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ACC Advocate

Promoting Strong Practices, Protecting Patient Access

Current Issue - April 17, 2014

Patient Access to Imaging Under Fire in CA: In an effort to defeat California Senate Bill 1215 (S.B. 1215), which seeks to remove the in-office ancillary exception for advanced modality imaging and many other services performed outside cardiology, your ACC has joined numerous other medical organizations in signing onto a Coalition for Patient Centered Imaging letter PDF sent to the California Senate. The letter points to a Medicare Payment Advisory Commission report from 2011 that recommended against limiting the Stark law exception for ancillary services. "There is widespread agreement that improving the U.S. health care system will require more care coordination, not less," the letter underscores. "The in-office exception recognizes that referrals within a group practice promote continuity of care in a setting that is lower cost, more convenient, and familiar to the patient." ACC California Chapter (CA-ACC) members have been meeting face-to-face with lawmakers to educate them on how the bill will diminish patient care and CA-ACC members and cardiovascular patients will speak in Sacramento in opposition to the bill on April 28. Stay tuned for developments.

Changes Coming to HHS: President Barack Obama announced last week that he will nominate Sylvia Mathews Burwell, current director of the Office of Management and Budget, to be the next secretary of the Department of Health and Human Services (HHS). Burwell would replace current HHS Secretary Kathleen Sebelius who announced she is stepping down from her position. "Kathleen Sebelius has presided over the Department of Health and Human Services during a challenging and crucial time in our evolution towards a new paradigm for health care," said ACC President Patrick T. O'Gara, MD, FACC. "On behalf of the ACC, I thank her for her dedicated service and wish her well in her future endeavors. The College looks forward to working with her successor to promote the interests and health of cardiovascular patients."

EHR Deadline Ahead: In order to avoid a penalty in 2015, physicians must begin participating in the Electronic Health Record (EHR) Incentive Program by July 1, 2014 and must attest to 2014 participation by Oct. 1, 2014. Physicians struggling to meet the requirements for the program must submit hardship exception applications by July 1, 2014 at midnight (ET). View a newly expanded list of exceptions. Navigate the EHR Incentive Program based on your level of participation.

2014 PQRS Program Update: Starting in 2015, the Centers for Medicare and Medicaid Services (CMS) will apply future negative Physician Quality Reporting System (PQRS) payment adjustments to providers who do not satisfactorily report data on quality measures for covered professional services. Beginning in the 2014 program year, different thresholds for measures reported across the National Quality Strategy domains have been introduced for PQRS adjustment avoidance and incentive eligibility. Did you know that PINNACLE Registry® participants can seamlessly take part in federal quality reporting programs, including PQRS? For the 2013 Program Year, the PINNACLE Registry submitted data on behalf of 1,236 providers across 96 practices.

Two Midnight Rule Reminder: CMS has notified hospitals that Medicare Administrative Contractors (MACs) PDF have been conducting prepayment patient status probe reviews on a sample of 10 claims for the majority of hospitals (25 claims for large hospitals) with admission dates on or after Oct. 1, 2013 as part of the "two midnight" rule. While the education component of the process has begun, MACs have been directed to wait 45 days before requesting additional documentation from providers. "These ‘probe and educate' reviews are being conducted to assess provider understanding and compliance with CMS policy on inpatient hospital and critical access hospital (CAH) admissions," according to CMS. "Based on the results of the initial reviews, the MACs will conduct individualized educational efforts and repeat the process where necessary."

Pushing for Pulse Ox: After years of medical specialty societies and patients advocating for universal screening of critical congenital heart disease (CCHD) in newborns, pulse oximetry has finally become routine in the majority of states. "In 2011, at the urging of the American College of Cardiology and others, the Department of Health and Human Services recommended adding pulse oximetry to routine newborn screenings," noted ACC President Patrick T. O'Gara, MD, FACC, in a Washington Post letter to the editor. "So far, 35 states require this simple, non-invasive test. However, until all newborns are given this test and those with heart defects are given every chance to live, our work is far from done." CCHD legislation is one of the ACC's state advocacy priorities and the College is continually working with Chapters, partners and the Adult Congenital and Pediatric Cardiology section to ensure the voice of CCHD patients and caregivers is heard on the state level as well as Capitol Hill.