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All ACC members were called to action last week regarding the Medicare practice expense proposal for which the College has been actively lobbying. In a letter from ACC President George A. Beller, M.D., ACC members are urged to call, fax or write to Congress in support of a legislative proposal that would halt the transition to a resource-based relative value system for Medicare practice expense payments at current 2000 levels, while permitting certain office visit and office consultation codes to accelerate to their 2002 levels. "As a result of the BBA 97 [Balanced Budget Act of 1997], cardiology faces a 12 percent reduction in overall payments. The only way to stop the implementation of HCFA's fatally flawed system is through congressional action. For that to occur, lawmakers need to hear from physicians like you," Dr. Beller urged. Additional information on the proposal is available on the ACC Web site under Advocacy/Issues Center. For a copy of a sample letter to Congress (available electronically), please e-mail advocacydiv@acc.org or call 800-435-9203. Thanks for your support!

The ACC Pennsylvania Chapter provided testimony August 10th before the state's House Insurance Committee regarding the "Health Care Provider Joint Negotiation Act" (HB 2685). The bill would allow collective negotiations to occur between physicians and insurers. It would also allow physicians in practice settings to openly discuss issues with their colleagues such as practice guidelines, referral procedures and credentialing standards and other quality of care provisions in their insurer contracts. "This legislation is necessary to give physicians a seat at the table, relieving the present imbalance of power, and helping to reestablish the physician's rightful position in medical decision-making," said Richard C. Schott, M.D., F.A.C.C., who presented the testimony. Additional hearings are scheduled for August 29-30 in Harrisburg.

A bill in California that would create a tobacco settlement fund was amended this week to win Gov. Gray Davis' (D) support. SB 673 will use California's share of a tobacco suit settlement to extend health coverage to one million of the 7.5 million uninsured residents. State officials had been faced with having to return nearly $6 million in unspent federal funds allocated for Healthy Families, California's State Children's Health Insurance Program (CHIP), because of low enrollment. Sen. Martha Escutia (D) said her measure would allow California to salvage the money and leverage it to serve working adults. Under Healthy Families, for every dollar the state puts up, the federal government commits two. Escutia's measure calls for using a share of the state's tobacco money as the state's match. Until recently, Healthy Families was restricted to uninsured children. But new regulations allow states to petition the federal government to enroll parents.

State lawmakers in Nebraska are examining how the state may be affected by rising prescription drug costs. Representatives of the pharmaceutical industry, pharmacists, private insurers, the American Association for Retired Persons, the Nebraska Health and Human Services System and the National Conference of State Legislatures briefed two key legislative committees. State leaders say they want to explore what strategies are available for state governments. The hearings are being conducted jointly between Jensen's committee and the Banking, Commerce and Insurance Committee. Strategies under consideration are subsidization and price controls. The most likely option, however, is to join with neighboring states to create a drug purchasing pool that could lead to discounted prices.

The ACC and the North American Society for Pacing and Electrophysiology (NASPE) recently sent a letter of support to the Health Care Financing Administration (HCFA) regarding the revision of the national coverage policy for cardiac pacemakers. The letter supported the request to amend the 15-year-old policy to add coverage for the use of cardiac pacemakers to treat asymptomatic brachycardia, following myocardial infarction, for patients about to initiate long term beta blocker drug therapy. A complete revision of HCFA's outdated coverage policy may occur over the next 12 months. A copy of the letter is available from the ACC Advocacy Division at 800.435.9203 or via e-mail at regleg@acc.org.

The National Institutes of Health (NIH) published its final guidelines for research involving human pluripotent stem cells. The guidelines, to be published in the August 25 Federal Register, detail the procedures to help ensure that NIH-funded stem cell research is conducted in an ethical and legal manner. Among other things, the guidelines state specific criteria for informed consent and establish a Human Pluripotent Stem Cell Review Group to review compliance with the guidelines. Additional information about stem cell research, including the new guidelines, can be found on NIH's web site.

The National Heart, Lung, and Blood Institute (NHLBI), in collaboration with the American Heart Association (AHA), has funded a large multi-center study to test the life-saving potential and cost effectiveness of public access defibrillation. "We want to know if placing [automatic external defibrillators (AEDs)] in the community where trained volunteers could access them will prevent additional deaths - and whether such a program is feasible," according to NHLBI Director and ACC member Dr. Claude Lenfant. The two-and-a-half year study will be conducted in 24 centers throughout the U.S. and Canada. More information about the study is available in the National Institutes of Health news release.

The Health Care Financing Administration (HCFA) has issued a new Program Memorandum to its Intermediaries and Carriers providing guidance for pre- and post-payment audits of providers. According to the Memorandum, "[t]hese concepts are already part of existing manual instructions . . . but are amplified here for easy understanding of expectations and basic requirements." Among other things, HCFA emphasizes that carrier feedback and education of physicians are fundamental components of the medical review process. HCFA's Program Memorandum is available on the HCFA Web site.

The Food and Drug Administration (FDA) has announced an FDA/Industry Exchange Workshop on Clinical Research Involving Human Drugs, Biologics and Medical Devices to be held in Rockville, Maryland, October 5-6. The stated objectives of the program are to 1) promote patient safety and data integrity through education on the proper conduct of human clinical trials intended to support drug, biologic or medical device marketing applications; and 2) to educate scientists, physicians and others involved in clinical research on the proper conduct, monitoring, and reporting of clinical trials in order to facilitate the progress of new therapies through FDA review for the eventual benefit of consumers. More information, including registration information, is available on the FDA Web site.

On August 19, the College held a Payer Advocacy Retreat attended by representatives from various ACC policy committees. The retreat, which was co-chaired by James T. Dove, M.D., and Daniel J. Ullyot, M.D., served as the seminal point for the development of a strategic plan in the area of payer-issue advocacy.

As part of this effort, the ACC has launched a feedback mechanism on its Web site for ACC members and chapters to submit information about both problems and successes they have had in dealing with third-party payers. The Physician/Payer Interactions Form, will allow the College to quickly identify issues and trends at both the local and national levels, so that it may work with members/chapters to develop strategies for addressing these issues. All information submitted via the form is secure and confidential and will not be shared with other parties unless authorized by the individual/chapter that submitted the information.