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ACC Advocate

Promoting Strong Practices, Protecting Patient Access

Current Issue - September 26, 2014

One Year Countdown to ICD-10 (Again): The Department of Health and Human Services issued a rule finalizing Oct. 1, 2015, as the new compliance date for the conversion from ICD-9 to ICD-10. Will your practice be ready? Join ACC on Oct. 1 at 4 p.m. ET, one year ahead of implementation, for a webinar that will go over updated timelines and cardiology specific ICD-10 information to ensure your practice is prepared. The webinar will delve into guideline changes and discuss how your office should be preparing for modifications that will begin on Oct. 1, 2015. Register now. To ensure that the transition to ICD-10 is running smoothly, the Centers for Medicare and Medicaid Services will be conducting end-to-end testing Jan. 26-30, 2015. Providers who are interested in participating in the testing should complete a volunteer form, available through their Medicare Administrative Contractor, by Oct. 3.

State Advocacy in Action: California Governor Jerry Brown has signed into law S.B. 906, a measure strongly supported by the ACC's California Chapter. The law creates the Elective Percutaneous Coronary Intervention (PCI) Program in the California Department of Public Health. It also authorizes certification of general acute care hospitals that provide urgent and emergent cardiac catheterization laboratory service. In order to be certified, a hospital must provide proof that it follows ACC, American Heart Association and Society for Cardiac Angiography and Interventions recommendations for performance of PCI without onsite cardiac surgery, and agree to participate in and provide timely data to the NCDR.

Pulse Ox Wins: Three states are working toward joining the 40 that have mandated pulse oximetry screening for critical congenital heart disease (CCHD). The Rhode Island Department of Health has completed work on regulations that will become effective July 1, 2015. The Mississippi Department of Health has scheduled a vote on pulse oximetry regulations at its October meeting. According to Thad F. Waites, MD, FACC, a member of the ACC's Board of Trustees, the regulations will take effect immediately. Additionally, Washington State Rep. Dawn Morrell, a cardiac nurse, has written a letter to her state's department of health urging it to consider pulse oximetry regulations at its October meeting. Passing CCHD screening legislation is one of the College's state advocacy priorities and the ACC is continually working with local ACC Chapters, ACC's Adult Congenital and Pediatric Cardiology Section, and partners such as Mended Hearts and Mended Little Hearts to ensure the voice of CCHD patients and caregivers is heard on the state level as well as Capitol Hill.

Senate Finance Committee Examines CHIP Expiration: Last week, 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 the Children's Health Insurance Program (CHIP). 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. Panelists at the hearing cited difficulty with planning state budgets for 2016 because of uncertainty that the program would exist beyond its expiration date. Other panelists noted the challenge of a straight reauthorization of the program in a new regulatory environment, particularly those related to the Affordable Care Act. Sen. Jay Rockefeller (D-WV), one of the original architects of the program, and Rep. Henry Waxman (D-CA) have introduced legislation which would extend the program for four additional years, through 2019. In its June report to Congress, the Medicaid and CHIP Payment Access Commission called for the program to be extended for only two additional years. Stay tuned for developments.

Words of Wisdom: Fellow-in-training Howard Julien, MD, and Nicolas W. Shammas, MD, FACC, interviewed Sen. Charles Grassley (R-IA) last week while on Capitol Hill during ACC's Legislative Conference. Grassley weighed in on funding for graduate medical education and research, practice stability, Sustainable Growth Rate repeal, and the In-Office Ancillary Services Exception, and encouraged cardiovascular professionals to engage with lawmakers year round. "We would profit considerably by having more doctors being politically active...in the process of government," said Grassley. Visit the FITs on the Go video blog for additional coverage of Legislative Conference.

Voicing Support for Medicaid Payment Parity: Your ACC joined with twenty other medical societies to send a letter of supportPDF to Sens. Patty Murray (D-WA) and Sherrod Brown (D-OH) for introducing the Ensuring Access to Primary Care for Women and Children Act (S. 2694). This legislation would extend current-law payment rates under Medicaid for certain services to at least the level of Medicare through 2016. The bill ensures that physicians practicing in the specialties of family medicine, pediatrics, and internal medicine as well as related internal medicine and pediatric subspecialists continue to receive Medicare-level reimbursement rates for providing primary care and related subspecialty services to patients enrolled in Medicaid. A House version of the bill has been introduced by Rep. John Lewis (D-GA).

Addressing Impending Medical Isotope Shortage: Earlier this month, your ACC signed-on to a coalition letter of supportPDF to the Department of Energy (DOE) to address the impending shortage of molybdenum 99 (Mo-99), a critical medical isotope used in over 20 million nuclear medicine procedures per year in the U.S. to help diagnose heart disease and cancer. We are currently two years away from a patient access crisis due to a scheduled stop in the production of Mo-99 at Canada's National Research Universal reactor in October 2016. With a shelf-life of only 66 hours, Mo-99 cannot be stockpiled, and therefore reliable production is considered critical medical infrastructure. New U.S.-based technologies have demonstrated strong progress toward filling the supply gap, while solving nuclear proliferation issues, but additional support is still needed to get these technologies to the market. The American Medical Isotope Production Act of 2012 calls for the DOE to support commercialization of a reliable domestic source of Mo-99 as soon as possible. The DOE has an existing program with funding to do so and at this point, no new funding or legislation is required. However, changes to how the DOE is operating the current program are necessary to reduce the time it takes for any of the current promising initiatives to reach the commercialization stage and begin to put Mo-99 into the market. Those who signed the letter include organizations of patients, health care providers, medical imaging companies, radiopharmaceutical manufacturers and distributors.

PQRS GPRO Deadline Ahead: Groups of 10 or more eligible professionals (EPs) wanting to participate in the Group Practice Reporting Option (GPRO) for the 2014 Physician Quality Reporting System (PQRS) reporting period have until Sept. 30 to register. Group practices that successfully register and report will avoid the automatic -2.0 percent payment adjustment in 2016 for non-reporting. Group practices not participating in the GPRO can avoid the payment adjustment if at least 50 percent of EPs in the group participate in PQRS as individuals and meet the applicable reporting requirements. Registration is not required for individual EPs participating in PQRS via claims, a qualified PQRS registry, a qualified clinical data registry or electronic health record.

ACC Updates Choosing Wisely Heart Attack Recommendation: In response to new science showing that complete revascularization of all significantly blocked arteries leads to better outcomes in some heart attack patients, the ACC has withdrawn its Choosing Wisely recommendation that patients and caregivers examine whether this practice is truly necessary. As part of its American Board of Internal Medicine Foundation Choosing Wisely list of five things providers and patients should question released in April 2012, the ACC recommended questioning any intervention beyond unblocking just the "culprit" artery responsible for the heart attack in a hemodynamically stable patient. At the time the list was released, there were several nonrandomized studies demonstrating harm to patients when treating all significantly blocked arteries. However, over the past two years, new science has emerged showing potential improvements for some patients in their overall outcomes as a result of complete revascularization. Read more.

Global CVD in the Spotlight: With the United Nations poised to debate and decide its Sustainable Development Goals for 2015 and beyond, the cardiovascular diseases community has a rare opportunity over the next few months to convince international bodies to devote appropriate resources to curb the rise of noncommunicable diseases, including cardiovascular disease and stroke, according to a statement published this week from the Global Cardiovascular Disease Taskforce. The statement, published in the Journal of the American College of Cardiology (JACC), comes a week before the cardiovascular community will come together to build awareness of heart disease as part of World Heart Day. Given that the majority of cardiovascular disease is caused by food intake, physical activity levels and living environment, this year's World Heart Day will focus on promoting heart healthy environments where people live, work and play. Stay tuned to ACC's Facebook page and Twitter feed on Sept. 29 for World Heart Day messages.

ACC Chapters Key to Achieving College's Strategic Goals: "ACC chapters offer a uniquely personal touch point for members," writes ACC CEO Shalom Jacobovitz in a recent Leadership Page in JACC. The piece provides specific examples of ways ACC Chapters are providing rich member experiences from residency to retirement, whether its tailored educational programming, unique, local networking opportunities, or on-the-ground advocacy efforts. Jacobovitz notes that the continued success of ACC chapters is paramount to the success of the College. "It is by harnessing the power of these local organizations to advocate for and engage members and to strive for action-oriented, results-driven performance in the states that the ACC can make a difference," he says. "I look forward to seeing big things in the states over the coming year."