Karen Collishaw

1
DC update

• Karen Collishaw
• Associate Executive Vice President
• Advocacy, American College of Cardiology
• Bethesda, MD

2
ACC legislative priorities
Medicare practice expense (i)

• Practice expense portion of fee schedule has been
  undergoing transformation over the last couple of
  years.
• Initial HCFA proposal had cuts of up to 24 in
  cardiology payments, but a change in methodology
  has allowed for the transition to a new system.
• This transition was to have taken 4 years.

3
ACC legislative priorities
Medicare practice expense (ii)

• 2 years into this transition and the refinements
  have still led to cuts in specialty medicine.
• The ACC and other specialty groups have brought
  forward a new proposal to congress, that the
  transition be halted at this point.
• Any proposal requires good averaging of all
  practice expenses that MDs incur delivering
  service to Medicare beneficiaries.

4
ACC legislative priorities
Medicare practice expense (iii)

• The new proposal would exempt from this
  transitional halt all office visit and
  consultation codes that are scheduled to increase
  by 2002.
• All provider groups are asking congress for some
  relief from balanced budget cuts made several
  years ago.
• MDs are forwarding a proposal that aims to help
  everyone.

5
ACC legislative priorities
Medicare practice expense (iv)

• The new proposal results in a net positive impact
  for almost every specialty, including primary
  care.
• The AMA has also adopted this policy.
• All cardiovascular specialists need to write to
  their member of congress highlighting a need for
  change in the practice expense methodology.

6
ACC legislative priorities
Managed care reform (i)

• This issue is represented in the Patients Bill
  of Rights.
• Both the house and the senate passed bills last
  year that yet need to be reconciled in conference
  committee.
• During an election year, resulting laws may be
  weak, but touted as amazing achievements, or may
  simply be vetoed.
• There is a pressure for each party to do
  something.

7
ACC legislative priorities
Managed care reform (ii)

• Regarding a proposed Patients Bill of Rights,
  the managed care conference committee has had
  difficulty in determining
• (1) the scope of the bill (ie, coverage of all
  Americans or just those in protected plans)
• (2) whether HMOs should be held accountable (and
  liable) for decisions made in treatment

8
ACC legislative priorities
Managed care reform (iii)

• Democrats in general have been very supportive in
  getting the bill passed.
• The house bill is endorsed by the ACC and all
  medical groups, including the AMA and is stronger
  than the senate bill.
• In June, the Democrats attempted to pass a new
  senate bill that mirrors the house bill, but were
  unsuccessful by 1 vote.

9
ACC legislative priorities
Coverage for the uninsured

• Renewed attention has been given to this issue,
  in part because of the election year.
• The ACC is working with a coalition of interested
  groups to put together a proposal in the next few
  years.

10
ACC legislative priorities
Ambulatory patient classifications (i)

• Attention is focused on a new Medicare outpatient
  ambulatory patient classification (APC) scheme.
• In the past, outpatient services were classified
  according to a retrospective cost analysis.
• The new APC system is prospective, and analogous
  to the DRG system in hospitals.
• Like services will be grouped together in the
  outpatient setting.

11
ACC legislative priorities
Ambulatory patient classifications (ii)

• The new scheme has been made effective as of
  August 1.
• The new APC has an indirect impact on
  cardiologists and cardiovascular specialists.
• At the current time, there appears to be no
  logical relationship between the proposal to pay
  in an outpatient setting versus the proposal to
  pay in a physician office setting.

12
ACC legislative priorities
Ambulatory patient classifications (iii)

• The scheme allows for a pass-through, where new
  devices and drugs are to be treated differently
  (ie, an interim payment).
• The new plan also requires all angioplasty
  performed on an outpatient basis to have
  immediate surgical backup. The exact definition
  of these terms has yet to be determined and
  implementation of this rule awaits the results of
  an ongoing debate at the ACC regarding surgical
  backup requirements in angioplasty.

13
ACC legislative priorities
Immediate surgical backup

• At the ACC, 2 documents are currently being
  updated
• - guidelines for cardiac catheterization (in
  conjunction with the AHA)
• - catheterization laboratory standards
• HCFA is awaiting the outcome of these documents
  before proceeding with the enforcement of what
  may be a relative distinction.

14
ACC legislative priorities
Chest pain observation centers

• The APC scheme also denies payment for
  observation care, and this directly affects chest
  pain observation centers.
• Chest pain centers may avoid costly admissions by
  taking the time to observe patients with some
  symptoms of acute myocardial infarction.
• HCFA does acknowledge that the literature shows
  chest pain centers to improve efficiency and save
  costs.

15
Election year outcomes

• If the Democrats win the presidential election,
  there will be a greater chance of passing the
  Patients Bill of Rights, and the issue of the
  uninsured will be brought to the forefront.
• If the Republicans win the presidential election,
  there will be a greater opportunity to pull back
  the regulatory burden that HCFA places on
  everybody participating in Medicare, and tort
  reform may gain prominence.

16
Payer advocacy issues
Collective negotiation

• Several state action doctrines allow MDs to
  collectively negotiate with managed care
  companies.
• A number of MD specialty groups are working in
  coalition to pass a similar measure, the Campbell
  bill, at the federal level.
• Prompt payment issues have also passed.
• Kentucky was able to ban all-product clauses in
  insurance company contracts.

17
Payer advocacy issues
Anti-competitive behavior

• The College is attempting to work primarily with
  state medical societies and focus on local
  issues.
• State medical societies and the AMA have
  approached insurance agencies who may be using
  unfair tactics and all-product clauses, in order
  to bring pressure onto the payers.
• The federal trade commission may also become
  involved.

18
How to get involved

• Cardiologists should keep themselves informed of
  the issues at a very high level so that they may
  have a say while the issue is still in play.
• Become involved both locally and federally.
• Read Advocacy Weekly, from the ACC.
• The most effective advocacy programs combine
  grassroots advocacy with regular access to
  legislators.
• Communicate with your state official or member of
  congress on important issues.