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Advocacy Newsletter - July 12, 2012

Testifying before the Senate: Yesterday, W. Douglas Weaver, MD, MACC, testified on behalf of the ACC during a Senate Finance Committee hearing that addressed problems plaguing the current Medicare physician payment system and sought to identify new payment models and quality initiatives that incentivize high quality and high value care at reduced costs. This was a vital opportunity for the College, one of only five provider groups invited, to reiterate its long-term dedication to exploring innovative payment models in Medicare and abolishing the sustainable growth rate. According to the testimony, "the current uncertainty in the future stifle both our practices and our hospitals in making real investments aimed at improving integration and reducing the current fragmentation of care and reducing waste." Weaver took this opportunity to discuss how ACC's quality initiatives are sparking innovation. "This morning, Dr. Doug Weaver provided examples of real programs that are making a difference in patient care. These programs support evidence-based care by providing feedback to physicians about their performance and by allowing the patient and physician to work together to make appropriate decisions," said ACC President William Zoghbi. Read full coverage of the hearing and stay tuned for an ACC in Touch Blog post.

Fixing a flawed formula: Following the release of the 2013 Medicare Physician Fee Schedule last week, ACC President William Zoghbi, MD, FACC, released a statement on behalf of the College. "The proposed Medicare physician fee schedule rule released today undeniably has negative consequences for physicians and their patients. In addition to the mandated 27 percent SGR cut, CMS proposes an additional 3 percent reduction for cardiovascular services," said Zoghbi. "With the ACA ruling behind us, it's time to continue down the path to health care reform. The American College of Cardiology's goal is a sustainable system that rewards quality and focuses on patient-centered care. While this rule takes steps in that direction, it is undermined by old ways of cutting payments without improving quality." Read more about the rule's impact on cardiology.

Hard work pays off! McKesson Health Solutions has announced that it will reverse problematic coding changes in response to pressure from the ACC along with the American Society of Echocardiography (ASE) over the past year and a half. The change impacts coding edits that deny separate payment for echocardiogram interpretations when performed on the same date of service as an inpatient evaluation and management (E/M) visit. McKesson anticipates that the complete removal of these edits for each insurer may take anywhere from three to seven months due to necessary software updates. In the meantime, the ACC and ASE recommend that cardiovascular professionals continue to bill these procedures with the most appropriate modifier. Find out more.

On the road to improving device safety: The Food and Drug Administration (FDA) recently released the proposed rule covering the unique device identifier (UDI). Upon full implementation, the UDI will allow the FDA to track individual devices in the event of a recall or safety concern. The proposed rule would require device packaging and labeling to include a UDI in plain-text and in a form that uses automatic identification and data capture technology. Certain categories of devices, such as implantables and those intended for reuse, will also need to have the UDI imprinted upon them directly. With the passing of the FDA Safety and Innovation Act earlier this week, the Agency is required to release a final rule within six months of the close of the notice and comment period and implement the UDI for implantable, life-saving and life-sustaining devices within two years from the release of the final regulations. Public comments are due to the FDA by Nov.7 and can be submitted at www.regulations.gov.

Three day payment window in the spotlight: As more cardiologists have moved into hospital employment, their practices are faced with some new regulations and requirements that can vary from those that apply to physicians in private practice. The "three day payment window" rule, intended to prevent hospitals from unbundling services from an inpatient stay and providing them in the three days prior to the admission so that they are separately paid, is one of the regulations that has garnered some attention recently. In recent years, as part of rulemaking for both physicians and hospitals, the Centers for Medicare and Medicaid Services (CMS) issued two changes/clarifications with important ramifications for cardiologists. Your ACC has urged CMS to delay the implementation due to concerns that the implications of the rule were not fully considered and significant confusion on the part of physicians and hospital administrators regarding what is required of them. Read about the changes CMS made and find out what this means for hospital-owned practices.

Weigh in on AUC: As the College's appropriate use criteria (AUC) documents have taken on a central role in the process of reviewing patterns of care for patients, additional feedback on the process and terminology has been received from stakeholders. The AUC Task Force has constructed a survey to gather additional input. Help Your ACC improve and enhance the AUC process by taking the survey by July 18.

Did you hear? CMS recently released new educational materials indicating that a long delayed policy regarding payment for services ordered or referred by non-Medicare providers may be effective in the near future. The policy, first announced in 2009, would deny payment for services ordered or referred by providers who are not enrolled in the Medicare program. Enrollment here does not require that providers participate in the Medicare program, merely that their information is contained within CMS' provider database. Practitioners will be given a 60-day notice before the policy takes effect and Your ACC will provide updates as needed. Get the details, including a sample letter for your referral sources, here.