December 10, 2009 Dear Montana ACC member, In three weeks, the CMS Rule will take affect that will seriously impact cardiology and patients' access to cardiovascular care. Dedicated ACC members from across the country participated in this week’s “Take Action for Access Week” Legislative Fly-In. Participants met with congressional leaders face-to-face in Washington, D.C. Others participated in the “virtual fly-in” with calls and emails. But not enough are speaking out against the outrageous cuts to cardiology that CMS implemented in their Rule! And if we don't care, Congress won't either! I cannot stress enough just how important it is to have a mass push on the Hill for the next several weeks!!!! I know you are tired, or maybe even think that the Final Rule, like the SGR, will be fixed at the end of the year. However as shown in the ad that is attached, you must know that we have other specialties against us, Congressional staffers are tired of healthcare issues in general due to Healthcare Reform, plus the clock is ticking before Congress leaves for winter break. We really need the help of all cardiovascular specialists and their patients now! Do you know how much of a hit your practice will take when this Rule goes into affect at the end of this year? Use the ACC's practice impact calculator and instructions to see what impact this Rule will have on your practice and you will likely be very surprised and scared. Congress, and especially Senator Baucus, needs to know the unintended consequences of this Rule, including staff layoffs and the impact on our patients! Use the Practice Impact Calculator and send your results to Molly Nichelson (mnichels@acc.org) at ACC so she can collect all Montana's results and pass them along to Senator Baucus' office. Get your patients involved! This Rule will impact their ability to secure quality cardiovascular care and will cost them more money in copays. Talk to your patients. Circulate the patient materials on ACC's website, www.acc.org. We’ve Got Legislation! The Hill visits coincided with the imminent introduction of legislation by Charlie Gonzalez (D-TX) holding cardiology at current 2009 practice expense values, while allowing other specialty practices to operate at 2010 physician practice information survey (PPIS) values. We are asking everyone, as part of the "Take Action for Access Week," to contact their representatives and ask them to call Julie Hart in Rep. Gonzalez office (202-225-3236) by Friday, December 11 to be an original cosponsor of the bill. The proposed Gonzalez legislation could go a long way towards mitigating the impacts of this Rule. However, we need everyone to act now! The College has made it as easy as possible for you to take action. The toll-free grassroots hotline (800-210-7193) will connect you directly with your members of Congress. The Campaign for Patient Access Web site also provides easy access to your lawmakers via email. Sample letters and talking points, as well as materials for you and your patients, are readily available. I strongly encourage you to use these flyers and sample letters in your office and ask for the support of your Medicare patients who will be affected by this Rule with increased co-payments. The New Web Site! ACC has launched a new Web site, www.campaignforpatientaccess.org, which features more information about the Rule and ways to get involved. In addition to the congressional resources mentioned above, the site makes it easy to keep up with the latest news and to share your stories with each other and the media. The site also makes it easy to donate to the campaign. Your financial support can help us continue the fight to preserve patient access. Your donation will help cover the costs of this campaign, including but not limited to legal fees, campaign management fees, etc. Your donation is not a charitable contribution, but may be tax-deductible as a business donation. Counter Attacks from Other Physicians Have Begun Please note the counter-campaign to our efforts from other specialty societies on page 31 of the December 9 issue of Politico paid for by the “Practice Expense Equity Coalition”. See ad attached. Message to the Hill “Take Action for Access Week” participants carried the following message to Capitol Hill: Medicare Payment Rule for 2010 Threatens Cardiovascular Care The American College of Cardiology (ACC) asks for your help in stopping a disproportionate cut in payment for cardiovascular services included in the 2010 Medicare Physician Fee Schedule (MPFS) Final Rule. Due to a variety of technical changes the Centers for Medicare and Medicaid Services (CMS) included in the 2010 fee schedule, nearly all services performed by cardiologists will see payment cuts ranging from 10 to more than 40 percent over four years. These cuts are separate from current health reform efforts and do not include the 21.2 percent Medicare physician payment cut due to the sustainable growth rate (SGR). The impact on individual cardiovascular practices is causing many practices to take drastic measures according to a recent survey: • 60 percent of private practice cardiology plans staff layoffs • 46 percent of private practice cardiology plans to eliminate service lines • 17 percent of private practice cardiology will stop accepting Medicare • the majority of private practice cardiology will integrate (46 percent) or already has integrated (19 percent) into a hospital system Overall, CMS projects an 8% decrease in Medicare payments for cardiovascular services in 2010, and a 13% decrease over the next four years due to policies implemented in the Final Rule for the 2010 Medicare Physician Fee Schedule. These aggregate projections underestimate the impact on individual private cardiology practices. A big portion of these cuts is related to practice expense. CMS incorporated the results of the American Medical Association’s Physician Practice Information Survey into its formula for calculating practice expense relative value units (RVUs). The cardiovascular community has serious concerns about validity of the survey process and the quality of the data. CMS is phasing the cuts in over a four-year period versus all at once. A few key examples for 2010: • SPECT Myocardial Perfusion Imaging (78452): 36% cut • Transthoracic echo with spectral and color flow Doppler (93306): 10% cut • Coronary Stent (92980): 4% cut • EKG (93000): 5% cut • Level 4 established patient office visit (99214): 7% increase Several other policies implemented in the final rule also contribute to the payment cuts to cardiology: • Bundled codes for myocardial perfusion/SPECT imaging: In 2010 myocardial perfusion imaging/SPECT studies including wall motion and ejection fraction will now be reported with a single code. CMS decided to substantially reduce the payment for myocardial perfusion imaging as part of this rule by reducing both the physician work value and the practice expense value. Because there is a new code for the service, CMS is not applying the four-year transition of the practice expense cuts and instead is using the fully implemented value. The result is a 36% cut in payment for 2010. This change alone accounts for more than one-third of the projected payment cut to cardiology. • Consultations: Payments for consultations provided in office and hospital settings are eliminated under the final rule. The RVUs assigned to these codes will be redistributed to office and hospital visits and services now billed as consultations will be billed as hospital or office visits. This will reduce payments to varying degrees for consultation services. • Malpractice: CMS has chosen to update the malpractice RVUs with data from a new survey of specialty-level malpractice premiums. In addition, CMS has proposed a new method for determining malpractice RVUs for technical component services. The proposed new malpractice RVUs would reduce overall cardiology payments by 1 percent, however the impact is much greater for imaging services already being cut through other policy changes. • Equipment utilization: CMS is implementing a new policy that assumes that all diagnostic equipment with an acquisition cost greater than $1 million is used 90 percent of the time an office is open, thus driving down the practice expense RVUs for services using that equipment. Cardiac MR and cardiac CT services will be subject to payments set based on this utilization assumption. I can honestly say that we need more calls and emails than what we've been getting. ACC leaders and staff are doing what they can -- the ACC Advocate is going out twice a week, and ACC's advocacy and communications teams are pulling out all the stops to educate, inform and activate our membership. But what we need is your calls, emails and in-district visits to Congressional leaders and their staff. And we especially need your practice impact information to bring to Senator Baucus and his staff! We have all the tools for you -- an 800 number, an ACC CAN website to send emails, faxes and letters to members of Congress, the Campaign for Patient Access website, patient materials on the Campaign for Patient Access website, the practice survival tools, Op-Eds in newspapers across the country, including ads in the Hill newspapers along with the New York Times, Chicago Tribune, Washington Post and USA Today. A link to the ad placed on Tuesday may be found here. And if you want to visit your member at their district home office, contact ACC Advocacy staff at advocacydiv@acc.org and they will help set it up. Spread the message far and wide! Now, more than ever, we need to step up and tell Congress to save cardiology - for our profession and our patients! Sincerely, J. Scott Millikan, President Montana Chapter, American College of Cardiology