ACC 2007 Congressional Agenda
Replacing the sustainable growth rate tops the legislative agenda at the American College of Cardiology, Dr. Jack Lewin, the new college CEO, said at a briefing last month. “We have to look for a stable approach” to physician payment, said Dr. Lewin, adding that it's “a big challenge.” When asked about a draft report on alternatives from the Medicare Payment Advisory Commission (MedPAC) that is in circulation, he said, “What I've read doesn't inspire me.” Dr. Lewin, formerly CEO of the California Medical Association, said the ACC recruited him largely because of his experience with benchmarking and pay for performance. Working with Congress and MedPAC on developing “reasonable” quality reporting measures will also be a priority for ACC, along with promoting interoperability of health information technology and improving access to care, he said.
Heart Disease Still No. 1 Killer
The American Heart Association's latest statistics show that heart disease is still the top killer in the United States, with stroke coming in at no. 3. The AHA's 2007 report contains data from 2004, the most recent year for which statistics were available. Cardiovascular disease is the underlying cause for 36% of deaths in America, according to the report. Incidence of stroke, which affects 700,000 people a year, is due to rise precipitously: By 2032, an estimated 275,000 Americans will die from ischemic stroke, a 100% increase from 2000, the AHA said. The AHA wants more patients and physicians to get the message that at least as many women are affected by cardiovascular disease as men. Each year, about 461,200 women die from cardiovascular disease, compared with 410,400 men. At an AHA-sponsored meeting with reporters last month, Dr. Susan Bennett, director of the Women's Heart Program at George Washington University Hospital, Washington, said that while the death rate for men has declined 10% since 1979, it has stayed the same or increased for women. Dr. Bennett is leading the AHA effort to secure congressional passage of the HEART for Women Act, which had 189 sponsors in the last Congress. The bill will be reintroduced this month, according to the AHA.
Unique New Drugs on Decline
The Food and Drug Administration only approved 18 new molecular entities—including 4 biologics therapies and 4 new vaccines—last year, on par with the previous year, but close to a historic low. Throughout the 1980s and 1990s, the agency approved at least 20–30 NMEs annually. The paltry number of approvals and a Government Accountability Office report issued in December may point to a decline in new drug development, according to Rep. Henry Waxman (D-Calif.), Sen. Richard Durbin (D-Ill.), and Sen. Edward Kennedy (D-Mass.). The legislators requested the GAO report, which found that huge increases in drug industry research and development from 1993–2004 were not accompanied by a similar rise in new drug applications to the FDA. From 1993–2004, research and development spending increased 147%, while NME applications increased by only 7%. “These submission trends indicate that the productivity of research and development investments has declined,” the GAO report said. Further, over the same period, FDA has continued to approve most submissions, but the number approved overall has declined.
Cardiac Cath Injection Code Added
The Centers for Medicare and Medicaid Services will now pay national rates for two cardiac catheterization injection codes, CPT 93539 and CPT 93540. The ACC and the Society for Cardiovascular Angiography and Interventions prevailed upon CMS to make an emergency update to the 2007 Medicare physician fee schedule. The two codes previously were priced by local Medicare carriers. Now they have been assigned relative value units, allowing them to be priced nationally, according to ACC. Local Medicare carriers can still price the technical component of the following injection codes, however: 93501, 93533, 93555, and 93556.
Part D Battle Begins in Congress
As promised during the midterm elections, House Democrats began work immediately on tweaking Medicare's Part D drug coverage. Rep. John Dingell (D-Mich.) along with 189 colleagues introduced H.R. 4, the Medicare Prescription Drug Price Negotiation Act of 2007, which would require the Health and Human Services department to negotiate prices with drugmakers. The legislation was passed by the House in January by a vote of 255–170. The Senate Finance Committee held hearings Jan. 11 to investigate the impact of price negotiations. If the legislation is enacted as currently written, new prices would go into effect for the plan year beginning Jan. 1, 2008.
FDA Panels Held Less Often