Wide access to imaging, increasing Medicare physician payment, and reforming the medical liability system still top this year's agenda for the American College of Cardiology. “They are all battles that have not yet been won,” said Dr. Pamela S. Douglas, ACC president.
Officials at the ACC have partnered with the Coalition for Patient-Centered Imaging, which also includes the American Society of Nuclear Cardiology and the Heart Rhythm Society, to ensure that imaging services are not restricted. Dr. Douglas said officials at the ACC want to ensure that all properly trained physicians continue to be able to perform and be paid for imaging services. The college has urged Congress to oppose efforts to impose physician certification policies benefiting one specialty over another. ACC officials also have opposed efforts to expand accreditation requirements for independent diagnostic testing facilities to physician offices. But the growth in imaging should be done with quality in mind, Dr. Douglas said.
Without a fix to the Medicare physician payment system, this year's planned 4.4% cut will be the first of many years of cuts to physician fees for seeing Medicare patients. As a result, Dr. Douglas said ACC supports the elimination of the current Sustainable Growth Rate formula used in calculating physician reimbursement levels. The SGR is tied to changes in the gross domestic products, which does not accurately reflect the cost of providing care to Medicare patients, according to the ACC. Instead, the SGR should be replaced with a medical growth formula, Dr. Douglas said. As cardiovascular care is increasingly successful, patients are living longer but require more care to stay well. But the current payment system fails to recognize the complexity of care delivered by cardiologists, she said.
Medical Liability Reform
ACCofficials have partnered with Doctors for Medical Liability Reform in a multiyear effort to win federal legislation to help curb rising professional liability insurance premiums. Last year, the House moved forward on medical liability reform by passing the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act (H.R. 5), which would have imposed a $250,000 cap on noneconomic damages. But the issue failed in the Senate.
Pay for Performance
On the regulatory side, Dr. Douglas said ACC favors efforts to develop pay-for-performance programs as long as they are properly designed. But it's key that the programs include incentives for physicians and are not used solely as a way for payers to contain costs. There is a cost to physicians for tracking and reporting quality, Dr. Douglas said, and those costs need to be covered.
Redding Doctors Settle
Four physicians accused of performing unnecessary heart surgeries at Redding (Calif.) Medical Center have agreed to pay a total of approximately $27 million to settle lawsuits. The money will go to compensate patients and the Medicare and Medi-Cal programs. In addition, the Tenet Healthcare Corporation, which used to own Redding Medical Center, will pay $5.5 million. Tenet has already paid $54 million to settle claims that it defrauded the government by billing Medicare for unnecessary cardiac catheterizations and bypass surgeries. Two of the physicians from Redding Medical Center have also agreed to never again perform cardiology procedures or surgeries on Medicare, Medi-Cal, or TRICARE patients. Under the terms of the settlement, the physicians have received a commitment that the U.S. Attorney's Office will not initiate criminal charges against them.
New Head for FDA Women's Health
Dr. Kathleen Uhl has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, was most recently a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said Dr. Andrew von Eschenbach, FDA acting commissioner. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. She also has dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.
Groups Sue Over Part D
Countless numbers of poor men and women “will fall through the cracks” during transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual-eligible” patients—those who are enrolled in both Medicare and Medicaid—will lose their Medicaid drug coverage on Jan. 1. The groups said they're seeking protections for patients who are not seamlessly and immediately transitioned to the new drug program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or only have a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokesman with the Centers for Medicare and Medicaid Services said the agency was not commenting on the pending lawsuit.