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ACC Advocate

Promoting Strong Practices, Protecting Patient Access

Current Issue - April 10, 2014

Data Dump: The Centers for Medicare and Medicaid Services (CMS) has released data on the health care services delivered by individual physicians in 2012 and how much Medicare paid for these services. As of April 9, Medicare Part B Fee-For-Service data are available on more than 880,000 health care professionals across all 50 states and will include 6,000 types of services and procedures. Data is available in Excel by provider last name here. While your ACC is disappointed and troubled by the decision to publicize physician payment data without risk adjustment or description of the context, it is important to realize that patients may view these data as an opportunity to raise questions about the care they receive. The College encourages physicians to engage with patients about their care and provide additional perspective so that they may gain a fuller understanding of the context in which Medicare payments are made. This is also an opportunity to educate patients about clinical practice guidelines and appropriate use criteria that contribute to careful decision-making.

CA Imaging Legislation: Your ACC and the ACC California Chapter (CA-ACC) are working with cardiovascular specialist organizations, the California Medical Association and a broad range of stakeholders 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. CA-ACC members are meeting personally with lawmakers to educate them on how SB 1215 will diminish patient care and a chapter-wide grassroots campaign is underway. In addition, Chapter leaders will speak in Sacramento on April 21 in opposition to the bill. We are carefully monitoring this legislation to ensure such sweeping prohibitions are not copied by other states.

Beyond the Patch: The “Protecting Access to Medicare Act of 2014” does more than delay the 24 percent Medicare physician payment cut stemming from the Sustainable Growth Rate (SGR) formula for yet another year. The law also delays ICD-10 implementation and includes a requirement for consultation with appropriate use criteria (AUC) and clinical decision support for advanced diagnostic imaging. Here are some more details:

  • ICD-10: The law delays ICD-10 from Oct. 1, 2014 to as early as Oct. 1, 2015. Your ACC will closely follow what CMS and industry are saying going forward regarding what practices should do now for ICD-10. ACC will release additional information as soon as it becomes available.
  • AUC: The law also includes development of an AUC program for certain advanced imaging services. This includes MRI, CT, nuclear medicine, and PET. The law directs CMS to specify applicable AUC by Nov. 15, 2015 and to specify qualified decision support mechanisms for use by ordering physicians by April 1, 2016. AUC reporting is required to begin Jan. 1, 2017. Low adherence ordering professionals face prior authorization requirements in 2020. Critical implementation details remain to be worked out by CMS. Your ACC 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.

Your ACC is following these and other provisions closely and will work with members to understand and meet requirements as they are developed.

PQRS Group Registration Now Open: As of April 1, group practices can self-nominate and select the Group Practice Reporting Option (GPRO) web interface, registry reporting mechanism, or the CMS-calculated administrative claims reporting method for the 2014 PQRS reporting period. Practices already submitting data to the ACC's PINNACLE Registry can learn more about PQRS opportunities, here.

Coding Update: The American Medical Association has released its Category III CPT coding update. These updated codes have an effective date of Jan. 1, 2014 although they are not in the 2014 HCPCS book. Cardiovascular codes to note are the Category III codes for Transcatheter Mitral Valve Repair Percutaneous. Read more on the AMA website. PDF

News You Can Use: The Food and Drug Administration (FDA) has approved the anticoagulant dabigatran (Pradaxa) "for the treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients who have been treated with a parenteral anticoagulant for five to 10 days, and to reduce the risk of recurrent DVT and PE in patients who have been previously treated," according to a press release from Boehringer Ingelheim Pharmaceuticals, Inc. Read more.

A new research letter published in the Journal of the American Medical Association evaluates the evidentiary rationales used by specialty societies to create their Choosing Wisely Top 5 lists of things patients and physicians should know about certain procedures. Choosing Wisely is an initiative of the ABIM Foundation to help physicians and patients engage in conversations to reduce overuse of tests and procedures, and support physician efforts to help patients make smart and effective care choices. As of August 2013, 25 participating specialty societies, including the ACC, had produced one or more Top 5 lists containing a total of 135 services. "As Choosing Wisely continues to grow, clarity on the evidentiary justifications for the lists will be crucial for the overall credibility of the campaign," the authors write. Learn more about the efforts and download physician and patient resources.