ACC Says Quality Is Job #1
The American College of Cardiology has launched a preemptive strike in the likely upcoming battle for health reform. The organization and 300 member-cardiologists spent a day last month lobbying Capitol Hill, armed with ACC's new QualityFirst campaign and evidence that cardiologists are already collecting quality data and crunching numbers to improve care. The QualityFirst campaign, which will be focused inside the Beltway, backs cost-effective, quality care; payment incentives; increased transparency; and coordination across care sites. “The current system and its focus on quantity, not quality, is unsustainable,” said Dr. W. Douglas Weaver, ACC president, at a press briefing. The ACC also shared results of a poll of 1,003 likely voters conducted for the organization. Eighty-six percent of respondents said they'd trust physicians or medical or patient advocacy groups to set quality standards. In addition, 83% agreed that ACC's QualityFirst objectives were extremely or very important, and 64% said the organization's top priority should be setting new standards for health reform.
CMS Proposes Denial of CAS
The Centers for Medicare and Medicaid Services has proposed to keep the status quo—no coverage—of percutaneous transluminal angioplasty (PTA) of the carotid artery concurrent with stenting. The ACC, the Society for Vascular Medicine, and the Society of Vascular Interventional Neurology had asked the agency to reconsider and add coverage for patients who are at high risk for carotid endarterectomy because of defined anatomic factors, and who have symptomatic carotid artery stenosis of 50%-90% or greater or asymptomatic carotid artery stenosis of at least 80%. In comments on the proposed decision, the organizations again argued for coverage, citing “compelling scientific evidence” that revascularization prevents stroke, compared with medical therapy. “CMS should not require that CAS be superior to [carotid endarterectomy] to consider it a valid treatment option,” according to the groups.
CMS Alters Overpayment Policy
CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the agency can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, apply to most Part A and Part B claims for which a demand letter has been issued. The changes do not affect the appeal process or the normal debt collection and referral process, according to the CMS.
PQRI Frustrating, But Not Costly
A total of 90% of physicians answering a Medical Group Management Association survey said that they had trouble accessing their confidential 2007 Physician Quality Reporting Initiative (PQRI) reports from the Centers for Medicare and Medicaid's secure Web site. Overall, 70% sought CMS help in getting the reports; of those, 11% rated the help as not satisfactory. The PQRI reports received average marks for clarity and slightly lower ratings for providing guidance on improving outcomes. Even so, 90% of the practices said they would participate in the 2008 PQRI program. Survey responses were taken from 295 practices who said they had reported on PQRI measures from July to December 2007. When asked why they participated, the largest weight was given to preparing for the future, when quality reporting is anticipated to play a bigger role in Medicare reimbursement. Overall, 61% of practices earned a bonus from 2007. Most practices said that participation had not led to the need for more staff or higher expenses.