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ACC Advocate

Promoting Strong Practices, Protecting Patient Access

Current Issue - October 30, 2014

Your ACC in Action – Advocacy Success Countdown: By advocating for a quality driven health care system, provider stability, population health and the future of cardiovascular medicine, the ACC is leading the transformation of care. As we approach the end of the year, each issue of the Advocate will feature a top advocacy success from the year. Your ACC pushed for a permanent Sustainable Growth Rate (SGR) fix by working with most of organized medicine and key congressional committees to produce a bipartisan, bicameral SGR repeal bill. While Congress failed to agree on budget offsets for final passage of the bill, a one year patch was passed to avert a 24 percent cut to Medicare payments without any onerous provisions. The patch will expire on March 31, 2015, and the ACC continues to advocate for permanent payment reforms that will provide stability and facilitate the delivery of high quality, cost-efficient care. The Protecting Access to Medicare Act of 2014, which delayed payment cuts associated with the SGR, also requires consultation with appropriate use criteria (AUC) and clinical decision support for advanced diagnostic imaging, beginning in 2017. The ACC is working with the Centers for Medicare and Medicaid Services (CMS) on a regulatory framework and will be engaged every step of the way to ensure that the use of AUC in Medicare works to improve patient care and creates the minimum possible burden for physicians. Take a closer look at how your ACC is advocating for youPDF.

Lookout for Physician Fee Schedule and Hospital Outpatient Rules: Any day now, CMS is expected to release the 2015 final Physician Fee Schedule and Hospital Outpatient Prospective Payment System rules, which layout Medicare payment and quality provisions for next year. See what CMS proposed back in July. Stay tuned to the Advocate and CardioSource.org for information on the rules as soon as they are released. Be sure to save the date for two upcoming webinars that will help you navigate changes for next year. The first webinar, covering coding changes for 2015 and other documentation, will take place on Nov. 12 at 4 p.m. ET. You can also stay ahead of the coding curve by ordering the 2015 CPT Guide for Cardiovascular Coding. A second webinar will cover changes made in rulemaking, including those to the Physician Quality Reporting System program and the value-based modifier. This webinar will take place on Dec. 4 at 2:30 p.m. ET.

Protecting Children From e-Cigarette Advertising: Your ACC sent letters of supportPDF to Sen. Barbara Boxer (D-CA) and Rep. Elizabeth Esty (D-CT) for S. 2047/H.R. 4325, the "Protecting Children from Electronic Cigarette Advertising Act of 2014." E-cigarette use has risen sharply in youth in recent years. According to a Centers for Disease Control and Prevention study, the percentage of middle and high school students who had ever used e-cigarettes more than doubled from 2011 to 2012. Unfortunately, adolescents are particularly vulnerable to the adverse effects of nicotine – delivered through battery operated e-cigarettes in the form of an inhaled aerosol – because exposure increases the chance of developing premature heart disease and has lasting negative consequences for brain growth and development. Furthermore, research shows that adolescents who use e-cigarette devices are more likely to smoke conventional cigarettes and, once addicted, are less likely to quit using other tobacco products. This bill will prohibit the advertising, promoting or marketing of e-cigarettes to minors and will prevent children and teens from becoming the next generation of nicotine addicts.

ACC Supports Continued Funding for Children's Health Insurance Program: The College has also taken action to protect children by signing onto a joint letter urging Congress to secure continued funding for the Children's Health Insurance Program (CHIP) during the upcoming lame duck session. Specifically, the letter called for a four-year CHIP funding extension. Although the program is authorized through 2019, funding for CHIP expires in 2015. A lapse in funding for this crucial program could lead to significant disruption for state governments, private health plans, hospitals and numerous other stakeholders in addition to the families whose children are enrolled in the program. "For nearly two decades, CHIP has been an essential source of coverage for families, ensuring access to high-quality, affordable, pediatric-appropriate health care for children in working families whose parents earn too much to qualify for Medicaid but too little to purchase private health insurance," notes the letter. "If Congress fails to act now, the 10.2 million children estimated to be enrolled in CHIP in FY 2015 will be at risk of having their health coverage disrupted." The letter comes shortly after the Senate Finance Health Subcommittee held a hearing titled, "The Children's Health Insurance Program: Protecting America's Children and Families," which focused primarily on the pending expiration of CHIP.

ClinicalTrials.gov Identifier Issued for TMVR: Since Jan. 1, 2014, CMS has mandated submission of a clinical trial number to report claims for items and services in clinical trials, clinical studies or registries that are required for coverage. The STS/ACC TVT Registry™ Mitral Module for trancatheter mitral valve repair (TMVR) recently obtained a clinical trial number. Medicare coverage with evidence development (CED) TMVR procedures in the STS/ACC TVT Registry will use identifier NCT02245763. As a reminder, those who participate in trials or coverage-mandated registries (STS/ACC TVT Registry and the ICD Registry™) can locate relevant clinical trial numbers at ClinicalTrials.gov. CED implantable cardioverter defibrillator procedures in the ICD Registry will use identifier NCT01999140. CED transcatheter aortic valve replacement procedures in the STS/ACC TVT Registry will use identifier NCT01737528. More information is available through the Medical Learning NetworkPDF.

Changes Ahead for Modifier 59: CMS has established four new Healthcare Common Procedure Coding System modifiersPDF to define subsets of the 59 modifier, a modifier used to define a "Distinct Procedural Service." Beginning on Jan. 1, 2015, providers can use the X modifiers if they are currently using modifier 59 for a reason within the published definition of the X modifiers. Providers also have the option to continue using modifier 59 until CMS issues examples of circumstances in which the X modifiers are or are not appropriate. Additional direction on the use of the specific modifiers will be published in by CMS as it is released.

In the News: The implementation of pilot Accountable Care Organization (ACOs) has demonstrated an inability to limit the use of discretionary or non-discretionary cardiovascular care in ten large health systems, according to a study published recently in Circulation. It is the general hope that providers participating in ACOs will cut costs by reining back on discretionary care where it is safe and appropriate, all while holding onto current levels of provision of non-discretionary, high-value care. This new study sought to determine whether these results were in fact taking place. Employing evidence from the Physician Group Practice Demonstration (PGPD), a pre-ACO demonstration project on which much of the ACO program is modeled, the authors compared the use of cardiovascular care before and after PGPD implementation, studying both discretionary and non-discretionary carotid and coronary imaging and procedures. The authors ultimately found that despite the investment of millions of dollars into the infrastructure, there was no difference in trends in utilization of either discretionary or non-discretionary cardiovascular imaging or procedures between the PGPD groups and local controls. The groups were similar in both the pre-PGPD period and the post-PGPD period on all metrics of utilization that the authors examined. Read more.