they've had with cardiologists in their states about the impacts of the cuts on local communities and patient services. We're being heard and we must not let up. We are working with our partner cardiovascular societies on legislative language that is slated to be dropped next week. We also continue to meet with CMS about phasing in the massive cuts to nuclear imaging. ACC President Alfred Bove and President-Elect Ralph Brindis have meetings with key CMS officials and members of Congress as part of next week's "Take Action for Access" activities. We are also continuing to reach out to consumer groups and others about the serious patient access issues posed by the rule. We'll also be running ads in three Capitol Hill-based papers next week. Links to the ads will be included on the "Campaign for Patient Access" Web site and in the next edition of The Advocate. Get Online! Check out the ACC's new "Campaign for Patient Access" Web site for daily updates on what's happening now, quick access to your members of Congress and easy opportunities to share your stories about the cuts' impacts on your patients and your community. The site also contains background information on the issues and resources for both patients and practices. This site is designed for you, so your feedback is appreciated. Ready. Set. Go. We're going to need each and every member to visit, call and write members of Congress as part of next week's "Take Action for Access" grassroots effort. We have a good-sized contingent of people coming to Washington, D.C., December 7, 8 and 9 for face-to-face meetings with their congressional delegations. Those still interested in coming to D.C. should contact ACC's grassroots team as soon as possible for help with scheduling meetings and briefing materials. For those who can't make it to D.C., your ACC stands ready to help schedule in-district meetings and provide you with easy ways to call and write your members of Congress asking them to support our legislation. More information on this virtual effort will be posted in the coming days on the "Campaign for Patient Access" site. We're committed to helping you navigate the coding changes included in the 2010 rule. Your ACC is hosting two Webinars just for members over the next two weeks. The first call will take place on Tuesday, December 8 at noon (ET) and will walk practices through the most pressing CPT changes for cardiology, including the new nuclear cardiology SPECT-MPI, Cardiac Computed Tomography, and Cardiac Magnetic Resonance codes. The call will also address the most up-to-date information on Medicare changes to provider consultations. To register for this call, click here. The second call will take place on December 14 at 1 p.m. (ET). This call will feature a national health insurer panel with representatives from AETNA, CIGNA, WellPoint and UHC. The panel will discuss their respective plans for proper coding implementation, as well as their changes regarding provider consultations. Stay tuned for more information on how to register for this call. Speaking of new coding changes, don't forget about the new Practice Survival Toolkit! The toolkit contains a wealth of information on not only the coding changes, but all of your practice options. Our goal is to help you make the best choices for your practice and your patients in light of the challenging health care environment. Again, this is a resource designed for you, so your feedback on what tools will help you both now and moving into the future is encouraged. November 20, 2009 We'll be coming to you more often, now that we are in the next phase of our campaign to protect patient access to quality CV care. We will have specific requests, provide you with specific tools and keep you informed of our progress every step of the way. Your ACC leaders are in constant conversations with key White House, HHS, Congressional, media and consumer groups to make clear the consequences of this bad government policy. We are detailing the suspect nature of the data used to make payment policy; and we are painting a disturbing picture of disrupted services, blocked patient access, increased disparities and increased Medicare Part B costs caused by shifting services to hospitals. We have willing legislative sponsors for bill language to stop the cuts that should be introduced in the coming days. The introducing members of Congress are checking with CMS to verify technical details over the next several days. Watch this space for a bill number that you can push for. We're not stopping with legislation. We are vetting high-profile law firms and putting the final touches on a strategy to pursue a legal injunction. We are seeking partners in this legal effort from our CV society colleagues, CAA, interested Chapters and other affected specialty societies. We need to continue the pressure on lawmakers during this critical time. The coming weeks present a terrific opportunity for you to meet with your representatives while they are home. Please contact ACC's Grassroots staff at grassroots@acc.org to set up in-district meetings. You will want to illustrate for them the devastating impact the rule will have on your practices and your patients. Your ACC stands by ready to help you get to those offices and make the strong case against this debilitating rule. If you have already arranged meetings on your own, please let us know about them so we can keep a tally of activities. Go to acc.org and get involved with this campaign. You will see links to issue briefs with details about the negative consequences of the rule. You can access a practice expense calculator to specifically define the effects on your practice so that you can deliver the message in your community and to your elected officials. You can access materials for your patients to get them involved in the effort. And you can get complete information about how to contact the lawmakers representing your area. Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org. November 17, 2009 Thanks for dialing in! More than 550 members took advantage of ACC's all-member call last Thursday to learn more about the final 2010 Medicare Physician Fee Schedule and hear from ACC President Fred Bove and ACC CEO Jack Lewin about member resources and next steps. For those of you who could not make the call, slides are available. A recording of the call will be available in the coming days. So what is next? Many of you are asking what you can do. The short-term answer is simple: assess the impacts on your practice. Not only do you need to assess the impacts in order to know how best to plan for the coming year in terms of staffing, negotiating with health plans and meeting the needs of your patients, but you need this information for your members of Congress. We now need to prove to Congress and to CMS that these cuts will in fact impact access to care. We're asking everyone to take advantage of ACC's practice expense calculator to gauge the initial impacts. From there, you are strongly encouraged to send these results to advocate@acc.org, where ACC's media and grassroots team stand ready to help you use these results in messages to Congress, to patients and to your local media. Speaking of media, your ACC is launching a "media blitz" designed to put faces on the cuts at the state and local level. If your office is forced to lay off staff, or you have patients that will need to drive hours to the closest hospital for a test they used to get at your office, we are ready to help make sure these staff and patients are heard. The ACC media team can work with you on op-eds in local papers, radio interviews and even local television interviews. For more information, contact advocate@acc.org. Survey says. As a result of the recent CMS ruling, a new ACC member survey indicates that many practices will need to take action to protect the viability of their practice. The majority of practices report staff layoffs (42%), elimination of service lines (33%), limiting office hours (14%) or not accepting Medicare (13%). Only one-quarter report no action and those which will not change practice patterns tend to be in academia or work in hospitals. Patient Impact: Patients seeing solo practitioners (100 patients seen on a weekly basis) will feel the effect of the ruling the hardest with anticipated cuts across the board in staff, service lines, Medicare payment and office hours. Medicare patients will also be extremely inconvenienced, as 13% of practices (17% of private practices) anticipate a need to reduce the number of Medicare patients or stop accepting Medicare payment. Cardiovascular practices report that about 50% of their patient volume is Medicare patients. Taking that into account, calculations reveal that 14% of the Medicare population receiving cardiovascular care (or 7% of all cardiovascular patients) would be directly impacted by the anticipated cuts. The survey also shows a clear trend toward hospital migration, especially given the 2010 CMS Medicare cuts. Almost one-in-five (18%) of active, practicing cardiologists in the U.S. have already migrated to another practice or hospital and 28% say that a practice merge is on the horizon. When you look at practice type, private practices which expect to be hit the hardest by the recent ruling are more likely to consider integration into a hospital system (39%), although remaining in private practice (32%) is also planned. We will be coming to you in the coming days and weeks with specific ways you can help influence regulatory and legislative efforts to minimize aspects of the rule. Remember that there could be cuts no matter what. However, we are exploring every single option to mitigate the cuts that we believe are based on flawed and unvalidated data and/or are excessive to the point that the consequences to important patient services like medical imaging are devastating. A sample letter to Congress asking members to stop the cuts by any means necessary is currently posted at www.acc.org/can. Information on coding changes and how to work with health plans as you transition to the new codes is available at www.acc.org/practicemanagement. November 12, 2009 We are engaged in a fight for survival. Every cardiovascular professional in the United States must get personally involved in the fight to protect patient access. The CMS Final Rule is bad government policy and it can not stand. The viability of outpatient cardiology and hence patient access to quality cardiovascular care is at extreme risk. Because of your efforts to date, we have succeeded in buying a little time. Since the rule phases in some of the cuts to cardiology over four years, we have mitigated the damage a bit. But these cuts, whether immediate or spread out over time are simply unacceptable. Your ACC is working hand-in-hand with the Cardiology Advocacy Alliance (CAA) and the other cardiovascular societies. We ARE working together and we will do whatever it takes to win. The odds against stopping the cuts completely are high, particularly by Jan. 1, 2010, but that only makes us redouble our efforts. We will need your tireless support during this battle. In the short-term we need you to continue to spread the message within your community and with your elected officials about the specific impacts of these cuts on your practice and your patients. ACC's new practice expense calculator can help. We also need your stories and your patients' stories to put the unintended consequences of these cuts in human terms. Send these stories to advocate@acc.org. As mentioned in previous issues of The Advocate we are exploring all legislative, legal and regulatory options. As we pursue specific strategies in the coming weeks ahead, we will give you specific instructions on how you can help. (Watch this space!) Keep in mind that we will provide as much detail about these strategies as is possible, but we need to be cautious about giving intelligence to those in the house of medicine who would oppose our efforts. On the regulatory front, we have made a specific request to CMS to phase in the 36 percent cut to nuclear imaging. Again, the cuts are unacceptable but we need to buy a little time here as with the other proposed cuts. On the legislative front, our goal is to turn back this bad government policy by building on the goodwill and support created by your efforts to date, and at the same time minimizing opposition. We want to win here, not just feel good about our efforts. The requests for your support will be specific and we will need your full-throated response. If we hit a dead-end with one strategy, we will move on to the next and ask for your support again. If we have a success, we will build on it with additional strategies. On the legal front, we have retained high level legal counsel with experience in challenging this kind of bad policy. Our legal strategy will run in parallel with our regulatory and legislative efforts. Be engaged and get involved. You can start today! Don't forget to join today's all member call with ACC CEO Jack Lewin, M.D., and President Alfred Bove, M.D., Ph.D., F.A.C.C., from 4:00 to 5:30 p.m. (EST) to discuss the rule. To RSVP, click here. Slides are also available at: http://qualityfirst.acc.org/advocacy/Documents/AllMemberCall2010RuleSlides.ppt. In addition, the ACC is ramping up its practice management Web site to help you assess the initial impacts of the cuts and provide FAQs on key components of the rule. Visit www.acc.org/practicemanagement for these and other resources. Finally, there is no better time to contribute to the ACC's Political Action Committee (www.accpacweb.org). October 29, 2009 It's crunch time and we're not letting up! Your ACC's efforts to stop the proposed Medicare payment cuts continue on all fronts. ACC leaders and staff understand the very real impacts these cuts will have on your practices, your staff and your patients and are working around the clock to fight the implementation of these cuts until a rigorous review is conducted of the practice expense survey data. We're appealing directly and publicly to the president to step in and stop this tragedy. Your ACC, working with the Cardiology Advocacy Alliance, today placed an open letter in the nation's flagship newspapers, calling upon President Obama to stop the cuts that will drastically reduce access to cardiovascular care and greatly impact the health of the nation. The print ads ran in today's "A Sections" of The Washington Post, USA Today, The New York Times, and the president's hometown newspaper, The Chicago Tribune. Take a look, and please let others know about these advertisements. Over the past four months, we have worked together to fight this nightmare scenario, in which patients will be forced to battle heart disease without the necessary and critical treatments from their cardiac care providers. To date, approximately 120 members of Congress have written letters to Health and Human Services Secretary Kathleen Sebelius on behalf of the ACC asking for clarification and intervention. In addition, you have made more than 19,000 e-mails, calls and visits to members of Congress. Your ACC remains completely focused on saving cardiology practices and stopping these cuts, but only President Obama can step in and prevent this looming disaster. The final rule is expected by Nov. 2. The ACC is preparing for all scenarios and will communicate with you as soon as we have any information. In the meantime, plan on joining ACC President Alfred Bove and ACC CEO Jack Lewin for an all-member call about the final rule on Nov. 12 from 4:00 to 5:30 p.m. (EST). To RSVP for the call, click here. For more on ACC's efforts regarding the proposed rule, visit: qualityfirst.acc.org.gress about the benefits of appropriate use criteria and clinical guidelines to ensure that the right tests are delivered at the right time to the right patients. We're still at the table (or at least in the garden) when it comes to health care reform. Just this week, ACC CEO Jack Lewin represented the ACC at a special White House event in the Rose Garden with physicians from all 50 states. The ACC was the only specialty group in attendance. Click here <http://emessaging.vertexcommunication.com/ct/5331759:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> to read the ACC's statement. To read the president's remarks, click here <http://emessaging.vertexcommunication.com/ct/5331760:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> . Note his intention to fix the SGR! Check out the president's plan. President Obama's health plan is actually quite pragmatic and includes all of the basic elements that your ACC has been lobbying for over the past few years. There's not much in there we couldn't get behind, particularly as compared to all the controversies in the major bills. The plan primarily targets insurers, and the president has made it clear he's not 100 percent dependent on a public option. He's also open to discussion about the MedPAC idea. If we want to be at the table when really tough decisions are being made over the next 2-3 months, it may be in our best interest to align ourselves with this moderate approach now. The cardiovascular community, by virtue of our past experience and leadership, has some very real insights into payment and delivery system reforms that could add a lot of value as we get into the details. To view the president's principles, go to: http://www.whitehouse.gov/issues/health_care/plan/ <http://emessaging.vertexcommunication.com/ct/5331761:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> . Don't miss this. CMS has finalized its proposal to eliminate blanket noncoverage of MRI for blood flow determination and will allow local carriers to determine coverage policies for this service. The ACC worked with Society of Cardiovascular Magnetic Resonance and the American College of Radiology to request that CMS consider current evidence on MRI blood flow determination and reverse its decision on noncoverage. Removal of the restriction on coverage will permit local carriers to cover blood flow determination performed with cardiac MR studies. In addition, a CPT coding change to be implemented in January 2009 will enable correct reporting of services. October 7, 2009 Full steam ahead! Your ACC's efforts to stop the proposed Medicare payment cuts continue on all fronts. Approximately 25 percent of Congress has sent letters to Health and Human Services expressing concern about the cuts' impacts to the practice of cardiology. Our hope is that the Centers for Medicare and Medicaid Services (CMS) will delay implementation of the cuts until it can fairly evaluate the practice cost data. But hope isn't enough. We must keep the pressure on. The significant decreases in cardiovascular-related mortality over the past decade should not be reciprocated with a 27 percent cut in practice reimbursement that will literally KILL outpatient and community cardiology. The Wall Street Journal <http://emessaging.vertexcommunication.com/ct/5331757:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> agrees. The paper ran an editorial this week, titled "The War on Specialists." The editorial highlights the impacts of the proposed CMS cuts on specialties like cardiology and oncology and criticizes the process used to get there, saying "HHS justified its decision with a flimsy survey whose data it won't release and whose results can't be replicated." ACC CEO Jack Lewin is also quoted, saying the cuts "will cause a horrible disruption that will force many community and independent practices to close their doors, lay off staff or make senior patients wait days or weeks for tests and services." Your ACC continues to take this message to lawmakers, the White House and the media. You can too! Talking points, sample letters to Congress and patient materials are all available at www.acc.org/can <http://emessaging.vertexcommunication.com/ct/5331758:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> . We won one for imaging. The awful imaging amendment by Reps. Anthony Weiner (D-NY) and Bruce Braley (D-IA) to eliminate the ability of physicians to provide advanced diagnostic imaging services in their offices beginning in 2013 was fortunately withdrawn. Special thanks to all of the ACC members who have contacted their representatives on the Energy and Commerce Committee asking them to oppose this amendment. ACC staff and leaders continue to meet regularly with members of Congress about the benefits of appropriate use criteria and clinical guidelines to ensure that the right tests are delivered at the right time to the right patients. We're still at the table (or at least in the garden) when it comes to health care reform. Just this week, ACC CEO Jack Lewin represented the ACC at a special White House event in the Rose Garden with physicians from all 50 states. The ACC was the only specialty group in attendance. Click here <http://emessaging.vertexcommunication.com/ct/5331759:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> to read the ACC's statement. To read the president's remarks, click here <http://emessaging.vertexcommunication.com/ct/5331760:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> . Note his intention to fix the SGR! Check out the president's plan. President Obama's health plan is actually quite pragmatic and includes all of the basic elements that your ACC has been lobbying for over the past few years. There's not much in there we couldn't get behind, particularly as compared to all the controversies in the major bills. The plan primarily targets insurers, and the president has made it clear he's not 100 percent dependent on a public option. He's also open to discussion about the MedPAC idea. If we want to be at the table when really tough decisions are being made over the next 2-3 months, it may be in our best interest to align ourselves with this moderate approach now. The cardiovascular community, by virtue of our past experience and leadership, has some very real insights into payment and delivery system reforms that could add a lot of value as we get into the details. To view the president's principles, go to: http://www.whitehouse.gov/issues/health_care/plan/ <http://emessaging.vertexcommunication.com/ct/5331761:2422536165:m:1:178 227520:34ED223E4402969831180BF72C1A7800> . Don't miss this. CMS has finalized its proposal to eliminate blanket noncoverage of MRI for blood flow determination and will allow local carriers to determine coverage policies for this service. The ACC worked with Society of Cardiovascular Magnetic Resonance and the American College of Radiology to request that CMS consider current evidence on MRI blood flow determination and reverse its decision on noncoverage. Removal of the restriction on coverage will permit local carriers to cover blood flow determination performed with cardiac MR studies. In addition, a CPT coding change to be implemented in January 2009 will enable correct reporting of services. September 21, 2009 Our ACC storms the Hill. Thanks to the relentless efforts of you and your patients, nearly 60 members of Congress signed on to a letter from Charles Gonzales (D-TX) and Mike Rogers (R-MI) to Department of Health and Human Services Secretary Kathleen Sebelius condemning the proposed CMS cuts. This does not count the many other letters that individual senators and representatives sent to Secretary Sebelius themselves. You are being heard! We stand firm as we deliver formal comments to CMS. The ACC's formal response to CMS decries the use of the American Medical Association's (AMA) flawed Physician Practice Information Survey to calculate practice expense relative value units (RVUs). The AMA data have not been reviewed for precision or accuracy, and as you well know, the ACC is strongly urging CMS and Congress not to finalize the proposal without further examination. Our formal response is available online. Our Legislative Conference had record-breaking attendance with more than 350 FACCs meeting personally with their congressional delegations in Washington, D.C., last week. The conference brought together members from nearly every state to learn more about current issues facing the cardiovascular community, including the proposed 2010 Physician Fee Schedule, health care reform, medical malpractice and state advocacy. On the final day of the conference, attendees made hundreds of visits to offices on Capitol Hill, reaching lawmakers and their staff on these very important issues. For those of you who couldn't make it to D.C., updates on key sessions, posts from attending members, polls, videos and more are posted on the The Lewin Report blog. Slides and briefing materials are also available on the Legislative Conference Web site. You can also send an email letter or fax to your members of Congress from www.acc.org/can. We are keeping up the pressure with advertising. In addition to the Hill meetings and educational sessions, ACC print and online ads timed to coincide with the Legislative Conference ran in National Journal, Politico, CongressDaily, www.politico.com and www.rollcall.com. To view the ad, go to: qualityfirst.acc.org. Support for the PAC is helping to open doors. Special thanks go to everyone who supported the ACC PAC during the Legislative Conference. Donors gave more than $60,000 to help further the cardiovascular message on Capitol Hill during this critical time. For more information on the ACC PAC visit www.accpacweb.org, or contact Kaycee Smith at ksmith@acc.org. While we're fighting the cuts, we're also seeing health reform bills take shape. Finally, there is a bill out of the Senate Finance Committee that includes some things we like, such as some attempts to address medical liability reform and a few ways to test new payment structures. But the bill falls far short with only a one-year fix to the SGR and not enough heft in long-term payment reform. Our statement on the bill can be found at qualityfirst.acc.org. Click here to read the Finance Committee release. The shortage in cardiologists is growing, according to a report from The ACC Board of Trustees Workforce Task Force. The report finds that an estimated doubling of the CV workforce is necessary between 2000 and 2050 to adequately meet patient need. The report also issues several recommendations for relieving the shortage. The chair of the Task Force, former Texas Chapter Gov. George Rodgers, is featured in the ACC's The Lewin Report as part of the 2009 Legislative Conference coverage. To read the report, click here. Bless you! CMS has released information regarding billing for the Influenza A (H1N1) Vaccine. In the event that it is necessary for Medicare beneficiaries to receive both a seasonal flu vaccination and an H1N1 vaccination, Medicare will pay for both. CMS also will pay for earlier-than-normal seasonal flu vaccinations. More information from CMS is available here. Also, more information and resources regarding pediatric influenza immunization can be found at: www.preventchildhoodinfluenza.org. Are you ready for ICD-10? CMS has issued a fact sheet clarifying differences between the current International Classification of Diseases-9 (ICD) and the ICD-10 system that must be implemented by Oct. 1, 2013. The fact sheet is available online. While implementation is still four years away, the ACC encourages practices to take steps to begin to prepare for the transition. Practices should inquire with their vendors about ICD-10 compliance so they can make budget plans for the coming years. Physicians also should begin familiarizing themselves with the codes. For more information, visit the ICD-10 section of the CMS Web site. August 26, 2009 We've been making significant progress on our Congressional sign-on letter to get the proposed cuts in the Medicare rule reversed. Advocacy staff and ACC leaders have been meeting with members of Congress back in their districts to encourage them to sign on. As we reach the end of the comment period for the rule, we'll need to continue to push hard to win congressional support for our cause. To date at least 4,000 letters from patients and cardiovascular specialists have been sent to Congress. If you have not contacted your Congressional representative about the proposed cuts, please do so right now. Margo Minissian, chair of the CCA Chapter Liaison Working Group and co-chair of the Cardiovascular Team Council, advocates for how important it is for the entire cardiovascular team to contact their lawmakers on ACC's blog, The Lewin Report. For more information, sample talking points and patient materials go to: www.acc.org/can. The comment deadline for the CMS rule is Aug. 31. Your ACC is preparing detailed comments, which will be posted at www.acc.org once completed. The final rule is expected at the end of October. We're making news. Hundreds of cardiologists descended on downtown Orlando as part of a rally organized by the ACC Florida Chapter last week to draw attention to the effects of the CMS cuts. In Oregon, ACC Chapter President Michael Widmer was featured in an opinion piece in the Oregonian where he says the proposed cuts will "lead to reduced access and quality care for patients with cardiovascular disease," as well as limit free care provided to the uninsured. Meanwhile, Iowa Chapter President Craig Clark was featured as a guest columnist in the Des Moines Register. Clark discusses the importance of focusing on the patient in designing reform because if we "focus on patients, we will simultaneously increase quality and reduce expenses, making our system viable in the long term, so we can provide access to quality care for all Americans." Read more at qualityfirst.acc.org. Your ACC is working closely with the Cardiovascular Advocacy Alliance on a PR campaign designed to draw attention to the impacts of the proposed cuts and the resulting need for health reform. We'll keep you posted on this important effort. In other news, ACC's video team hit the road last week to meet with a practice in Culpeper, VA, that would be forced to close its doors if the CMS cuts go through. Stay tuned for the video and keep stories like these coming. What are they thinking? "Fair" and "accurate, those are the words the American College of Physicians (ACP) is using to describe the CMS cuts. ACP's vocal support of the rule is surprising and disappointing, especially considering that many of its cardiovascular members will be forced to make drastic decisions about their practices should the cuts go through. The ACC fully understands the need for primary care physicians to receive fair reimbursement and increased funding for practice viability and workforce pipeline enhancement. To that end, the College has been working to get the medical home and primary care reimbursement increased in a truly major way. We would all be better off working together on such efforts. The small increase proposed by CMS for primary care physicians will not fix internal medicine, family practice or pediatrics. We aren't surprised other specialties that would benefit from the rule are working against us, but ACP and ACC have been historic colleagues on these types of issues. Not this time. We believe the ACP needs to rethink its position and have let them know. If you are an ACP member you should do so as well. Looking for an easy way to improve patient safety and your liability protection? Your ACC has worked with the FDA, American Medical Association, state medical societies and liability carriers to bring you a free service that delivers FDA-mandated drug alerts immediately online. The Health Care Notification Network (HCNN) is free for ACC members. HCNN is precluded from selling, or in any way re-disclosing any of the information provided to it by the users of the service. The registration form is secure and registrants' privacy is protected by the iHealth Alliance. Registration only takes only a few minutes. More information is available at www.hcnn.net or via email at info@hcnn.net. Trying to decide what integration to have with your local hospital system? Your ACC is hosting a Practice Alignment Symposium in Washington, DC, from Nov. 5-6, to assist you in making decisions on what management model to use. The symposium will provide you with the information you need to help your practice thrive in this challenging environment, and is designed to address your specific questions and concerns about the practice alignment process by connecting you with those who are currently working through the alignment process. The Practice Alignment Symposium also will help you cut back on costs during integration by supplying you with the information and understanding you need to budget your expenditures. Registration information is coming soon. August 13, 2009 Now we're rolling! Reps. Charles Gonzalez (D-TX) and Mike Rogers (R-MI) are circulating a letter to HHS Secretary Kathleen Sebelius, expressing concerns regarding the 2010 CMS Proposed Rule and its drastic cuts for cardiovascular and oncology-related services. Click here to see a copy of the letter. Your ACC is asking each and every one of you to contact your respective representative and ask him/her to sign on to this critical letter. Click here to act now. Over the next week, a list of lawmakers who have signed on to the Gonzalez/Rogers letter will be posted at www.acc.org/can. A sample thank you letter to those members will also be provided. In addition, your ACC staff and leaders continue to work to find Senate sponsors for a similar letter. If you have close ties to a specific senator (or senators) and would like to help in this effort, contact Molly Nichelson (mnichels@acc.org). More than 1,500 - that's the total number of emails, faxes, letters and phone calls that have been made to congressional offices across the country from ACC members. More than 80 - that's the total number of visits to key congressional offices and CMS that have been made by your ACC staff and leadership alone. Three - that's the number of op-eds that have been placed to date regarding the payment cuts and their impacts on quality and patient access. One wine tasting - that's the creative way the Ohio Chapter is planning to educate its members about the payment cuts and the overarching need for real health reform later this month. These numbers don't include the incredible efforts of each and every ACC Chapter to send letters to their entire state congressional delegations; schedule face-to-face meetings with members of Congress while they're home on August recess; and host "Cardiologist for a Day" events. Keep up the good work! The CMS comment deadline is quickly approaching. Public comments on the proposed rule are due to CMS at the end of this month. The ACC is crafting a detailed response, but ACC members who wish to write CMS to voice their opinion regarding the proposed rule may do so by clicking here. Don't forget to explain how your practice and your patients will be impacted and what you will do if the cuts are implemented. A recent survey of ACC members shows that 95 percent of you in private practice would be significantly affected by these cuts, with staff layoffs and service limitations listed as the primary impacts. CMS and Congress need to hear this information. If the payment cuts were not enough, we need to make certain the Weiner-Braley imaging amendment is not incorporated into the House health care reform bill (H.R. 3200) when Congress returns in September. Energy and Commerce Committee Chair Henry Waxman (D-CA) has promised to hold an expedited hearing on the amendments not voted on prior to the August recess. Amendments that survive the hearing will be included in broader discussions around a final House package. The ACC position: Let's use appropriate use criteria and science to improve the effectiveness of imaging, not limit who and where imaging is performed. Your ACC Board of Trustees met last week for its annual retreat. Beyond tuning up our strategic plan to reflect the changing health care environment, the Board spent significant time discussing the College's policy positions in the rapidly changing face of system reform, and how we can redouble our efforts to positively influence the final proposal. This all leads up nicely to our major Legislative Conference in September. To register for the conference, click here. Registration closes this Friday! Victory! You may recall that earlier this year the ACC worked with the American College of Radiology (ACR) and the Society for Cardiovascular Magnetic Resonance (SCMR) to request that CMS change its National Coverage Determination (NCD) on MRI to eliminate language that prohibited coverage of blood flow studies with MR. Patients whose physicians recommended a cardiac MR study with blood flow faced a situation in which the entire service was not paid for because of overly restrictive coverage language. We formally requested that CMS reopen the NCD, eliminate the problematic language and return decision-making authority for coverage of cardiac MR blood flow studies to local contractor discretion. CMS recently published a draft decision in which it proposes to do exactly what we requested. Now if they'll only listen to us on the proposed rule. July 8, 2009 Lawmakers are scrambling to put health reform ideas on the table. Key House and Senate Committees have released their respective proposals, with the goal of passing the bills before the August congressional recess. The ACC has submitted detailed comments on the proposals and continues to work with leaders in the Senate and House to be sure your interests are protected. Meanwhile, President Obama on June 15 addressed the economic imperative for health care reform in a speech to attendees of the AMA's annual meeting in Chicago. To view the ACC's congressional comments, as well as a statement reacting to President Obama's speech, go to qualityfirst.acc.org. You can also share your thoughts on health care reform and related issues via the ACC's online forum, The Lewin Report. Watch this space for more detailed information. Under the headline "The Right Care at the Right Time Saves Lives," the ACC has launched an aggressive Capitol Hill ad campaign to let policymakers know that cardiologists and their patients must be directly involved in health care reform. The ads will run in Capitol Hill publications, including CongressDaily AM, Roll Call, National Review, National Journal and Politico, over the next several months while Congress considers health care reform options. The ad also will run in Cardiology and the Journal of the American College of Cardiology. To view the ad, visit the Quality First Web site. Chalk one up for the good guys. We applaud the Senate action late last week to pass the "Family Smoking Prevention & Tobacco Control Act." The bill gives the Food and Drug Administration (FDA) the authority to restrict tobacco marketing and sales to youth; requires detailed disclosure of ingredients; allows FDA to require changes to tobacco products; and requires larger, more specific health warnings. The ACC has been a long-time leading advocate for this legislation, working hand-in-hand with the Campaign for Tobacco Free Kids. Special kudos go to FACCs in Alaska who stepped up to secure co-sponsorship of the legislation from Senator Murkowski. As part of our efforts to help you prepare for widespread adoption and use of electronic health records, the College last week sent a paper to HHS National Coordinator for Health Information Technology David Blumenthal, M.D., with our recommendations for defining meaningful physician use of health IT. By law, practices can begin receiving bonus payments for "meaningful use" of health IT starting in 2011. However, what constitutes meaningful use has yet to be defined, so we are sending in our two cents. To view the paper and for more information on how to choose the best EHR for your practice, visit the ACC's Health IT Web site. Cardiac cath lab procedures have fallen by 111 percent over the past two years, according to a recent report by market research firm IMV Medical Information Division. Total patient cases accommodated by U.S. cath labs declined to 3.75 million in 2008, a drop from 4.21 million in 2006. This is in contrast to IMV's 2006 report, which identified a gradual 9 percent increase in patient cases from 3.85 million in 2002. When are expert witnesses a little too "expert?" When they have become "professional expert witnesses" and make their entire living testifying as medical experts. The testimony of these hired guns may not always be objective and unbiased, and they may function as advocates rather than scholars. Part of the reason these folks have a market for their services is because physicians have been reluctant to testify as expert witnesses. It's understandable--physicians may have a distrust of lawyers, uneasiness with the legal system and the process of testifying, or fear of being censured by other physicians. And yet the ACC and other professional associations have all made strong recommendations that it is the duty of physicians to act as expert witnesses in their areas of expertise. With the availability of adequate numbers of physicians willing to act as expert witnesses, the use of the professional expert witness will decrease. If you are directly involved in a case with one of these professional witnesses there is also an ACC process for you to make a report. Check out the following link to the expert witness testimony guid If you don't read another edition of this publication, read this one. Then read it again and get ready to join the ACC's fight for the viability of your practice! CMS late last week proposed mind-boggling cuts to cardiology that could be 30 percent or higher beginning in 2010. Taken together with the payment cuts cardiology already has experienced, this wrongheaded proposal represents a real threat to your practice and to the patients you serve. Let's break down the horrible numbers. The proposed rule slashes Medicare payments by more than 11 percent for the average cardiology practice as a result of a badly managed practice expense survey. Out of thousands of cardiology practices solicited this survey is based on input from approximately 50. Somehow this small sample size showed that CV practices have experienced a 30 percent reduction in practice costs. Does that match up to the numbers in your practice? Of course not. This survey has no credibility and CMS chose to disregard the standards it previously put in place to ensure the quality of practice expense data. We believe this is a significant departure from previous policy and may be a violation of the law. It is ironic that the agency that purports to support an evidence-based approach to medicine is making major decisions based on shoddy and incomplete data. It gets worse! As if the 11 percent were not bad enough, most of the core cardiology services face cuts ranging from 20 to 40 percent. Add in the regularly scheduled SGR cuts of more than 20 percent and practices could see possible payment cuts ranging from 25 to almost 50 percent. This is not what we meant by putting quality first. The timing couldn't be worse. Just as we're moving forward with real proposals for health care reform that would improve quality, reduce waste, slow spending and improve the viability of CV practices, along comes this CMS hatchet job. Arbitrary price controls do not equal reform and will only lead to greater disparities in health care. That's the bad news. The good news is that this proposal is subject to revision. Your ACC is fighting this change at all levels through CMS, Congress and the Administration. ACC President Fred Bove, and your elected officers and Washington-based staff are all over this crisis on your behalf. Working closely with our partner cardiovascular societies we are developing a detailed response to CMS and working the halls of Congress to bring political pressure to bear on the agency. We are reaching out beyond cardiology to engage other specialties like oncology that also face daunting cuts that will inevitably impact patient diagnosis and treatment. On the regulatory side, ACC staff is working closely with the Advocacy Steering Committee and the CV RUC to prepare a substantive analysis and response to this proposed rule. We anticipated this action from CMS and have identified technical expert consultants who can assist us with our analysis and help propose alternatives. We have been rocked by this proposal and now it's time to roll! Here are four key ways you can get involved: The ACC has launched a grassroots campaign to get Congress involved. Go to www.acc.org/can and send a letter to your members of Congress explaining in detail how 20 to 40 percent cuts will impact your ability to practice medicine. Take part in a video campaign that can be shared with members of Congress, regulatory officials and the public. Upload a 30-40 second video about the impacts of large-scale cuts on your ability to provide patients with the right care at the right time. Email Molly Nichelson at mnichels@acc.org to have it posted for you on ACC Advocacy's YouTube" site. Don't own a video camera? Submit your story via the ACC's online forum, "The Lewin Report." Take part in the ACC's "Cut the Cuts Roadshow" and volunteer to give your own or facilitate an ACC-taped presentation on the implications of the cuts on cardiology to your hospital or practice group. Email qualityfirst@acc.org for more information Get involved with your local Chapter's efforts: this could include volunteering your practice to host a "Cardiologist for a Day" event, writing op-eds and more. Go to www.acc.org/chapters for contact information or email qualityfirst@acc.org Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org or 202-375-5407. elines, as established by our Ethics Committee: www.acc.org/qualityandscience/clinical/consensus/ethics/taskforce5.cfm. June 17, 2009 Lawmakers are scrambling to put health reform ideas on the table. Key House and Senate Committees have released their respective proposals, with the goal of passing the bills before the August congressional recess. The ACC has submitted detailed comments on the proposals and continues to work with leaders in the Senate and House to be sure your interests are protected. Meanwhile, President Obama on June 15 addressed the economic imperative for health care reform in a speech to attendees of the AMA's annual meeting in Chicago. To view the ACC's congressional comments, as well as a statement reacting to President Obama's speech, go to qualityfirst.acc.org. You can also share your thoughts on health care reform and related issues via the ACC's online forum, The Lewin Report. Watch this space for more detailed information. Under the headline "The Right Care at the Right Time Saves Lives," the ACC has launched an aggressive Capitol Hill ad campaign to let policymakers know that cardiologists and their patients must be directly involved in health care reform. The ads will run in Capitol Hill publications, including CongressDaily AM, Roll Call, National Review, National Journal and Politico, over the next several months while Congress considers health care reform options. The ad also will run in Cardiology and the Journal of the American College of Cardiology. To view the ad, visit the Quality First Web site. Chalk one up for the good guys. We applaud the Senate action late last week to pass the "Family Smoking Prevention & Tobacco Control Act." The bill gives the Food and Drug Administration (FDA) the authority to restrict tobacco marketing and sales to youth; requires detailed disclosure of ingredients; allows FDA to require changes to tobacco products; and requires larger, more specific health warnings. The ACC has been a long-time leading advocate for this legislation, working hand-in-hand with the Campaign for Tobacco Free Kids. Special kudos go to FACCs in Alaska who stepped up to secure co-sponsorship of the legislation from Senator Murkowski. As part of our efforts to help you prepare for widespread adoption and use of electronic health records, the College last week sent a paper to HHS National Coordinator for Health Information Technology David Blumenthal, M.D., with our recommendations for defining meaningful physician use of health IT. By law, practices can begin receiving bonus payments for "meaningful use" of health IT starting in 2011. However, what constitutes meaningful use has yet to be defined, so we are sending in our two cents. To view the paper and for more information on how to choose the best EHR for your practice, visit the ACC's Health IT Web site. Cardiac cath lab procedures have fallen by 111 percent over the past two years, according to a recent report by market research firm IMV Medical Information Division. Total patient cases accommodated by U.S. cath labs declined to 3.75 million in 2008, a drop from 4.21 million in 2006. This is in contrast to IMV's 2006 report, which identified a gradual 9 percent increase in patient cases from 3.85 million in 2002. When are expert witnesses a little too "expert?" When they have become "professional expert witnesses" and make their entire living testifying as medical experts. The testimony of these hired guns may not always be objective and unbiased, and they may function as advocates rather than scholars. Part of the reason these folks have a market for their services is because physicians have been reluctant to testify as expert witnesses. It's understandable--physicians may have a distrust of lawyers, uneasiness with the legal system and the process of testifying, or fear of being censured by other physicians. And yet the ACC and other professional associations have all made strong recommendations that it is the duty of physicians to act as expert witnesses in their areas of expertise. With the availability of adequate numbers of physicians willing to act as expert witnesses, the use of the professional expert witness will decrease. If you are directly involved in a case with one of these professional witnesses there is also an ACC process for you to make a report. Check out the following link to the expert witness testimony guidelines, as established by our Ethics Committee: www.acc.org/qualityandscience/clinical/consensus/ethics/taskforce5.cfm. Welcome to the first edition of the ACC Advocate The biweekly newsletter dedicated to the viability of your CV practice. We know you get a lot of stuff from the ACC, but we thought the time was right to give you regular updates about our day-to-day efforts to protect your ability to give the best care to your patients. The Advocate comes in two flavors--email and fax. If you'd like one but not the other, let us know. If you would like neither, let us know. In fact, let us know about anything at all--questions, answers, successes in your practice or your community, topics you want us to cover, things that keep you up at night. Email us at: advocate@acc.org. Fax us at: 202-375-6848. Call us at: 202-375-5407. Speaking of faxes, we don't have that many numbers, especially from practice administrators. Send us yours, please. In the Advocate you'll find coverage of the battle to give you fair reimbursement for your services. And what's more we will send you the latest tips and techniques on practice management to keep more of what you earn. We'll cover the fight on Capitol Hill and in the states to stop wrongheaded attempts by other specialties and lawmakers to restrict your ability to provide appropriate diagnostic services. As soon as we know about coding changes and other regulatory maneuvers, we'll let you know. And we'll give you recommendations on how to make the best of them. We'll cover tort reform, but more than that, we will let you know effective new strategies you can use to reduce your risk. In short, if the College is out there advocating on your behalf, you will hear about it here. So let's get started. Your ACC (again) helped put the brakes on the FTC's new Red Flags rule that classifies doctors as "creditors" because they regularly defer payment for goods and services. If it stands, the rule would require you to develop and implement a written program to protect consumers by identifying potentially suspicious "red flags" that may signal identity theft. The rule is now delayed until August 1, a reprieve that will allow us to continue the fight to exempt your practice. If you want to be extra careful, we recommend you take a look at sample Red Flags Rule documents developed by MGMA (Red Flags Rule Resource Center) and AMA (Red Flags Rule Physician Resources). For more information from your ACC, contact Gretchen Wyatt at gwyatt@acc.org. We've made a request to CMS for coverage for PTA of the carotid artery concurrent with stenting. In a letter cosigned by SCAI and SVM, we urged CMS to expand its coverage policy to allow carotid artery stenting (CAS) in patients who are at increased perioperative risk for carotid endarterectomy (CEA) complications due to currently defined anatomic and comorbid factors and who have either symptomatic carotid artery stenosis of 50-99% or asymptomatic carotid artery stenosis of >/-80%. We expect a decision by July. We'll keep you in the loop. Here is a coding alert. The NCCI removed its restriction on billing the echocardiography "add-on" codes (CPT 93320 and 93325) together. The NCCI accepted your ACC's recommendation to retroactively remove the coding edit and permit medical providers to bill these codes with the appropriate echocardiography CPT code during the same visit on the same day. + 93320 - Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to code for echocardiographic imaging); + 93325 - Doppler echocardiography color flow velocity mapping (List separately in addition to code for echocardiographic imaging) We advise you to resubmit any claims on or after Jan. 1, 2009, denied for using both CPT 93320 and 93325 together. These codes can still be used with congenital, stress, fetal and transesophageal echocardiography. The first real salvo in the national health care reform debate comes from the Senate Finance Committee. Their proposal addresses payment reform options and infrastructure investments to support delivery system reform. This is early in the game, and we won't burden you with pages of minute details here. (Details are available at qualityfirst.acc.org.) Suffice it to say your ACC is going over all proposals with a fine-tooth comb to ferret out any efforts to threaten the viability of your practice. Stay tuned for specific requests for your comments to lawmakers. Take a look at a great article from ACC BOG Chair John Harold in ACC's online forum, The Lewin Report. Dr. Harold writes eloquently about the vital importance of your involvement in state advocacy and gives a terrific example from his home Chapter of California of how partnerships can lead to legislative victories. Read the post in full. If you prefer the "hands-on" approach to advocacy, save the dates of Sept. 13-15 for the ACC's 2009 Legislative Conference at the Fairmont Hotel in Washington, D.C. There is no one better than you to help educate lawmakers about the impact of their policy decisions on your patients and your practice. For more information go to www.acc.org. Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org or 202-375-5407.