If you would like to submit a Bulletin Board topic for consideration for our listing, please contact Jenny White at info@msacc.org. December 2011: News You Can Use ACC and STS Launch New Transcatheter Valve Therapy (TVT) Registry The STS/ACC TVT RegistryTMis a new benchmarking tool developed by the American College of Cardiology (ACC) and The Society of Thoracic Surgeons (STS) to track patient safety and real-world outcomes related to new and emerging transcatheter valve therapy (TVT) procedures. Launched December 1, the TVT Registry is the first national program to evaluate safety and efficacy of a transcatheter valve aortic replacement (TAVR) option for patients who are otherwise considered to be non-operable for conventional valve replacement surgery. The registry was developed in collaboration with the Food and Drug Administration (FDA) and Centers for Medicare and Medicaid Services (CMS) with input from other professional societies including the Society for Cardiovascular Angiography and Interventions (SCAI) and the American Association for Thoracic Surgery (AATS), and trial sponsors from industry. The TVT Registry is governed by a joint Steering Committee with representatives from the STS and ACC selected through each society’s standard selection process. For more information, visit www.tvtregistry.organd read a blog post by ACC President David Holmes about the TVT Registry on the ACC In Touch Blog.   Calling all Medicare providers!  Under the new risk screening criteria required by the Affordable Care Act, Medicare contractors will be alerting providers enrolled in the Medicare program regarding revalidation of their enrollment. The revalidation process has four steps. Upon notification, providers will need to: 1) update enrollment through the online Provider Enrollment, Chain and Ownership System (PECOS) or complete the 855; 2) sign the certification statement on the application; 3) pay any fees through pay.gov;and 4) mail supporting documents and certification statement to their MAC. To help providers better understand and prepare for this process, the Centers for Medicare and Medicaid. You can review the Medicare Learning Network’s fact sheetfor more information.   New Cardiovascular Imaging Section Provides Specialists Opportunity for Involvement American College of Cardiology (ACC) members will have an additional opportunity for involvement with the addition of the new Cardiovascular (CV) Imaging Member Section. CV Imaging Section membership will provide members a forum to advance professional priorities, offer input into the coordination of imaging activities within the College and facilitate networking with peers in their field. Governed by the ACC Imaging Council, the section hopes to represent the cardiovascular imaging community and work with ACC leadership to promote collaboration on issues facing cardiovascular specialists using imaging technologies to provide optimal patient care. As the CV Imaging Member Section grows in its inaugural year, members may establish work groups to address imaging-specific issues related to research, education, quality, guidelines, advocacy and more. Membership is open to physician, cardiac care associate and fellow-in-training members of the ACC. Those interested may join by opting in on their dues statement or calling the Resource Center at (800) 253-4636, ext. 5603. Visit CardioSource.org/Imagingfor more information.   Free AUC Module Software Trial The new Health Outcomes Sciences (HOS) ePRISM® platform serves as the only software solution to embed the Appropriate Use Model and deliver it to clinicians at the point of care. The Appropriate Use Criteria module supplements ePRISM’s existing capacity to support bleeding avoidance therapy, stent choice and to better engage the patient in selecting the best possible treatments. With e-PRISM’s capability to take the complex algorithmic process of classifying an individual patient’s appropriateness for PCI and generate those results at the point of care, it can serve as an invaluable tool for clinicians when and where it matters most.   HOS is offering a free trial of the model for anyone who signs up prior to Dec. 31. Don’t miss the opportunity to view the software and understand how the use of a decision support aid at the point of care can help turn the Appropriate Use Criteria to your organization’s advantage. The American College of Cardiology (ACC) and Health Outcomes Sciences (HOS) have a business relationship designed to use NCDR risk models at the point of care to improve medical decision-making. To learn more, please view the disclosure of the ACC and HOS relationship. For more information, visit h-outcomes.com or call (816) 979-3100.   CardiologyDebuts New Features The Nov/Dec issue of Cardiology magazine's online flipper debuts some exciting new features! In addition to the interesting articles, you can now watch videos and listen to audio files. In this issue: the American College of Cardiology’s (ACC’s) Board of Governors (BOG)recently instated new representatives from the Army, Navy and Air Force to act as liaisons between their respective services and the ACC. The cover story highlights their role and compares the military health system with the traditional practice system. Also in this issue, a commentary from the Veterans Affairs representative to the BOG and a profile of the public health representative. View the newest issue on www.CardioSource.org/CardiologyMagazine and download the new Cardiology app for your iPad.    ACC Joins Campaign to Promote Wise Use of Resources Among Physicians, Patients The American College of Cardiology (ACC) has joined the ABIM Foundation and eight other leading national medical specialty societies in Choosing Wisely. The goal of this campaign is to help physicians, patients and other health care stakeholders think and talk about overuse or misuse of health care resources in the United States. Consumer Reports, the nation’s leading expert, independent, nonprofit consumer organization, has also joined the campaign to provide resources for consumers and physicians to engage in these important conversations.    As part of the campaign, the ACC will develop a list of five common tests or procedures in cardiology whose necessity patients and physicians should question and discuss. The resulting lists will be released in April 2012 and aim to spark discussion about the need – or lack thereof – for many frequently ordered tests or treatments in America.   The Congressional Budget Office estimates that up to 30 percent of care delivered in America goes toward unnecessary tests, procedures, doctor visits, hospital stays and other services that may not improve people’s health – and in fact may actually cause harm. If current trends remain unchanged, the Centers for Medicare & Medicaid Services project U.S. health care spending will reach $4.3 trillion and account for 19.3 percent of the nation’s gross domestic product by 2019.   To learn more about Choosing Wisely,visit www.ChoosingWisely.org.   Last Chance to Save 10% on CPT Guide Efficiently and accurately report cardiovascular services and procedures with the new CPT® Reference Guide for Cardiovascular Coding. Co-published by the American Medical Association (AMA) and the American College of Cardiology Foundation (ACCF), this all-inclusive cardiology coding and reimbursement resource provides a complete overview of the heart, including cardiovascular basics and common ailments. CPT guidelines, explanations of significant recent code revisions and the general intent and use of diagnostic and therapeutic clinical procedures and services will help ensure that providers, administrators and allied health professionals code properly and avoid costly coding mistakes. Order by Dec. 31 and save 10%. Advocate December 14, 2011 SGR bill on the move! The House last night passed the "Middle Class Tax Relief and Job Creation Act of 2011" (H.R. 3630)-- a year-end legislative package addressing the expiring payroll tax, jobless benefits, and more importantly the sustainable growth rate (SGR) and Medicare extenders. Specifically the bill would prevent the 27.4 percent SGR cut from taking effect on Jan. 1 and would provide a 1 percent payment increase in 2012 and 2013. The bill would require MedPAC, the Government Accountability Office (GAO), and the Department of Health and Human Services (HHS) to report to Congress on their research of long-term replacements to the SGR and innovative physician payment models, such as bundled or episode-based payments for congestive heart failure or medical device implantation, during the two years of stable payments. Beyond the SGR, the legislation would extend the current floor used in calculating Medicare physician payments that account for the geographic area where a physician practices through Dec. 21, 2012, and more. Next stop the Senate! The House-passed bill now moves to the Senate for a vote. The Senate leadership has stated that the Senate will not approve the bill as written. Several provisions in the bill are non-starters in the Senate, including reducing funding for the Prevention and Public Health Fund by $8 billion, restarting the Keystone XL pipeline, and shortening unemployment aid. Although things remain very fluid between the House and the Senate, it is expected that the Senate will vote on a revised legislative package including the SGR before Congress adjourns for the holidays. It is important to note that while cuts to advanced diagnostic imaging or other physician services are not included as offsets in this legislative language, they could become relevant should House and Senate leadership disagree on health-care offsets. What you can do: Allowing the 27 percent cuts on Jan. 1 to go through would be devastating to physicians and patients. Your ACC is asking everyone to contact their members of Congress and urge them to come together to agree on legislation that stops the cuts and does not do any further damage to providers. It is time for our elected leaders to take the high road, set aside their differences and come together for the sake of public health. Take action now! Reminder: Don't miss the last PINNACLE Networkwebinar of the year. The ACC is joining with the Office of the National Coordinator, the Centers for Medicare and Medicaid Services and Million Hearts on a special webinar on Dec. 15 at 3 p.m. (ET) addressing the electronic health record (EHR) incentive program and meaningful use. In this era of continued cuts, this is a great opportunity to get your questions answered by experts on how to successfully participate in the EHR program. Register at CardioSource.org/webinars. Advocate December 6, 2011 SGR call to action: Without further action from Congress, Medicare physician payment will be cut 27.4 percent on Jan. 1. In addition to the pending SGR cuts, it is important to note that further payment cuts and prior authorization for imaging services were discussed during deficit committee negotiations and could be used to pay for any Medicare bill. Your ACC is asking all members to contact their representatives and senators and urge them to protect patient access to care by enacting a long-term solution to the SGR and opposing further payment cuts to medical imaging. Cardiovascular professionals that provide imaging services need to stress that further payment reductions for imaging services cannot be absorbed by physician practices without impacting access to high quality care. Even if you have already contacted your lawmakers this year, this week is critical for building pressure for the best possible SGR agreement. There are two ways to take action: Call the AMA Grassroots Hotline at (800)-833-6354. Use the ACC's grassroots advocacy system to send a letter to your respective lawmakers. Be sure to personalize the draft letter. Creating a RACket ...The last edition of the Advocate reported on the announcement by the Centers for Medicare and Medicaid Services (CMS) of three RAC demonstration projects to be conducted in 11 states, one of which includes prepayment review of inpatient hospital claims. Your ACC is very concerned about the limited information available, as well as the implications of these programs, and has spoken with CMS about these concerns. ACC staff has also emphasized the need for CMS to work with professional societies like the ACC to educate and inform physicians. To date, CMS has not determined which DRGs the RACs will focus on for the prepayment review project, but noted that reviews will be conducted on only a subset of claims. Your ACC will continue to monitor developments on the RAC demonstrations and will advocate for fair treatment of all providers. Stay tuned to the Advocate for more information as it becomes available. Florida Update:Independent of the newly announced RAC demonstration project, First Coast Service Options (FSCO), the Medicare Administrative Contractor (MAC) for Florida, Puerto Rico and the U.S. Virgin Islands, will begin a program of prepayment review of 100 percent of hospital inpatient claims for 15 cardiovascular and orthopedic DRGs. If, after review of documentation the inpatient claim is denied, FSCO will conduct post-payment review of physician claims related to the admission and may demand repayment. Only providers in Florida are affected. The ACC's Florida Chapter is actively engaged and advocating for members in Florida. Read more about the FSCO project. Don't miss this "Meaningful" webinar!The ACC's PINNACLE Network is sponsoring a webinar on Thursday, Dec. 15 from 3-4 p.m. ET entitled, "Enhance your Practice and Make Quality Count: Invest in Health IT." Tune in to learn about the evolving role of health information technology within the health care industry and how electronic health records (EHRs) can impact your medical practice. Additionally, the panel will discuss current key issues under consideration for Stage 2 Meaningful Use. Please join Michael Mirro, MD, FACC, Joshua Seidman, PhD, Office of the National Coordinator, Robert Anthony, Centers for Medicare and Medicaid Services, and Janet Wright, MD, FACC, Million Hearts Campaign, for this informative webinar. Register now. Will You Be Accredited by Jan. 1?All Nuclear Medicine, PET, MRI or CT facilities affected by the CMS deadline for MIPPA are required to be accredited by Jan. 1 in order to qualify for reimbursement. If you have not yet submitted your completed application, your ACC and the Intersocietal Accreditation Commission (IAC) urge you to do so immediately. Although submitting today will not allow the IAC sufficient time to process your application in order to meet the January deadline, it does bring your facility one day closer to achieving your accreditation and ensuring reimbursements. December 6, 2011: Archive of All Member Webinar: 12/1/2011 If you were unable to participate in the PINNACLE All Member Webinar on December 1, please click the link below to access the archived recording.  http://eventcenter.commpartners.com/se/Meetings/Playback.aspx?meeting.id=800171 For additional information and webinars, please visit: http://www.cardiosource.org/Science-And-Quality/Quality-Programs/PINNACLE-Network.aspx Register now for the upcoming PINNACLE network webinar! Enhance your Practice and Make Quality Count: Invest in Health IT. December 15 at 3:00 - 4:00 PM ET. Tune in to learn about the evolving role of health information technology within the healthcare industry and how Electronic Health Records (EHR) can impact your medical practice.  Additionally, the panel will discuss current key issues under consideration for Stage 2 Meaningful Use.  Please join Michael Mirro, MD, FACC, Joshua Seidman, PhD, Office of the National Coordinator, Robert Anthony, Centers for Medicare and Medicaid Services and Janet Wright, MD, FACC, Million Hearts Campaign for this informative webinar.  Click to register now!  Advocate November 17, 2011 Next week is expected to be "super" ...The special congressional Super Committee, designated to identify recommendations for further reduction of the U.S. budget deficit, is required to release its recommendations and hold a vote by Nov. 23. There is currently no indication of what will be in the recommendations, particularly as they relate to the College's priorities of fixing the Sustainable Growth Rate formula, protecting medical imaging and addressing medical liability reform. A special Advocate will be sent as soon as any recommendations are released. A final vote count will also be included on CardioSource.org/Advocacyas soon as it is available. In addition, the ACC's PINNACLE Network and Advocacy staff are holding a special webinar on Dec. 1 from 7-8 pm (ET) to discuss the Super Committee outcome and answer any member questions. Registration for the webinar is available at CardioSource.org/Webinars. Update from the Hill:Legislation to eliminate the 3 percent tax withholding on Medicare payments was approved by Congress and is expected to be signed into law by the President. Without this action by Congress, the Internal Revenue Service would have required Medicare contractors to withhold 3 percent of Medicare payments to physicians and other health care providers until the following tax year. HOPP on over to CardioSource ...The Centers for Medicare and Medicaid Services (CMS) has released the 2012 Hospital Outpatient Prospective Payment System (HOPPS) final rule. Your ACC has prepared a high-level overview of the provisions within the rule of importance to cardiovascular professionals. Get the details. A focus on fraud and abuse:CMS recently announced two new demonstration programs designed to root out fraud and abuse that may impact cardiovascular specialists. The Recovery Audit Prepayment Review program will rely on Recovery Audit Contractors (RACs) to conduct prepayment claims reviews to assist in lowering the improper payment rate and to identify potential fraud and abuse in Medicare. Initially, the demonstration will focus on inpatient hospital claims, particularly short stays, based on CMS data illustrating a high improper payment rate. Eleven states (CA, FL, IL, LA, MI, MO, NY, NC, OH, PA and TX) will be included in this program. The Part A to Part B Rebilling Demonstration program will focus on inpatient billing for services that should have been performed in the outpatient setting and billed under Medicare Part B, rather than Part A. Under the demonstration program, providers will be able to resubmit claims denied under Part A for wrong place of service, provided the service would have been considered reasonable and necessary had it been billed properly initially. Medicare will pay the provider 90 percent of the Medicare Part B allowable in exchange for agreeing to waive appeal rights. Both of these programs are slated to last three years, beginning on Jan. 1, 2012. A third program requiring prior authorization for power mobility devices, was also announced but is expected to have little to no impact on cardiology practices. Your ACC is very concerned about the limited information available, as well as the implications of these programs, and has reached out to CMS to discuss these concerns. Stay tuned to the Advocate for updates and more information as it becomes available. What do you want to know about Meaningful Use?Your ACC is working with CMS and the Office of the National Coordinator for Health Information Technology (ONC) to develop two webinars devoted exclusively to how cardiologists can participate in the Electronic Health Record (EHR) Incentive Program. While the details and logistics are still being finalized, we need your help in identifying any questions or concerns you would like to have answered related to the EHR program. Please send your questions to advocate@acc.org. More details on dates will be included in the next Advocate. Mark your calendars!Don't miss the final webinarin the PINNACLE Network/Paragon Health series on Nov. 29 at 4 pm (ET) focused on aligning incentives through co-management models. In addition, archived versions of the five previous webinars are available on the PINNACLE Network webpage. In addition, the PINNACLE Network and ACC Advocacy are holding a special webinarfocused on preparing cardiovascular professionals for new 2012 coding changes, which will take place on Nov. 30 at 3:30 pm (ET). November 17, 2011: Update on Medicare Administrative Contractors Medicare is transitioning to regional Medicare Administrative Contractors (MACs) from statewide carriers.  The parts A and parts B will be administered by the same carrier.  The contract to administer Medicare in Mississippi and several other states in the new MAC region has been awarded to Highmark Medicare Services.  Look for more information on this change in the coming months.  All of this is to be more cost efficient hopefully.  We will continue to have a state representative to the Carrier Advisory Committee meetings which occur periodically to review various determinations for reimbursements policy as Medicare sees fit.  Some of these reviews involve cardiology issues but many do not.  The issue with the MAC in Florida and some other states in the MAC region involves review of certain inpatient charges.  This is a demonstration project and does not involve our state and would not involve us until data has been collected and decision made as to whether or not this should be done in other parts of the country.  This process would probably take a couple of years and already is meeting serious objections from those states involved.  Please continue to visit our website for updated information.  The ACC is monitoring this situation on an ongoing basis and is helping in the objections to Medicare regarding this project. November 15, 2011: ACC Breaking News BREAKING NEWS: CMS has awarded Jurisdiction H A/B MAC to Highmark Medicare Services, Inc. in the amount of $406,473,150.  As you will remember, this jurisdiction was the merger of former Jurisdiction 4 (Oklahoma, Texas, Colorado, and New Mexico) and Jurisdiction 7 (Arkansas, Louisianan, and Mississippi).  The Jurisdiction 4 incumbent is TrailBlazer and Jurisdiction 7 was never successfully awarded, with the workload currently being processed by Cahaba (Mississippi Part B) and Pinnacle (the remainder of the workload).   The RFP for this contract was released March 4, 2011 and proposals were submitted April 12, 2011.  This contract represents 13.2% of the national workload.  Highmark is currently the Jurisdiction 12 A/B MAC, which is 10.9% of the national workload.  Following is the link to the award notice posted this afternoon on FedBizOpps: https://www.fbo.gov/index?s=opportunity&mode=form&tab=core&id=2269b7c3fd74261272b892833c229133&_cview=0 November 7, 2011: ACC News You Can Use FDA Approves SAPIEN Transcatheter Heart Valve The Food and Drug Administration (FDA) has announced approval of the Edwards Lifesciences SAPIEN Transcatheter Heart Valve. This is one of several devices in development for use in the emerging field of transcatheter aortic valve replacement (TAVR). In announcing the decision, the FDA also noted that Edwards Lifescience will continue to evaluate the outcomes of the SAPIEN transcatheter heart valve through a national Transcatheter Valve Therapy (TVT) Registry that will track patient safety and real world outcomes related to emerging TAVR procedures. The American College of Cardiology and the Society of Thoracic Surgeons have been working with the FDA and the Centers for Medicare and Medicaid Services in the development of this new registry, called the TVT RegistryTM, which is scheduled to launch in late 2011. It will be the first national program to evaluate safety and efficacy of a TAVR option for patients who are otherwise considered to be high-risk or non-operable for conventional valve replacement surgery. For more on the announcement and what this means for TAVR, click here.   2012 Physician Fee Schedule Final Rule Released The Centers for Medicare and Medicaid Services released the final 2012 Medicare Physician Fee Schedule on Nov. 1.  This final rule, which sets payment levels and other associated policies for next year, includes a number of issues important to cardiology. On a broad scale, the rule cuts payments to cardiologists by an average of 2 percent depending on the mix of services provided. It also includes the mandated 27.4 percent cut in overall Medicare payments as a result of the sustainable growth rate formula, or SGR. This cut will take effect on Jan. 1, 2012without congressional action. Other payment adjustments of note: a 29 percent reduction in payment rates for the replacement of pulse generators on pacemakers and ICDs, as well as a 25 percent reduction in payment rates for the professional component of advanced imaging services  provided by the same physician on the same day. CMS had initially proposed slashing the imaging payment rates by 50 percent, but changes its mind as a result of advocacy efforts by the ACC and others.  Learn moreinformation about the Final Rule, including policy implications relating to e-prescribing and the physician quality reporting system.  A special webinar to discuss the coding changes included in the final rule is scheduled for Nov. 30. Registration is open at CardioSource.org/webinars. In addition, providers can also pre-order the 2012 CPT Reference Guide for Cardiovascular Codingand save 10 percent.   Don’t Ignore RUC Surveys! Annual updates to the physician work relative values are based on recommendations from a committee involving the AMA and national medical specialty societies—the RUC. The RUC is an expert panel of the AMA and specialty societies charged with developing relative value recommendations to Medicare. A key part of the RUC processis the completion of relative value surveys. Data from these surveys are used to establish the physician work that determines Medicare reimbursement. This November, surveys will be distributed related to percutaneous coronary intervention, ablation, and extremity artery/vein ultrasound. If you are randomly selected and receive a survey, please take 15-20 minutes to thoughtfully complete it. Contact James Vavricek at the ACC at 202-375-6421 or jvavricek@acc.orgif you have questions or would like to receive a survey.   ACC In Touch Blog: Opening Doors for CHD Patients The lack of continuous care for congenital heart disease (CHD) patients who are transitioning from the pediatric to adult care settings has been a concern for adult cardiology practices. Enhancing collaboration between a coordinated care team, to include congenital heart specialists, and CHD patients would open the doors to consistent and efficient treatment. In an ACC In Touch Blog post, Michael Mansour, MD, FACC, Mississippi governor and member of the Coding Task Force shares what he thinks is the essential information patients should easily be able to provide their cardiologists upon an initial visit, which includes initial diagnosis, operations chronologically with institution and surgeon, all operative notes and most recent diagnostic studies and results. He points to the ACC’s Adult Congenital and Pediatric Cardiology (ACPC) Sectionand the NCDR’s IMPACT Registry™(IMproving Pediatric and Adult Congenital Treatment) as advocates for improved treatment in CHD patients. Readthe full blog and look for the Nov./Dec. issue of Cardiology magazine for an article on ACHD.   Significant Downward Trend in Hospitalization for Medicare Beneficiaries With HF Overall heart failure (HF) hospitalization rates among Medicare patients has declined significantly since 1998, with the overall one-year mortality rate also declining slightly over the past decade, according to a new study published in the Journal of the American Medical Association (JAMA). Considered the largest study to date examining trends in HF hospitalization rates across the United States, it showed heart failure hospitalizations dropped nearly 30 percent between 1998 and 2008. The study authors attributed the decline to fewer individual patients being hospitalized with HF rather than a reduction in the frequency of HF hospitalizations. Other findings included: black men had the lowest rate of decline for HF hospitalization among those studied; despite the decline over the past decade the one-year mortality rate remains high – 31.7 percent in 1999 and 29.6 percent in 2008; one-year mortality rates declined significantly in four states but increased in five states. This study comes on the heels of a paper published earlier this year showing significant improvements in D2B times. To learn more about this study and to access a link to the full article, read the CardioSource journal scan.    American College of Cardiology Launches PINNACLE-AF The American College of Cardiology (ACC) is expanding the PINNACLE Registry, with a new platform focusing on atrial fibrillation and including the next generation of anticoagulants. The new platform, PINNACLE-AF, will operate within the existing PINNACLE Registry, the largest cardiovascular outpatient database in the U.S., and part of the ACC’s National Cardiovascular Data Registry (NCDR). NCDR is the most comprehensive, outcomes-based cardiovascular patient data registry for quality improvement in the United States. PINNACLE currently has 2.1 million patient records representing valid patient encounters from hundreds of outpatient practices nationwide. Of those patients, over 100,000 have atrial fibrillation. Participation in the Registry is free to all cardiology practices. For more information about the PINNACLE Registry and PINNACLE-AF, visit www.PINNACLEregistry.org.   PINNACLE Network/Paragon Health Webinar Series to Focus on Advancing the Business of CV Care The ACC’s PINNACLE Network is partnering with Paragon Health to present a six-part webinar series focused on "Advancing the Business of Cardiovascular Care." The webinars, all of which will take place from 4-5 p.m. (ET), are free to ACC members and will feature key health care and/or physician leaders addressing hot topics related to the evolving models of cardiovascular practice. The final two webinars on Nov. 8 and Nov. 29 will focus on optimizing revenue cycle management and aligning incentives through co-management models, respectively. Archives of the four earlier webinars are also available. Learn more at CardioSource.org/PINNACLE Network. Advocate November 1, 2011 Breaking news! The Centers for Medicare and Medicaid Services (CMS) today released the final 2012 Medicare Physician Fee Schedule, which sets payment levels and other associated policies for next year. This wide-ranging rule covers a number of issues of importance to the cardiovascular community. As required by current law, physicians will receive a 29.5 percent cut in overall Medicare payments, barring any Congressional action. (Read more on this topic in a new blog postby ACC CEO Jack Lewin, MD.) Outside of the legally mandated cuts associated with the SGR, the rule is estimated by CMS to have a -2 percent impact on payments to cardiologists. However, individual impacts will differ substantially based on the mix of services provided by a practice.   The rule includes the following items related to payment for specific cardiovascular services: Physicians will no longer report separate removal and replacement codes when replacing pulse generators on pacemakers and ICDs and will instead report a single code for the combined service. The result of these coding changes and subsequent valuation efforts is an approximately 29 percent drop from current rates of payment. Payment rates for the professional component of advanced imaging services (CT, MR, ultrasound) provided by the same physician on the same day will be reduced by 25 percent for the second service. CMS had proposed to reduce these payments by 50 percent in the proposed rule released in July – a cut that was strongly criticized by your ACCand other organizations. However, CMS indicates that it will consider reductions for other services provided by the same physician on the same day in the future. The rule also details a series of policies that will help to determine payment adjustments in the future. Highlights include: Physicians who did not report electronic prescribing in the first half of 2011 or who do not file a hardship exemption by Nov. 8will receive payments that are 1 percent lower than indicated by the physician fee schedule. Physicians who successfully reported their use of e-prescribing in 2011 will avoid a penalty in 2013. Those who did not successfully report in 2011 can avoid the 2013 penalty by reporting e-prescribing at least 10 times between Jan. 1, 2012 and June 30, 2012. Physicians successfully participating in the Physician Quality Reporting System (PQRS) will receive a 0.5 percent bonus on all Medicare payments for 2012. This bonus will continue the next two years and transition to a penalty in 2015. However, the penalty in 2015 will be based on 2013 participation, similar to the e-prescribing penalty. Cardiologists will be required to report on at least one "core measure" rather than being able to select from all available measures. CMS has begun to finalize details related to the planned expansion of public reporting of physician quality and the use of performance data to adjust payment starting in 2015. The ACC will continue to work with CMS throughout the year to ensure that decisions made by the agency continue to allow access to high quality cardiovascular care. MS-ACC Newsletter: Heart of the Matter November 1, 2011 We had an excellent chapter event in Jackson on October 11 at the MS Sports Museum in collaboration with our colleagues at the MS Chapter of the American College of Physicians.  Dr. Tracy Wang from Duke University and Dr. Tom Skelton from the University of MS were our program speakers.   We plan to have another chapter event on Saturday February 18, 2012 at the Beau Rivage in Biloxi from 6-8pm.  We will have a guest speaker and dinner.  I hope many of you can attend especially all of you from the coast and south MS.  Registration information is available online, on the events page.    Important matters are at hand with upcoming elections and I hope all of you will support candidates that are in touch with issues important to our patients and our practices.  Please make your views and priorities known to your state and national legislators.   Medicare Payment Advisory Commission (Med PAC) recently recommended replacing the sustainable growth rate (SGR) with a Medicare payment model that would freeze payments to primary care physicians over the next 10 years while reducing payments to all other physicians by 5.9% per year between 2012 and 2014.  These cuts would be followed by a seven year freeze in Medicare payments to these other physician specialties.  The ACC strongly opposes MedPAC’s SGR plan.  A letter opposing the Med PAC plan has been introduced by Representative Michael Burgess, M.D. (R-TX) and Representative Gene Green (D-TX).  Ask your congressional representative to sign on to the Burgess/Green letter to MedPac regarding SGR cuts.   The ACC also supports TORT reform measures and opposes any further cuts in imaging as part of any plan to replace the SGR with a more acceptable reimbursement formula.   The ACC needs your help with upcoming RUC surveys due in November. If you receive a survey please take the time to complete it.    RUC Surveys are used to determine the Relative value of procedures cardiologists perform.  This information is then used by medicare to determine reimbursement for procedures.  The November surveys will be distributed related to the PCI ablation and extremity artery/vein ultrasound.  If you are randomly selected to receive a survey, please take 15-20 minutes to thoughtfully complete it.  Contact James Vavricek at 202-375-6421 or jvavricek@ace.orgif you have questions or would like to receive a survey. October 7, 2011: ACC News You Can Use ACC Submits Comments on Proposed 2012 Medicare Physician Fee Schedule The ACC submitted formal comments to the Centers for Medicare and Medicaid Services on its proposed 2012 Medicare Physician Fee Schedule. The letter addresses coding of certain services; expansion of the multiple procedure payment reduction policy; physician quality reporting (including future payment adjustments under the Physician Quality Reporting System); Maintenance of Certification program incentives; e-prescribing; and the Physician Compare website. Readthe full letter. The final rule is expected in late October.   VIDEO: October ACC Update Looks at Reduced D2B Times, Payment Innovations and More The latest edition of ACC Update focuses on the stunning improvements in door-to-balloon (D2B) times for patients undergoing percutaneous coronary intervention following an acute myocardial infarction. In addition, ACC CEO Jack Lewin, MD, and health care economist Len Nichols, PhD, discuss payment innovations in health care, including the ACC’s new Community on Payment Innovation led by Nichols. The video also looks at the future of lifelong learning and membership opportunities. Watch the complete video.   New Online Community Focuses on Payment Innovations The American College of Cardiology (ACC) and the American Journal of Managed Care (AJMC) have launched a new online “Community on Payment Innovations,” funded by Johnson & Johnson, with the goal of bringing together a unique combination of key stakeholders to advance the payment reform debate, encourage innovation and collaboration, and share best practices and lessons learned. This group, led by health care economist Len Nichols, PhD, will discuss new and innovative payment models to improve the health care system by bending the cost curve, with the Patient Protection and Affordable Care Act as the backdrop. The cardiovascular community, physicians, providers, practice administrators, health policy professionals, health care economists, federal and state governments, early innovators, payers and other health care stakeholders are encouraged to participate in the discussions.     Cardiologists on the EMR incentive uptake Fifty-five percent of cardiologists who responded to an American College of Cardiology(ACC) survey are either participating or plan to participate in the Centers for Medicare and Medicaid Services’ (CMS) Electronich Heatlh Record (EHR) Incentive Program. Thirty-four percent have already registered, according to the survey published in the College’s Cardiologymagazine. CMS reported that in July, cardiology was the third highest specialty to participate in EHRs. The ACC's July survey of a 152 randomly selected panel of members found that 34 percent of participants reported that they have registered for the EHR Incentive Program, and about half of that group—18 percent of total respondents—have met the requirements for the program and have attested to doing so. Read more about this topic in Cardiovascular Businessand in Cardiologymagazine.   HHS Approves Plan to Screen All Newborns for Congenital Heart Defects U.S. Department of Health and Human Services Secretary (HHS) Secretary Kathleen Sebelius approved the Secretary's Advisory Committee for Heritable Disorders in Newborns and Children recommendation to add a screening for critical congenital heart defects to the recommended universal screening panel. This means that all children born in the U.S. will be screened for congenital heart defects within the first 48 hours of life using pulse oximetry. The American College of Cardiology, along with other members of the congenital heart disease community, played an important role in making this a reality.   ACC IN TOUCH BLOG: Next Steps for Reducing PAD Prevalence The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) released updated guidelinesfor the diagnosis and management of peripheral artery disease (PAD). The updated document provides agreed-upon approaches and treatments for PAD that clinicians can apply to help improve patient care. The guidelines include expanded criteria for using the ankle-brachial index (ABI) for earlier diagnosis; increased efforts to ensure all patients have access to smoking cessation services, improved use of clot-preventing medications, as well as a more focused definition of effective interventions for avoiding limb amputations and treating aortic aneurysms. In an ACC In Touch blog post, Thom Rooke, MD, FACC, and Alan T. Hirsch, MD, FACC, chair and vice chair of the PAD Guidelines Writing Committee, respectively, called the guidelines a road map to greater prevention opportunities, which will be necessary if we are to reduce the number of people needlessly affected by PAD. Read more on the ACC In Touch blog.     PINNACLE Network/Paragon Health Webinar Series to Focus on Advancing the Business of CV Care The ACC’s PINNACLE Network is partnering with Paragon Health to present a six-part webinar series focused on "Advancing the Business of Cardiovascular Care." The webinars, all of which will take place from 4-5 p.m. (ET), are free to ACC members and feature key health care and/or physician leaders addressing hot topics related to the evolving models of cardiovascular practice. Registration is open for the three remaining webinars. In addition, archives of the previous webinars are also available. Register today at CardioSource.org/Webinars!   Cardiovascular Service Line: Building a Foundation for Success- Understand the key elements for achieving alignment across the hospital and practice to bridge siloes and transform from a product line to a CV enterprise. (Oct. 18) Private Practice Success Strategies: How to Optimize Revenue Cycle Management- Focus on the best practices necessary for developing a meaningful revenue cycle management function within physician practices and learn what common pitfalls to avoid. (Nov. 8) Aligning Incentives Through Co-Management Models- Understand the key elements of clinical co-management structures through case study presentations and expert commentary. (Nov. 29) Early Bird Registration is Now Open for ACC.12 The American College of Cardiology’s 61st Annual Scientific Session & Expo reflects the College’s passion for science, education and peer-to-peer networking. ACC.12 in Chicago will highlight the ACC’s focus on lifelong learning and practice improvement, and will feature a new learning pathway structure to better address the needs of cardiovascular professionals round the globe. New this year: ACC.12 will officially kick off with the opening session at 8 a.m. on Saturday, March 24, and will close on Tuesday, March 27, at noon with a brand new ACC.12 Innovators session featuring the top leaders in cardiology. Register by November 8 for special early bird registration rates and the best availability of hotels. For more information visit www.accscientificsession.org.   New Spanish Language Patient Education Video on Cardiac Rehab In collaboration with CardioSmart, the Coalition to Reduce Disparities in Cardiovascular Outcomes (credo) has released a Spanish-language patient education videoextolling the benefits of cardiac rehabilitation.  Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, the National Alliance for Hispanic Health, the National Hispanic Cardiology Leadership Network and the Preventive Cardiovascular Nursing Association, the video highlights barriers to enrollment and completion of cardiac rehab and how patients overcome such barriers through vignettes of three cardiac rehabilitation program enrollees. Email credo@acc.orgto request a free DVD copy. MS-ACC Newsletter: Heart of the Matter September 27, 2011 We are back!  After change of our administrative personnel who help to get this letter out we are back in full active mode.  We are working with Jenny White and Charmain Kanosky at MSMA.  I know the Chapter will benefit greatly from their administrative expertise and  from the synergism of working with MSMA.   In an effort to actively engage our members around the state we will try to have several meetings around the state for educational and improved communication purposes.  Our most immediate meeting will be at the MS Sports Museum on Tuesday October 11 with dinner at 6:30pm and meeting on atrial fibrillation to follow.  We have invited members of the MS Chapter of the ACP to join in this meeting.  I hope you can take the time to be with us.  I know you will enjoy the evening.  Please RSVP to Jackie Massey jmassey@acc.orgby  Friday September 30 since seating is limited and a head count for dinner is required.  The dinner and program are complimentary.   Dr. Thad Waites, Chair of the Board of Governors, American College of Cardiology and I recently attended the ACC Legislative Conference in Washington, D.C. to represent the interests of our Chapter and the College to members of Congress.  There is general consensus that the SGR must be dealt with in a definitive way this year.  The debate is how to offset the cost of doing away with the SGR cuts due in January 2012.  Tort reform represented in congressional bill HR5 by Rep. Phil Gingrey(R-GA) and co- sponsored Rep. Gregg Harper (R-MS) could account for 200 billion of the 300 billion dollars needed according to the Congressional Budget Office.  We will see if this gets traction going forward. Another topic of great interest to all of us and promoted at the conference is the use of AUC (appropriate use criteria) for imaging as a better way to control cost through best practice rather than the inefficient RBM (radiology benefits manager) used by many payers.  The College has developed the FOCUS program for all of us to use in this regard.  It has been adopted as the method of choice to guide reimbursement in Delaware and will likely become more prominent in guiding reimbursement in a rational evidenced based way with regards to imaging utilization.  Please look at FOCUS at the Cardiosource website and see if it would be helpful to your practice. Advocate September 15, 2011 Heard on the Hill... The ACC's 20th Annual Legislative Conference ended yesterday with more than 350 participants descending on Capitol Hill to meet with lawmakers on repealing the flawed sustainable growth rate formula, preventing further cuts to medical imaging services and including medical liability reform provisions in recommendations to the "Budget Super Committee." By all accounts, members of Congress were receptive to these meetings and these issues will continue to be top priorities for ACC Advocacy moving into the fall. For those who weren't able to attend the conference, highlights including video, photos, ACC in Touch Blog coverage and slides, are posted on the Legislative Conference website. In addition, an easy way to help ensure the voice of cardiology is heard on Capitol Hill is to get involved with the ACC Political Action Committee. To learn more about the ACC PAC visit the website, or email Lucas Sanders at lsanders@acc.org. A "FOCUSed" model for success? In what is hoped to be a model for other states when it comes to ensuring appropriate use of medical imaging, the Delaware Insurance Commissioner announced on Sept. 13 that Blue Cross Blue Shield of Delaware (BCBSD) will support physician use of the ACC's FOCUS: Cardiovascular Imaging Strategies tool to make decisions about certain diagnostic imaging tests. Under the agreement, BCBSD will pay for Delaware physicians to use the online tool, which allows local physicians to consistently apply appropriate use criteria to determine when patient tests are needed. Importantly, the program also provides feedback reports on the patterns of appropriate use to physician practices and health plans. FOCUS participants then use the reports to complete action plans and share best practices. Get the details! Let's save one million hearts! ACC leaders this week attended the launch of the Department of Health and Human Services' (HHS) exciting new Million Hearts initiative aimed at preventing one million heart attacks and strokes over the next five years. The public/private program is focused on empowering Americans to make healthy choices such as preventing tobacco use and reducing sodium and trans fat consumption, as well as improving care by encouraging a targeted focus on aspirin, blood pressure control, cholesterol management and smoking cessation. Your ACC has been a long-time supporter of the very issues being addressed by this program and is excited about the opportunity to support this effort through the CardioSmart National Care Initiative, as well as through continued efforts to encourage the adoption and use of point-of-care tools and data registries. Read more. An innovative new community! In the current debate over how to achieve the "triple aim" of better health care quality, better health, and lower costs, payment system reform emerges as one of the central issues that must be addressed. While most would agree that any new payment system (or systems) needs to move away from rewarding volume and instead reward value; how best to do this remains the question. The ACC's new online Community on Payment Innovations -- a partnership with the American Journal of Managed Care, with funding from Johnson & Johnson -- aims to provide a forum where key stakeholders can come together to answer this question and advance the payment reform debate. Learn more about the community at CardioSource.org/PaymentInnovations. Get out your party hat! This week is National Health Information Technology (IT) Week, and the ACC is ready to celebrate. The ACC is partnering with HIMSS on this event to highlight the importance of efficient information systems that protect personal health information while improving the delivery of health care in the U.S. Its purpose is to raise national awareness regarding the consistent breakthroughs and hard work industry professionals, providers, and consumers put forward on a daily basis to ensure they are moving toward the common goal of advancing the future of health care through health IT. ACC's health IT efforts support the use and adoption of technology to promote quality in cardiovascular care. Learn more about selecting an electronic health record (EHR), federal incentive programs for e-prescribing and meaningful use of EHRs, and ACC policy and activities related to health IT. 2010 PQRS payments are in the mail. The Centers for Medicare and Medicaid Services (CMS) has announced that distribution of payments for the 2010 Medicare Physician Quality Reporting System (PQRs) is scheduled to be completed by Sept. 30. Learn more about the 2010 PQRI Incentive Payments on the CMS website. Advocate August 23, 2011 A quality success story! A new study published this week in Circulation shows that median door-to-balloon (D2B) times for patients undergoing percutaneous coronary intervention following an acute myocardial infarction have declined from 94 minutes in 2005 to 64 minutes in 2010. The improvements represent a more than 30 percent decline in D2B times based on Centers for Medicare and Medicaid Services data from Jan. 1, 2005, to Sept. 30, 2010. Read the journal scan! The study highlights the important role that ACC's D2B Alliance had on improving times by promoting the integration of proven strategies into practice. Launched in 2006, the D2B Alliance has grown to include more than 1,000 hospitals (including several internationally). ACC Chapters across the country played a critical role in garnering hospital participation in the program. According to the paper authors, the improvement in D2B times "demonstrates the results that can be produced by collaboration among health care professionals, hospitals, federal research agencies, and national organizations interested in patient care toward the achievement of a shared goal." Read a special ACC in Touch Blog post on this topic by study author Harlan Krumholz, MD, FACC. The authors go on to highlight that the collaboration should serve as a template for future quality efforts. For example, the level of care demonstrated by the D2B study's findings suggest that registry participation combined with dedication to programs like D2B leads to substantial improvements in the quality of care delivered. By measuring patient care in an appropriate and actionable way, registries bring to light the invaluable improvements being made by physicians and clinical care teams. Your ACC will be highlighting this point in its advocacy efforts, particularly during Legislative Conference in September. More Coverage: "Hospitals are much faster at opening blocked arteries for heart attack patients, study finds," AP/Washington Post "More Heart-Attack Patients Are Getting Treated Quickly," Wall Street Journal Advocate August 11, 2011 It's been a busy week for the Food and Drug Administration (FDA)! ACC President David Holmes, Jr, MD, FACC, yesterday represented the College at an FDA Medical Devices Advisory Committee panel meeting regarding pre-market approval of Edwards Lifesciences SAPIEN Transcatheter Heart Valve. Leaders from the Society for Thoracic Surgery (STS) and the Society for Cardiovascular Angiography and Interventions (SCAI) also spoke. Holmes provided well-received comments on behalf of the ACC that highlighted the issues outlined in the recent ACC/STS societal overview on transcatheter valve therapy (TVT). He also stressed the benefits of using clinical data repositories like the NCDR to document and optimize outcomes in patients, as well as identify areas that need to be changed or improved going forward. Following the hearing, the panel voted on three main questions. In general the committee agreed there was "reasonable assurance" that the SAPIEN Transcatheter Heart Valve was safe and effective for patients meeting specified criteria. They also agreed the benefits to these patients outweighed the risks. The next step is FDA approval. Your ACC has prepared a detailed summary that includes links to the official statements, more information on the specific committee questions, and background information on the PARTNER trial and ACC/STS efforts related to TVT. Future updates, including a video interview with Holmes and STS President Michael Mack, MD, FACC, will be posted here as well. Also yesterday, the FDA announced approval of the anti-platelet drug ticagrelor for patients with acute coronary syndromes (ACS). A boxed warning to health care professionals and patients warns that aspirin doses above 100 milligrams per day decrease the effectiveness of the medication. It also notes that, like other anti-platelet agents, ticagrelor increases the rate of bleeding and can cause significant, sometimes fatal, bleeding. Your ACC will be working with the American Heart Association to incorporate ticagrelor into future guidelines. Learn more about the decision. Meanwhile, the FDA's Circulatory System Devices Panel of the Medical Devices Advisory Committee is meeting today in response to the request for a humanitarian device exemption of Berlin Heart, Inc., for its EXCOR Pediatric Ventricular Assist Device (VAD). Your ACC submitted written comments for the record, highlighting the importance of device manufacturers venturing into the field of pediatric devices, given the limited number of treatment options for pediatric cardiology patients in need of a bridge to transplant. The comments note that both of the current options – Extracorporeal Membrane Oxygenation (ECMO) and maximal medical therapy – have severe time limitations making them less than ideal. While the literature documents potential risks to the implantation of VADs in the pediatric population, it also indicates opportunities to extend the time limits of therapy beyond ECMO and maximal medical therapy as children wait for a new heart. The comments urge the FDA to "encourage Berlin Heart and other device manufacturers to develop additional pediatric cardiology devices that appropriately treat the needs of this special population." Read the full testimony. Advocate July 21, 2011 It's been a busy week for the Food and Drug Administration (FDA)! ACC President David Holmes, Jr, MD, FACC, yesterday represented the College at an FDA Medical Devices Advisory Committee panel meeting regarding pre-market approval of Edwards Lifesciences SAPIEN Transcatheter Heart Valve. Leaders from the Society for Thoracic Surgery (STS) and the Society for Cardiovascular Angiography and Interventions (SCAI) also spoke. Holmes provided well-received comments on behalf of the ACC that highlighted the issues outlined in the recent ACC/STS societal overview on transcatheter valve therapy (TVT). He also stressed the benefits of using clinical data repositories like the NCDR to document and optimize outcomes in patients, as well as identify areas that need to be changed or improved going forward. Following the hearing, the panel voted on three main questions. In general the committee agreed there was "reasonable assurance" that the SAPIEN Transcatheter Heart Valve was safe and effective for patients meeting specified criteria. They also agreed the benefits to these patients outweighed the risks. The next step is FDA approval. Your ACC has prepared a detailed summary that includes links to the official statements, more information on the specific committee questions, and background information on the PARTNER trial and ACC/STS efforts related to TVT. Future updates, including a video interview with Holmes and STS President Michael Mack, MD, FACC, will be posted here as well. Also yesterday, the FDA announced approval of the anti-platelet drug ticagrelor for patients with acute coronary syndromes (ACS). A boxed warning to health care professionals and patients warns that aspirin doses above 100 milligrams per day decrease the effectiveness of the medication. It also notes that, like other anti-platelet agents, ticagrelor increases the rate of bleeding and can cause significant, sometimes fatal, bleeding. Your ACC will be working with the American Heart Association to incorporate ticagrelor into future guidelines. Learn more about the decision. Meanwhile, the FDA's Circulatory System Devices Panel of the Medical Devices Advisory Committee is meeting today in response to the request for a humanitarian device exemption of Berlin Heart, Inc., for its EXCOR Pediatric Ventricular Assist Device (VAD). Your ACC submitted written comments for the record, highlighting the importance of device manufacturers venturing into the field of pediatric devices, given the limited number of treatment options for pediatric cardiology patients in need of a bridge to transplant. The comments note that both of the current options – Extracorporeal Membrane Oxygenation (ECMO) and maximal medical therapy – have severe time limitations making them less than ideal. While the literature documents potential risks to the implantation of VADs in the pediatric population, it also indicates opportunities to extend the time limits of therapy beyond ECMO and maximal medical therapy as children wait for a new heart. The comments urge the FDA to "encourage Berlin Heart and other device manufacturers to develop additional pediatric cardiology devices that appropriately treat the needs of this special population." Read the full testimony. Advocate July 19, 2011 Call for innovative payment models! Your ACC, in partnership with the American Journal of Managed Care (AJMC) and with sponsorship from Johnson & Johnson, is creating a first-of-its-kind "Community on Payment Innovations" with the goal of providing an interactive, online venue where cardiovascular professionals and others can engage in meaningful dialogue to advance current and innovative payment models. The community will feature, among other things, case studies, videos, webinars and hot topic discussions. While an editorial panel of experts is already in place and developing venerable content and identifying discussion topics, the College is also seeking expert advice from members currently involved with testing and/or implementing new payment models. The goal is to use these "case studies" as the basis for discussion when the community launches in September. Submissions should be sent to advocate@acc.org with "Payment Models" in the subject line. For a primer on current and emerging payment models, read the ACC's new white paper on the topic. The Payment Community's launch coincides with this year's Legislative Conference, Sept. 11-13 in Washington, DC. The community's editor-in-chief and noted health care economist, Len Nichols, PhD, will deliver a keynote address focused on the payment reform landscape. In addition to Nichols, the Legislative Conference agenda is shaping up to include key Congressional staff and regulatory policymakers. General Stanley McChrystal also will address participants on the subject of leadership during Sunday night's dinner to benefit the ACC Political Action Committee (PAC). Conference registration closes on Aug. 5. For more information, click here. Are you prepared for the ICD-10 transition? The ACC's PINNACLE Network is hosting a special webinar next week (July 26) to help cardiovascular professionals prepare for the transition from ICD-9 to ICD-10 codes. The Webinar, which will be held from 4-5 p.m. (ET), will feature Debra Mariani from the ACC's Regulatory Affairs Team and will provide an overview of the transition timeline and what is needed to prepare. Registration is still open. The next PINNACLE Network webinar will be held on Sept. 6 and focus on Electronic Health Record (EHR) selection. More information is coming soon. Medical imaging services are under attack again! The Medicare Payment Advisory Commission (MedPAC) recently reported that advanced imaging services in Medicare grew only 0.1 percent between 2008 and 2009. Despite this evidence, imaging-related cuts are being actively considered this week as lawmakers scramble to craft a deal to reduce the deficit and raise the debt ceiling. It is critical that all ACC members contact their lawmakers today and urge them to oppose further cuts to medical imaging services. Let them know that continued reductions in medical imaging services will negatively impact Medicare beneficiaries' access to high-quality and appropriate imaging and result in the disruption of integrated patient-centered care. Call your member of Congress now at (202) 224-3121. In case you missed it, ACC CEO Jack Lewin, MD, testified for the College at a key House Committee hearing last week on the controversial Independent Payment Advisory Board (IPAB) concept that was included in the health reform law last year. The written testimony is online. You can also read the ACC in Touch Blog post, which includes a link to the hearing video. Also last week, the Social Security Administration (SSA) announced 12 additional Compassionate Allowances conditions involving severe heart diseases, bringing the total number of conditions in the expedited disability process to 100. Compassionate Allowances are a way to quickly identify diseases and other medical conditions that, by definition, meet Social Security's standards for disability benefits. Read the SSA press release for more on the specific conditions. This Thursday, ACC President David Holmes, Jr, MD, FACC, will be representing the College at an FDA Advisory Committee meeting regarding pre-market approval of Edwards Lifesciences SAPIEN Transcatheter Heart Valve. Leaders from the Society for Thoracic Surgery (STS) and the Society for Cardiovascular Angiography and Interventions (SCAI) will also be speaking. Your ACC is working closely with STS and SCAI to align efforts to ensure the physician community is prepared to appropriately use the technology and techniques. More information, including links to the testimony and a video interview with Dr. Holmes and STS President Michael Mack, MD, FACC, will be available in the FDA issues center under CardioSource.org/Advocacy. Additional updates will be posted to this site as they are available. Questions/Comments contact advocate@acc.org. Advocate July 5, 2011 A new study based on NCDR data examines appropriate use of percutaneous coronary intervention (PCI) procedures. The study, published in the Journal of the American Medical Association, used data from the ACC's CathPCI Registry. It examined records from 1,091 U.S. hospitals captured between July 1, 2009 and Sept. 30, 2010 and found that a vast majority of PCIs performed in acute settings (98.6 percent) was classified as appropriate. For non-acute indications, however, 11.6 percent was classified as inappropriate, with substantial variation noted across hospitals. These classifications were based on the College's "Appropriate Use Criteria (AUC) for Coronary Revascularization." Overall, the study found that although the majority of patients are appropriately selected for PCI procedures, there are opportunities for improvement, especially in the non-emergency setting. Studies like these are extremely beneficial to patients and to the entire field of medicine. They highlight the important role NCDR registries can play in identifying opportunities for individual hospitals and practices to monitor their performance and adopt or develop quality improvement initiatives to optimize the care they deliver. For more information on the study, click here. You can also learn more about the College's ongoing efforts related to appropriate use of PCI and other therapies and procedures in the "Appropriate Use" issue center on CardioSource.org. On a separate note, the Centers for Medicare and Medicaid Services released its proposed 2012 Medicare Physician Fee Schedule late last week. Your ACC is currently reviewing the rule and more details are forthcoming; however, a brief highlights summary is available online. Finally, don't forget that registration for the 2011 Legislative Conference (Sept. 11-13) is still open. The conference will feature a special "View from the Hill" session with key congressional staff serving as panelists and discussing health reform implementation efforts and more. In addition, health care economist Len Nichols will discuss payment innovation in a Monday keynote presentation and General Stanley McChrystal is the featured speaker during Sunday night's dinner to benefit the ACC's Political Action Committee. Get the details! Questions/Comments contact advocate@acc.org. Advocate July 1, 2011 At about 4:15 p.m. today, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule for the 2012 Medicare Physician Fee Schedule. This rule is CMS's opportunity to propose the payments for all physicians' services and the associated policies. Highlights for cardiology are outlined below. Your ACC will be doing a more thorough review in the coming days and will work with leadership and committees to craft official comments. Overall: The proposed rule includes CMS's estimate of the 2012 conversion factor based on current law. Congress will have to act again to prevent next year's SGR-based cut, currently estimated at 29.5 percent, from taking effect on Jan. 1. Outside of mandated revisions related to the SGR, CMS estimates the aggregate impact on cardiology from other provisions to be negative 1 percent, largely as a result of the third year of implementation of the AMA Physician Practice Information Survey (PPIS) into the practice expense formula. There were no other provisions with immediate significant importance for cardiology overall, but these numbers depend substantially on the mix of services provided in a practice. Imaging Payment Reductions: CMS proposes to reduce the payment by 50 percent for the professional component of certain imaging services provided at the same session on the same day by the same physician. Since 2007, Medicare has reduced the payment for the technical component of these services in a similar fashion.The Medicare Payment Advisory Commission (MedPAC) made this recommendation in a recent report released last month. Electronic Prescribing Penalty: By law, CMS is required to reduce Medicare payments to those practitioners who do not electronically prescribe and for whom at least 10 percent of their Medicare payments are associated with certain types of office visits. As part of the 2011 Medicare Physician Fee Schedule, CMS determined that practitioners who reported the e-prescribing measure at least 25 times in conjunction with those office visits between Jan. 1 and Dec. 31, 2011 would avoid the payment adjustment in 2013. As part of the 2012 proposed rule, CMS is considering providing practitioners with an additional opportunity to avoid the penalty. If practitioners prescribe electronically at least 10 times in conjunction with ANY Medicare service billable under the Physician Fee Schedule between Jan. 1 and June 30, 2012, they would also avoid the 2013 penalty. Potentially Misvalued Services: CMS proposes to continue efforts to examine payments for existing codes. CMS identifies three cardiology codes for review as potentially misvalued. Data for cardiovascular stress test (93015), extracranial study (93880), and complete electrocardiogram (93000), will be reviewed by the RUC for presentation to CMS before July 2012. In addition, CMS proposes that all evaluation and management codes be reviewed to determine if payment should be changed in coming years. Physician Compare and Value-Based Purchasing: CMS proposes another step towards the required implementation of value-based purchasing in 2015. In the proposed rule, CMS includes a series of claims-based measures that will be used to report on physician quality using the new Physician Compare website. In addition, CMS proposes a series of quality measures that will be used to adjust payment based on quality starting in 2015. These measures will include measures from the Physician Quality Reporting System (PQRS) and the Electronic Health Record Incentive Program. CMS does not propose how it will combine these measures or implement changes in payments based on these measures. PQRS and Maintenance of Certification (MOC): CMS proposes some changes to PQRS but largely keeps intact the registry reporting that is commonly used by cardiologists. Physicians that successfully participate in PQRS in 2012 will receive a 0.5 percent bonus of Medicare payments. Notably, CMS has proposed a series of "core measures" that must be used by physicians reporting through claims in certain specialties - including cardiology. CMS also proposes that a physician who completes any MOC module more frequently than is required for recertification is eligible to receive an additional 0.5 percent bonus. Coding: CMS, as expected, continues to move forward with bundling payments for certain services. Specific changes will not be available until November, but your ACC continues to stay on top of the situation and will notify members of any changes once the official codes for 2012 are released. Questions/Comments contact advocate@acc.org. Advocate June 27, 2011 Are we ready to be transformed? Your ACC and the Society of Thoracic Surgeons (STS) today released a "Professional Society Overview" of transcatheter valve therapy. This new technology has the potential to transform the treatment of patients with severe aortic stenosis who up until now have been deemed largely inoperable. However, the evolution of transcatheter valve therapy raises a number of questions for practitioners, patients and government agencies on the appropriate treatment strategy for patients who could be eligible for this procedure. According to the paper, some of the most important questions include: How will this technology be regulated and by whom? Where will this technology be available and who will be able to perform it? What types of patients will be able to benefit from this technology? How will training be accomplished? How will this new technology be reimbursed? The paper also underscores the importance of team-based care and complication management. Given the complexity of the procedure, patient selection will be extremely important and cardiologists, surgeons, hospitalists and others dealing with structural heart disease and heart failure will need to find a way to work together as a team. The paper also raises questions about data collection for long-term outcome assessment, comparative effectiveness research and cost-effectiveness analysis. The use of registries will be exceedingly important to document and optimal outcome in patients as well as identify areas that need to be changed or improved. It is important to note that this paper is only the first in what the College anticipates will be a series of documents, working with other specialty societies, to address the issues critical to successful integration of this new technology into medical practice in the United States. More information will be posted on CardioSource.org and in ACC publications like "The Advocate," Cardiology, and "CardioSourceNews" as it becomes available. Get complete ACC coverage of the paper here! Advocate June 23, 2011 More opposition: MedPAC last week released its June 2011 report to Congress. The report included recommendations related to diagnostic imaging that your ACC has – and continues to – oppose. In particular, the ACC is very concerned with the recommendation that reduces the physician work component for imaging and other diagnostic tests ordered and performed by the same practitioner. In addition, the ACC opposes prior authorization of advanced imaging procedures, as the report recommends, because requiring prior authorization would increase the administrative burden on Medicare, increase physician practice costs and could interfere with the physician-patient relationship, potentially delaying timely access to life-saving procedures. Get the details! The FDA has been very busy! Last week, the agency issued four Class I Recalls for the Boston Scientific Innova Self-Expanding Stent System, the Maquet Datascope Intra-Aortic Balloon Pump, the Boston Scientific iCross and Atlantis SR Pro 2 Coronary Imaging Catheters and the Terumo Coronary Ostia Cannula (10, 12 and 14). In addition, the FDA notified the public that the smoking cessation aid varenicline (Chantix) may be associated with a small, increased risk of certain cardiovascular adverse events in patients who have cardiovascular disease. On Tuesday, the FDA released nine new warning labels that will be used to deter people from smoking. These labels constitute the first major change to cigarette warning labels and ads in almost 25 years. Every ad for and package of cigarettes will be required to contain the new verbiage and graphics by Sept. 2012. The new images are graphic in nature and include depictions of the potential effects of cigarette smoking. Your ACC commented on the proposed rule, encouraging the government to take action against cigarette smoking. With this, the U.S. joins other countries in using graphic depictions of the effects of smoking to deter individuals from smoking, especially children and teens. Read more about all of these updates in the FDA Issues Center. The Annual Medicare Physician Fee Schedule proposed rule will be released very soon. This rule contains most of the major proposals for physician payment and quality programs for the coming year. ACC will review the rule as soon as it is released and inform members of the major proposals contained within it. Don't miss the 2011 Legislative Conference, Sept. 11-13 in Washington, D.C.! Planning for this much-anticipated annual event is well underway. Don't miss this opportunity to hear more about the issues facing cardiology and to meet face-to-face with your members of Congress. Just announced: the Sunday night dinner to benefit the ACC Political Action Committee (PAC) will feature General Stanley McChrystal. Tickets will be required! The cost is $250 for general admission, with discounted rates for FITs, CCAs and Practice Administrators. In addition, PAC contributors of $1,000 or more will receive preferred seating and an opportunity to meet General McChrystal during a VIP reception prior to the dinner. VIP tickets need to be requested by Aug. 11. Contact Lucas Sanders at lsanders@acc.org to register for the dinner. Questions about the conference should be directed to advocacyleg@acc.org. Advocate June 9, 2011 Don't ignore RUC surveys! Annual updates to the physician work relative values are based on recommendations from a committee involving the American Medical Association (AMA) and national medical specialty societies – the RUC. The RUC is an expert panel of the AMA and specialty societies charged with developing relative value recommendations to Medicare. A key part of the RUC process is the completion of relative value surveys. Data from these surveys are used to establish the physician work that determines Medicare reimbursement. A short, 30-minute webinar explaining the importance of the survey and the steps to complete it will be presented June 13 at 5 p.m. (ET). Please plan to attend. You can join us directly by using this link. Important FDA Alert: The FDA is recommending health professionals limit the use of the highest approved dose of simvastatin (80 mg) because of increased risk of muscle damage. Patients taking simvastatin 80 mg daily have an increased risk of myopathy compared to patients taking lower doses of this drug or other drugs in the same class. This risk appears to be higher during the first year of treatment, is often the result of interactions with certain medicines, and is frequently associated with a genetic predisposition toward simvastatin-related myopathy. The most serious form of myopathy, called rhabdomyolysis, can damage the kidneys and lead to kidney failure which can be fatal. FDA is requiring changes to the simvastatin label to add new contraindications (should not be used with certain medications) and dose limitations for using simvastatin with certain medicines. The FDA recommends that simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug. Read the full alert. You can keep on top of FDA alerts like the one above with PDR Drug Alerts (HCNN). PDR Drug Alerts offer immediate, electronic delivery of FDA-approved, specialty-specific drug alerts and safety information for ACC members, and are aggregated on PDR.net for convenient review. As an added benefit, you may also earn continuing medical education (CME) credit for Drug Alerts and FDA-approved product labeling. For more information and to register, go to www.acc.pdr.net. Your email or fax number will only be used to send and administer drug and device alert services. Registration for the ACC's 2011 Legislative Conference is OPEN! Don't miss this opportunity to hear from ACC leaders and health policy experts on important issues facing the cardiovascular community and to meet directly with congressional leaders. A select number of scholarships are available for FITs, CCAs and Practice Administrators. In addition, new this year, the ACC Political Action Committee (PAC) is holding a special dinner and reception on Sunday, Sept. 11 featuring General Stanley McChrystal. Cost for the dinner is $250 per person, with reduced rates for FITs, CCAs and Practice Administrators. A special VIP reception with General McChrystal will also take place prior to the dinner for PAC donors who have contributed $1,000 or more. For more information, contact advocacyleg@acc.org or visit CardioSource.org/LegislativeConference. Advocate May 27, 2011 Breaking e-prescribing news! The Centers for Medicare and Medicaid Services (CMS) has released a proposal that exempts some practitioners from the 2012 Medicare penalty that will be levied against those who are not e-prescribing by June 30. The proposal would create new categories for hardship exemptions, making the total list of exemptions as follows: Individual practices in rural areas without high speed internet access Individual practices in areas without sufficient available pharmacies for electronic prescribing Practitioners who have registered to participate in the Medicare or Medicaid EHR Incentive Program and have adopted certified EHR technology Practitioners who are unable to electronically prescribe due to local, state, or federal law or regulation. (This proposed exemption is designed to address practitioners who prescribe controlled substances.) Practitioners who infrequently prescribe. (For 2012, this means a practitioner must not have had the opportunity to e-prescribe at least 10 times between January and the end of June 2011 in order to qualify for the exemption.) Practioners with insufficient opportunities to report the e-prescribing measure due to program limitations Under the proposal, practitioners would have until Oct. 1, 2011, to claim a hardship exemption. CMS is working to create a web portal to allow for easy filing of the exemption requests and supporting documentation. This new proposal comes after months of pressure from your ACC, AMA and other physician organizations and will be formally published in the June 1 Federal Register. Comments on the proposal are due July 25, 2011. The College will be developing comments in the coming weeks, particularly as they relate to other provisions of the e-prescribing program not addressed by this new proposal, such as the June 30 deadline and the narrowness of the proposed infrequent prescriber exemption. Stay tuned for more detailed information to be posted at CardioSource.org/healthIT shortly. Advocate May 26, 2011 The June 30 e-prescribing deadline is looming! Starting in 2012, practitioners will be penalized if they have not successfully participated in the federal E-Prescribing Incentive Program in the preceding year. Unfortunately, the 2012 penalty will be determined based on services provided from Jan. 1 to June 30, 2011. If certain specified office visits total at least 10 percent of your Medicare charges, it is critical that you report on the e-prescribing measure for 10 unique office visits by the June deadline. If you do not, all your 2012 Medicare payments will be reduced by one percent. Now is the time to take advantage of the many ACC resources available to help navigate the e-prescribing requirements and not be caught with a penalty come January 2012. Also, don't miss the latest e-prescribing installment in the ACC in Touch Blog. Good news on the imaging front! After pressure from the ACC and other medical specialty groups, the Centers for Medicare and Medicaid Services (CMS) has decided not to require providers of advanced diagnostic imaging to update enrollment information upon receipt of their accreditation. Originally, CMS planned to require providers of advanced diagnostic imaging to list CPT codes for which they were accredited to perform services, as well as the model and make of the equipment to be used, on the Medicare enrollment applications. Additionally, providers were to use a specialty designation code to identify themselves as an accredited provider of advanced diagnostic imaging. Instead, CMS will now obtain the pertinent information from the accrediting bodies -- the Intersocietal Accreditation Commission (IAC), the American College of Radiology, and the Joint Commission. Reminder -- providers of nuclear imaging, CT or MR must be accredited by Jan. 1, 2012 in order to continue to be paid for services furnished for Medicare beneficiaries. Are you prepared for the HIPAA Version 5010 Transition? With the Jan. 1, 2012 Version 5010 compliance deadline fast approaching, it is important that all HIPAA-covered entities are taking steps now to get ready, including conducting external testing to ensure timely compliance. To assist in this effort, the CMS has announced "National 5010 Testing Day" on Wednesday, June 15. Don't miss this opportunity to test compliance efforts that are already underway with the added benefit of real-time help desk support and direct and immediate access to Medicare Administrative Contractors (MACs). Be on the lookout for information from your local MAC, as well as participating state Medicaid agencies. More information is also available at the CMS Version 5010 website and on CardioSource.org. Have you purchased your ACC/AMA 2011 CPT Reference Guide for Cardiovascular Coding? The books are still available for purchase. In addition, the AMA has developed an errata (available here) that includes important coding updates since the book was published. Advocate May 5, 2011 Two huge deadlines are approaching that cardiovascular professionals and practices need to take note of: Blue Cross Blue Shield Settlement (May 31) E-Prescribing (June 30) Take Advantage of the Blue Cross Blue Shield (BCBS) Settlement: Your ACC and the American Medical Association (AMA) are working to ensure physicians and practices know about the Thomas/Love Blue Cross Blue Shield settlement deadline. The settlement resolves a series of issues between a majority of BCBS Plans and physicians concerning claims processing and physician contracts. Issues include adherence to prompt pay requirements, 90-day advance notification for material adverse contract changes and more. Physicians and practices that feel their local BCBS Plan has violated settlement terms must file compliance disputes by May 31 to ensure they receive protections under the settlement. For more information, visit AMA's Blue Cross Blue Shield Settlement Information website. You can also watch an Archived Webinar for more details. Defend Yourself Against the E-prescribing Penalty: This week your ACC is kicking off a month-long campaign to help cardiovascular professionals avoid the 2012 e-prescribing penalty. Under the Medicare Improvements for Patients and Providers Act of 2007 (MIPPA), qualified e-prescribers will be penalized if they do not successfully participate in the federal e-prescribing incentive program. Despite protests from your ACC, the AMA and other professional societies, the Centers for Medicare and Medicaid Services will use e-prescribing data from January 1, 2011 through June 30, 2011 to determine whose payments will be reduced in 2012. Your ACC has developed several resources to help practices and providers understand the requirements and avoid the penalty. The Health IT section of CardioSource.org contains an entire section on e-prescribing that includes FAQ and slides focused on navigating the federal e-prescribing program and clarifying confusion around requirements. In addition, the ACC in Touch Blog will feature a series of guest posts on the e-prescribing requirements over the course of the month from the perspectives of private practitioners, practice administrators, cardiac care associates and others. ACC President David Holmes, MD, FACC, kicks off the blog series with his post, "E-Prescribe or Face the Consequences!" Additional questions regarding the e-prescribing program and the looming penalty deadline should be directed to advocacydiv@acc.org. To read the College's latest comments to CMS on the e-prescribing penalty, click here.   Advocate April 18, 2011 New reports find RBMs aren't so appropriate! The Senate Commerce Committee and the Delaware Insurance Commission late Friday released their respective reports of their investigations into consumer access to diagnostic imaging tests in Delaware. Both the Senate Commerce Committee and the Delaware Insurance Committee launched investigations following news reports last spring about a Delaware man who was denied a cardiac stress test by MedSolutions, the radiology benefit management companies (RBM) used at the time by BlueCross BlueShield (BCBS) of Delaware. The man ultimately was admitted to the ER, where a life saving CABG was performed. As a result of subsequent discussions with the ACC DE Chapter, BCBS of DE has removed MedSolutions as a vendor for review of cardiac imaging tests. ACC National, the DE Chapter, and BCBS of DE are now working together on addressing many of the findings in the report by working toward the launch of FOCUS: Cardiovascular Imaging Strategies, an ACC RBM alternative. Findings: The reports affirm what your ACC has been saying all along: RBMs, while providing cost-savings to payers, are burdensome, confusing, and potentially dangerous for both consumers and health care providers. Their ultimate goal is to reduce the use of advanced imaging services, not necessarily to ensure the appropriateness of tests for patients. The Delaware Insurance Commission report specifically found that the MedSolutions and BCBS of Delaware contracts volume-based contingency clause violated state insurance regulations. In addition, it found that MedSolutions denied a significant number of appropriate tests as well as engaged in substantial numbers of administrative denials based on technical not clinical omissions. The Senate report also found that MedSolutions cardiac testing guidelines conflicted with ACCs and resulted in unnecessary confusion and testing limits. Recommendations: The Delaware Insurance Commission report recommends that the criteria used by BCBS of DE going forward are not more restrictive than appropriate use criteria (AUC) established by your ACC or other recognized professional medical specialty organizations. In addition, once the information provided in the physicians request meets AUC recommendations, the Company should promptly approve the request for nuclear cardiac imaging testing. Both these recommendations will be implemented when BCBS of DE begins using our FOCUS: Cardiovascular Imaging Strategies program in a few months. Next Steps: Your ACC and the ACC Delaware Chapter are working to draft a follow-up letter to Senate Commerce Committee Chair John Rockefeller to provide an update on our work with BCBS to implement the new FOCUS: Cardiovascular Imaging Strategies, a product of the ACCs Imaging in FOCUS initiative. This product allows for transparent, AUC based and robust point-of-care decision support developed by ACC and powered by Medicalis. Unlike RBMs, it engages providers in ongoing feedback reports and quality improvement activities. At the same time it reduces third-party costs to physicians and health plans. Through the hard work on 300+ imaging labs across the country, ACC has been documenting significant improvements in appropriate use over the past year in ACCs voluntary FOCUS community. This significant progress will address one of the shortcomings of AUC cited in the Senate report: the limited ability of our initial 2007 pilot sites to improve. Both reports issued last week provide an opportunity for the ACC and cardiovascular professionals that provide imaging services to educate health plans and members of Congress about the benefits of AUC, as well as what the College is doing to put AUC directly in the hands of providers and ensure appropriate testing. If you are interested in finding out how to engage health plans or other stakeholders in your state around these issues as well as find out more about ACC's Imaging in FOCUS initiative, please contact focus@acc.org or visit www.cardiosource.org/focus.   More Information: Senate Report DE Insurance Commission Report NBC Nightly News Delaware News Journal Advocate March 23, 2011 Breaking news ... Health and Human Services (HHS) Secretary Kathleen Sebelius on Tuesday released the National Strategy for Quality Improvement in Health Care. The strategy, which is required under the Affordable Care Act, is the first effort to create national aims and priorities to guide local, state, and national efforts to improve the quality of health care in the United States. The strategy identifies six priority issues, including "promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease." HHS has said it will work with stakeholders to create specific quantitative goals and measures for each of these priorities. Your ACC provided detailed comments on the draft National Strategy this past October and will continue to monitor and be engaged as HHS moves forward with implementation. Also this week ... CMS formally established the new Center for Medicare and Medicaid Innovation, also created by the Affordable Care Act. The Innovation Center is charged with examining new ways of delivering health care and paying health care providers that can improve quality while also reducing health care costs. According to CMS, it will consult stakeholders across the health care sector to obtain direct input on its operations and to build partnerships with those interested in its work. You can rest assured that your ACC will be involved! CMS also announced the launch of new demonstration projects that will support efforts to better coordinate care and improve health outcomes for patients. Among the projects, a demonstration project to evaluate the effectiveness of doctors and other health professionals across the care system working in a more integrated fashion and receiving more coordinated payment from Medicare, Medicaid, and private health plans. Another project will test the effectiveness of doctors and other health professionals working in teams to treat low-income patients at community health centers, while another will look at a state plan option allowing Medicaid patients with at least two chronic conditions to designate a provider as a "health home." More information on the Innovation Center and these initiatives is available at innovation.cms.gov. Are you ready for ACC.11 in New Orleans? The meeting will feature a number of sessions that directly address advocacy priority issues like physician payment, delivery system reform, tort reform, health IT and regulatory changes. Check out the Advocacy highlights. There are also many great sessions focused on Practice Management. Finally, the ACC Political Action Committee (PAC) will have a special booth located right outside the Faculty Lounge, as well as a Suite at the New Orleans Marriott. The Suite will be open starting at 9 p.m. on Saturday, Sunday and Monday night. Sunday night is sponsored by CCA members. If you're a practice administrator, please come to the Suite on Saturday, April 2 at 5 p.m. for an opportunity to share your thoughts and provide feedback on what you'd like to see from the ACC PAC. Congress is in recess, BUT ... Your ACC is hearing that the "Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act" (H.R. 5) may again be on the move in the House when it gets back from recess. The HEALTH Act, introduced by Rep. Phil Gingrey, MD, was recently approved by the House Judiciary Committee. The College supports this comprehensive medical liability reform legislation, which currently has 100 cosponsors. To help its chances of moving through the House of Representatives, ACC members are encouraged to contact their representative and ask him or her to cosponsor this important bill. Coding Update! Physicians reporting the new code for transseptal puncture (93462) have indicated that Medicare was not properly paying for this service. Your ACC worked with CMS to correct this issue. Please be be aware that 93462 should not be billed with any modifier and it should be properly paid by Medicare.  Advocate March 3, 2011 Survey Says: Your ACC and the Heart Rhythm Society will be conducting a survey to assess the relative work value for a series of pacemaker and ICD services in the coming weeks. This survey, part of the process of the development of resource-based relative value scale, asks physicians to compare these services to other commonly provided services. Please be on the lookout for this survey. If you receive one, it is very important that you fill it out. If you have any questions, please contact Brian Whitman on ACC's Regulatory Affairs team at bwhitman@acc.org. Are we ready for Stage 2 of Meaningful Use? This was one of the questions posed by your ACC in formal comments sent to the Health Information Technology Policy Committee of the Department of Health and Human Services. The comments express the College's concern that discussions regarding Stage 2 of Meaningful Use are already well underway, despite Stage 1 having only launched in January. "The federal government and the HIT Policy Committee have no data to suggest that physician practices have been able to successfully complete what has been asked of them for Stage 1; how is it then reasonable to be this far along in the discussions for Stage 2?" The comments urge the government not to get ahead of technology and vendor ability to develop cost-effective solutions. More importantly, they also urge implementation not to get ahead of physician abilities to "purchase and implement the new solutions while maintaining high-quality patient care." Read the specific recommendations. Good news on the imaging accreditation front! Effective February 14, National Imaging Associates, Inc. (NIA), a radiology benefit manager for numerous health insurers, began accepting practices with the Intersocietal Accreditation Commission's (IAC) ICACTL and ICAMRL Accreditation into the NIA Provider Privileging Program. The IAC's founding organizations, which include your ACC, stressed the importance of including IAC as practices prepare and make decisions for the beginning of the Medicare accreditation requirement for advanced diagnostic imaging tests. Previously, NIA only accepted the American College of Radiology accreditation body. Save these dates: Your ACC and the Heart Rhythm Society are hosting a free webinar on Monday, March from 6 - 7:15 p.m. (ET) that addresses "The Focused Update on the Management of Patients with Atrial Fibrillation: Who Should Get What, When?" Register at http://www.HRSonline.org/Education. The ACC PINNACLE Network is hosting a free webinar on Tuesday, March 15 at 1 p.m. (ET) that will focus on "Getting the Most Out of Medicare Incentive Programs" (e-Prescribing, EHR Incentive Program and the Physician Quality Reporting System). Register now. Advocate February 17, 2011 Humana settlement deadline is Feb. 28! Under a settlement negotiated by the American College of Emergency Physicians, Humana is accepting resubmission for separate payment of 12 Lead ECG interpretations (CPT 93010) with dates of service from October 1, 2009 through March 31, 2010. Don't miss this opportunity to get significant incremental reimbursement for your practice. Your ACC, working with the Managed Care Advisory Group, is ready to assist with your filing. They can be reached at 800.355.0466, or at physicianservices@mcaginc.com. Resubmitted claims received by Humana after Feb. 28 will not be reprocessed. Get the results. United HealthCare (UHC) extension: Due to delays in notifying cardiologists of whether they qualified for UHC's UnitedHealth Premium designation, the ACC and other physician organizations worked to secure a two-week extension from UHC for those physicians seeking reconsideration of their status. Physicians now have until Feb. 26 to submit their reconsideration requests in time for any changes to be reflected by the March 30 display date. Requests received after this date will be reviewed on an expedited basis, however, results of the review may be posted in subsequent display dates. For any additional concerns, please contact ACC Advocacy at 800-435-9203. New Jersey Blue Cross Blue Shield (BCBS) radiopharmaceutical payment policy overturned! Thanks to the efforts of your ACC, the ACC New Jersey Chapter, the American Society of Nuclear Cardiology and the Society for Nuclear Medicine, Horizon BCBS of New Jersey will eliminate its payment policy restricting the number of reimbursable radiopharmaceutical units (A9500 and A9502) administered as part of a multiple SPECT MPI study (CPT code 78452). Horizon has also agreed to automatically reprocess and repay all claims with applicable interest for the reimbursement of radiopharmaceuticals from the policy's effective date of September 2009. Members are encouraged to review their Horizon claims and explanations of benefits to ensure the claims were reimbursed correctly. For any additional questions, please contact ACC Advocacy at 800-435-9203. Self referral win in Utah! "Medical Practice Self Referral" Legislation (S.B. 91) before the Utah Senate failed to pass out of the Health and Human Services Committee this week. The bill would "require disclosure and reporting by a health care provider when the health care provider refers a patient for imaging services and the provider has a financial interest in the imaging services." As the fight to ensure cardiovascular professionals are able to provide in-office imaging services moves to state capitols across the country, this is a very important victory. Your ACC worked with the Utah Chapter and the State Medical Association to educate legislators on the importance of patient access to quality imaging services. We will continue to monitor this and similar legislation in other states. Eliminating inequities in CV care was the subject of a special Capitol Hill briefing this week sponsored in part by your ACC. ACC CEO Jack Lewin, M.D., spoke at the briefing and specifically addressed reducing inequities through quality measurement. He said the keys to reducing disparities include performance measure-based quality improvement and provider and patient education. This was a great opportunity to highlight the benefits of registry use, as well as the work of credo (Coalition to Reduce Disparities in CV Outcomes). Read More. Advocate February 8, 2011 Avoid the e-prescribing penalty! Starting in 2012, health care providers will be penalized if they do not successfully participate in the federal e-prescribing program. If you think you have until 2012 to avoid the penalty, think again! Despite protests from the ACC, the AMA and other physician organizations, CMS will use e-prescribing data from January through June 2011 to determine whose payments will be reduced in 2012. In short, this means that if you have not begun to report on the 2011 e-prescribing requirements by the end of June 2011, you will see all of your 2012 Medicare payments reduced by one percent. Get the details and avoid the penalty! Medical liability reform legislation up for a vote. Rep. Phil Gingrey, M.D., an OB-GYN from Georgia, has introduced the "Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act" (H.R. 5). Your ACC is supporting this legislation, which would increase patient safety; ensure that injured patients are compensated quickly and fairly; improve provider-patient communications; and foster an environment for affordable and accessible medical liability insurance. The House Judiciary Committee is expected to vote on the bill this Wednesday. ACC members with representatives on the Judiciary Committee are asked to contact their lawmakers ASAP. Stay tuned to "The Advocate" for updates and next steps. This issue is an ACC Advocacy priority! Getting face-to-face with Congress! Former ACC Texas Governor Rick Snyder, M.D., F.A.C.C., a Dallas-based cardiologist, is representing the College this week on the subject of physician ownership at a special Hill briefing organized for House Republican freshmen. The ACC has long advocated that the quality of care, not the type of ownership should dictate where services are provided. "This is an unparalleled opportunity to get this ACC message before key decision makers," says ACC Senior VP for Advocacy James Fasules, M.D., F.A.C.C. "It also speaks volumes about the relationships that Dr. Snyder has built over the years with his Texas lawmakers both as an ACC leader and as a member of the ACC's Political Action Committee." Dr. Snyder's testimony will be posted at CardioSource.org/Advocacy later this week.  Advocate January 20, 2011 News from the House: The House of Representatives yesterday passed legislation to repeal the Patient Protection and Affordable Care Act (PPACA). Your ACC did not dive into the repeal debate, recognizing it as a partisan process that would not prevail in the Senate. We continue to pursue our health reform principles, a number of which are included in the PPACA, and to push to amend those we do not support. In addition, the College, as always, continues to advocate for important delivery system changes like comprehensive medical liability and payment reforms that are absent in the PPACA. Stay tuned to “The Advocate” or CardioSource.org/Advocacy for updates on this legislation and other health reform implementation policies and provisions. Read the ACC’s comprehensive overview of the law and its impacts on cardiology. CMS is moving forward with its Physician Compare website. At the end of 2010, CMS changed its existing online physician directory into a website called Physician Compare. Modeled after CMS' Hospital Compare site, this new site is intended to allow consumers to compare physicians before selecting one. For 2011, this only includes a modest adjustment to the existing site, which indicates whether a physician was a successful participant in the Physician Quality Reporting Initiative (PQRI). The ACC has endorsed the concept of an engaged and educated consumer but has expressed strong concern about the site being grossly inaccurate. Your ACC strongly recommends that all physicians review their information on the Physician Compare site for accuracy. In most cases, corrections to the data will require physicians to update their enrollment information through the Provider Enrollment Chain and Ownership (PECOS) system, but in some cases it may be corrected through the feedback tool on the site. Get up-to-date on 2011 coding changes! Avoid making costly coding errors with the "2011 CPT Reference Guide for Cardiovascular Coding," co-published by the American College of Cardiology Foundation (ACCF) and American Medical Association (AMA). This all-inclusive cardiology coding and reimbursement guide is designed to help cardiovascular professionals more efficiently and accurately report cardiovascular services and procedures. The guide also provides a complete overview of the heart, including cardiovascular basics and common ailments, CPT guidelines, explanations of significant recent code revisions and the general intent and use of diagnostic and therapeutic clinical procedures and services which will help ensure that providers, administrators and allied health professionals code properly. It's not too late to participate in the 2010 Physician Quality Reporting Initiative (PQRI). There is still time to submit data for 2010 PQRI before the Feb. 11 deadline. The ACC PQRIwizard is an easy to use online tool to help physicians and other eligible professionals quickly and easily participate in PQRI. Similar to online tax preparation software, the PQRIwizard helps guide professionals through a few easy steps to rapidly collect, validate, report and submit data to CMS for payment. The 2010 program offers the greatest financial incentive to participants. The ACC's PINNACLE Network is holding a special webinar (that is free for ACC members) to help review the basics of the CMS PQRI incentive program, share some PQRI "lessons from the field" and walk you through how to use the PQRIwizard to submit data for 2010. The webinar will take place on Monday, Jan. 24 at 2 p.m. (ET). Register for the webinar today! Advocate January 6, 2011 ACC and HRS Respond to JAMA ICD Study: By now you have surely seen the Jan. 5 JAMA paper on patient selection for ICD implantation. Using the CMS-mandated NCDR ICD registry, 111,707 patient records were evaluated for evidence-based guideline adherence in ICD implantation decisions. Researchers discovered that ICD implantations were not in accordance with practice guidelines in 22.5 percent of patients and that risk of in-hospital complications and deaths increased in the patients that did not meet the guidelines-based selection criteria. Most of the ICD placements considered inappropriate were in the setting of CHF and on closer review are likely to prove sound clinical decisions. In fact, the data that nearly four-fifths of the implants met the guidelines and only a bit over one-fifth did not is compatible with physicians both respecting the underpinnings of the guidelines but using their judgment when individual, exceptional clinical/social circumstances arise. Studies like this underscore the need for measurement and the importance of our quality tools and programs. Studies like this underscore the need for measurement and the importance of our quality tools and programs. Reviewing this type of data gives us a tremendous opportunity to improve cardiovascular care. Read the ACC/HRS joint statement in response to this important study. Comments? Share your opinion here. EHR incentive program update: Registration for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program opened this week for hospitals, office-based physicians and other providers. Under the program, physicians that demonstrate "meaningful use" of EHR technology and performance during the reporting period of each payment year will be eligible for positive payment incentives between 2011 and 2015. Learn more about the incentive program. Additional information on EHR selection and the e-Prescribing incentive program is available at CardioSource.org/healthit. In addition, don't miss the Health IT symposium on Sunday, April 3 as part of ACC.11 in New Orleans. More information on the symposium and the ACC.11 EHR pavilion will be coming soon! Is your lab accredited? New rules require all imaging labs to be accredited by Jan. 1, 2012. According to the Centers for Medicare and Medicaid Services (CMS), the accreditation process can take as long as nine months. A number of webinars are taking place this month in order to ensure practices are able to comply with the new rules. Also look for a special session on this topic at ACC.11 in New Orleans. Good news for EPs! CMS has developed a new specialty code for electrophysiology. The new designation allows CMS to distinguish an electrophysiologist (EP) from a cardiologist when billing for Medicare services. Since the establishment of the specialty code will require changes to the CMS enrollment and claims processing systems, this new designation will not be implemented until April 4, 2011. The ACC will be working in the coming months to provide more detailed information on the enrollment process. Are you ready for ICD-10? Your ACC has developed a special online resource center to help practices prepare for the upcoming transition to ICD-10 codes. The site contains information on preparing your practice as well as links to CMS resources and updates. Learn more at CardioSource.org. In addition, CMS has posted the 2011 versions of the ICD-10-CM and ICD-10-PCS crosswalks, formally referred to as the General Equivalence Mappings (GEMs), on the ICD-10 website at www.cms.gov/ICD10. These updated files complete the requirements of Section 10109(c) of the Affordable Care Act of 2010. "Red Flag" update: Right before the holidays, President Obama signed "red flag" legislation making physicians exempt from the anti-identity theft requirements and safeguards banks and other creditors must follow. 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 Red Flag Rule's implementation date. PAC progress: Your ACC Political Action Committee (ACCPAC) ended the 2009-2010 election cycle on a high note by surpassing for the first time $1 million in voluntary contributions from our individual members around the nation. Reaching this milestone places ACCPAC among the elite physician specialty PACs. One-hundred percent of your personal contributions are used to support the campaigns of members of Congress who will listen to our message aimed at improving health care for patients with cardiovascular disease, facilitating the delivery of cardiovascular services by practicing physicians, and funding cardiovascular research and prevention. Thanks to everyone who contributed.