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November 12, 2009 - CMS Cuts Update
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Oregon Chapter of the ACC
CMS Cuts Update
November 12, 2009
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The Governor's Message...
Dear Oregon ACC Chapter Members,
Last week I outlined the four-pronged strategy that the ACC is taking to further curtail, mitigate and stop the "final" CMS rule on the 2010 physician fee schedule. These four prongs included a legislative approach to prevent implementation of the rule; a regulatory approach with the goal of protecting access to care and practice viability; a public awareness campaign approach; and an approach to mobilize members to help fund and succeed in this critical challenge. This strategy is starting to take form with concrete actions and parts were implemented this past week as outlined below.
This strategy, however, has met with some consternation and doubt among the BOG. Several Governors have expressed their strong desire to see the ACC take a more aggressive approach and forego further political negotiations with an unwilling Congress. Several of our subspecialty Societies, including the American Society of Nuclear Cardiology and the American Society of Echocardiography, have also complained that the ACC is not doing enough to counter the threat we face. These individuals and entities are arguing that its time to play "hardball" and "go to war". They advocate job actions such as dropping out of Medicare en masse or legal action such as suing CMS. I suspect that many of you may feel the same way.
I want to assure you that your ACC leadership understands the gravity of the situation and all options are being considered. It is important, however, to understand that the legal option is our last option and the ACC cannot advocate its members abandoning Medicare. These actions would also very likely be perceived poorly by members of Congress and by our patients. It is also important to understand that the problem we face with the CMS rule is a regulatory problem and that our best option is continued education of members of Congress regarding the consequences of the CMS cuts. Despite what many may think, we have been successful. With the support of a third of Congress CMS did bend to our pressure in the face of overwhelming support by the rest of the House of Medicine (link to opposing letter) and we can continue to be successful by leveraging that support going forward.
The nuclear option of legal action if taken too soon would actually be detrimental. Two years ago Maryland faced an issue regarding self-referral and in-office imaging. The state legislature voted to ban physician owned in-office imaging. Instead of trying to change the law legislatively, the state medical society sued and the issue in now tied up in court. Now that the issue is in court, the Maryland state legislature will not address the issue of self-referral despite the fact that there are now enough votes to repeal the law. We certainly do not want to replicate this experience before we have exhausted all out options. While it is natural to feel angry and feel the need to strike back against those who injure us, we have to keep our cool. This is a political process. It takes time and it requires give and take. We will not make progress or be successful if we scream and threaten. We will lose our access and support if we "play hardball". "Going to war" will only close doors. We do not want "bold and aggressive" action as some argue. We want "smart and productive" action. Such action has a greater chance of accomplishing our goals. I will continue to provide frequent updates on this critical issue as I receive new or additional information. In the meantime, stay cool.
Mike |
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CMS Cuts Update
So what has happened within the past week? The ACC advocacy staff was on the Hill last week and hand delivered thank you letters and campaign contributions to every member of Congress who supported us either by signing on to the Gonzalez-Rogers letter or by sending their own communication to CMS or Secretary Sebelius. We used this opportunity to continue to educate members about the unintended consequences of the CMS cuts. The ACC explained that not only are the cuts going to decrease access of seniors to critical cardiovascular services, but that the shift of these office based services to the hospital setting will result in higher costs overall and higher co-pays to Medicare recipients. The awareness of the "double whammy" of decreased access and increased cost especially for rural and disadvantaged populations is already making a big impact. Several Representatives were identified as possible candidates to author amendments to upcoming bills to put a moratorium on the cuts until the PPIS data can be validated. I should mention here that it is unlikely that any member of Congress will put forth a stand alone bill or amendment to one of the health care reform bills at this point, so that the most likely outcome will be an amendment to a required omnibus spending bill in early to mid December. I should also note that if the fall back position of using the 2005 supplemental data is accepted, we will still see cuts in cardiology reimbursement, but it won't be the 8% cut for 2010.
The ACC staff also spoke with members of the Office of Budget and Management. It is hoped that the White House via the OMB will be embarrassed enough by the "double whammy", given their stated objectives to increase access and lower costs, to take a stronger position on the cuts. We have been concerned that the cuts represented a concerted effort to target cardiology and make up for years of inequities with primary care. Jack Lewin spoke with Zeke Emanuel (brother of Chief of Staff Rahm Emanuel) Friday who stated that while there is a desire to promote primary care, there is no directed policy or strategy targeting cardiology and encouraged us to continue our efforts at educating Congress regarding the consequences of the rule. Jack plans more meetings this coming Monday.
The Interim House of Delegate Meeting of the American Medical Association met in Houston, Texas last week. Gene Sherman, Jerry Kennett, Kim Williams, Sam Wann, Suma Thomas, Jack Lewin, Jim Fasules, Kathy Flood and Rebecca Kelly represented the ACC. The ACC delegation was crucial in the House of Delegates passing Substitute Resolution 203 which opposed Medicare payment cuts for physician services to partially offset bonuses from one specialty to another and arbitrary restrictions on physicians who refer Medicare patients to high quality facilities in which they have an ownership interest. The AMA also passed a resolution supporting the repeal of the elimination of consult codes in the rule. The support of the AMA for our legislative efforts regarding the rule will be important in the weeks ahead.
What's up next? In the upcoming week the ACC plans to meet with CMS officials regarding the cuts to nuclear cardiology services due to the new bundled codes. The cuts to nuclear are based on the fact that the bundled service is represented by a new code. In the past new codes have represented new services and are not subject to past regulatory provisions. The rule treats the bundled nuclear codes as a new service and therefore the cuts were not phased in over four years as the other changes in the rule. The ACC is prepared to argue that this is a regulatory error. While the bundled nuclear service is represented by a new code, it does not represent a new service and as such should not be treated differently in the rule. Phasing in the nuclear cuts over four years will provide additional relief to the overall impact of the cuts in January.
The ACC is also planning to meet with other strategic organizations to garner support. This includes the AAFP, AHA and AARP. The latter is considered key to mounting an effective PR campaign and engaging seniors in the fight to protect their access to cardiology.
The ACC has also launched the PINNACLE Network. This goal of this registry-based cardiovascular network is designed to provide practices with the resources they need to survive in this rapidly changing environment. A crisis toolkit will also be available through the website within the next 7-10 days. I would encourage everyone to take a look at the website http://www.pinnaclenetwork.org/
What can you do?
1) Continue to write letters to our Congressional representatives about the impacts of the cuts on your practice and patient care. You can estimate the impact of the cuts by using an Excel calculator on the ACC website http://www.acc.org/advocacy/advoc_issues/practiceimpactinstructions.cfm
2) Engage your patients in this effort. Resources for engaging your patients can be found at www.acc.org/CAN.
3) Support the PAC. We cannot influence Congress without access to our lawmakers. PAC money makes it happen. In addition the public awareness campaign being envisioned will be on the order of $5M. We need everyone to participate and we need everyone to donate. Do it today.
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Support the ACC PAC
Again, I cannot overstate how important your PAC contributions are. 100% of your personal PAC contributions go to Legislators who are supportive of the ACC (on both sides of the aisle). Please donate to the PAC today. I would encourage every chapter member to consider an individual contribution of $1000. Be part of the "$1000 from 1000" Campaign. Go to https://www.accpacweb.org/ssl/
Finally, I would encourage every Chapter member to Support the OR ACC PAC.
Of the three House members from Oregon who signed the Gonzalez-Rogers
letter, the ACC PAC donated to two: Walden and Schrader. I cannot
overstate how important these PAC contributions are. Did the PAC
contributions buy their support? No. The PAC contributions provided us
critical access and with that access we had the opportunity to develop
relationships that translated into support for the OR ACC. Consider
this: the trial lawyers outspend physicians 10 to 1 when it comes to
campaign contributions. Is it any wonder that tort reform is not even a
topic in the health care reform debate? Please consider donating to the
PAC today. I would encourage every chapter member to consider an
individual contribution of $1000 or a group contribution of $2500. If
every OR ACC member made at least a $100 donation, we will be well
positioned to ensure that your voice is heard. |
Save the Date for the
2010 Oregon Cardiovascular Symposium
June 5 - 6, 2010 |
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| Michael Widmer, MD, FACC
ACC Oregon Chapter Governor
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Oregon Chapter of the ACC
PO Box
55424
Portland, OR
97238
503-345-9294
www.cardiologyinoregon.org
Alan Morasch, CAE,
Chapter Administrator
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Our ACC Mission Statement
The mission of the Oregon Chapter of the
American College of Cardiology is to build a cohesive cardiovascular community
throughout the State of Oregon in order to locally promote cardiovascular
education, research, quality care and influence healthcare
policy.
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