ACC RI Chapter Governor's Update    February 8, 2010   Since my last communication with Chapter members there have been innumerable emails shared among the BOGs from many states and the ACC leadership in Washington. The content of these messages has largely focused on CMS cuts for Cardiology which were implemented in January despite the relentless efforts of the ACC and cardiologists in every state who prevailed upon their legislators to urge CMS to reconsider their position. A legal effort to block implementation was thwarted at the last minute when a Judge refused to hear our case, not because of lack of merit, but due to lack of jurisdiction. While legal recourse has not been entirely dismissed, this appears to be a long and expensive road without much promise for success. A few weeks ago, I participated in a conference call with ACC leadership to discuss the CMS situation and last month, Governor-elect Mike Gilson and I attended a BOG meeting in Washington and heard further updates from CEO Jack Lewin and Jim Fascules, Director of Advocacy. Although the lawsuit against CMS did not proceed, the discovery process yielded new insights and revealed that CMS was poorly informed about the contents of the survey and did not follow their stated policies to validate the data obtained (which may be even more flawed than previously appreciated). To date there are about 70 sponsors for the Gonzales bill which calls for a re-examination of the data and a new survey. ACC leadership has reiterated in several communications that if the number of sponsors increases to170, the bill will be heard and acted upon in the House. To achieve this will require a significant grass roots effort in every state, supported by specific examples which illustrate the impact the CMS cuts have had on disruption of private cardiovascular practice and access to care for seniors. In many states, satellite offices have closed, staff layoffs have occurred and services have been reduced as a direct result of these cuts. Some facilities have decreased acceptance of Medicare patients. Physicians are strongly encouraged to write or visit their legislator's offices and, whenever possible, bring patients who can share their story. Without these examples, the entire issues have been construed by some as a "food fight" among physicians for reimbursement dollars rather than a patient access crisis. Once we can gather sufficient evidence outlining the consequences of these cuts, ACC members should again meet with our legislators and press them for support of the Gonzales Bill. I would request that you forward a copy of any correspondence supporting our cause to both the ACC in Washington as well as the RI Chapter. I plan to meet again with our legislators in the next month to outline the consequences of these cuts upon cardiovascular care in Rhode Island. I welcome participation by all members and, when appropriate, by patients affected by any changes implemented by your practices. The Florida Chapter has been among the most vocal groups in fighting the CMS rule. It's now time for Rhode Island cardiologists to join their peers nationwide to protect the private practice of cardiology and the patients we serve. As cardiovascular specialists, someone recently commented that we had an image problem based on a series of recent events. The former Governor of the Montana recently expressed his outrage in words which appropriately describe the exploitation of our specialty: In my mind the real problem is the devaluation of the services provided by the cardiologists of this country. The reductions in mortality and morbidity, and the positive impact we have on quality of life are unmatched by any other specialty anywhere in the world. Our services have been reduced to a commodity traded back and forth by a dysfunctional Congress, greedy commercial payers, and an entitled public. We do not have an image problem at 3:30 in the morning when we are caring for a STEMI. We do not have an image problem when a patient plagued by SVT has been ablated. We do not have an image problem when a class 4 HF patient now has near normal exercise capacity.If the American public, the Congress, and the commercial payers no longer value the services we provide then let us stop providing the service. If a restaurant owner has something on the menu that doesn't sell (no value) then he takes it off the menu. I am convinced that the resetting of the value of our services will not occur until our services are not available. We have allowed this devaluation to happen. We just keep coming to work no matter how much we are belittled. Why do we continue to do LHC on Medicare patients for the same reimbursement as a shave biopsy? We continue to do what we do because we know we help. We need to convince this country of the same.   Blair D. Erb, Jr., MD, FACC Cardiology Consultants of Bozeman, PC   Our profession should not have an image problem when we realize that cardiovascular mortality has declined precipitously over the last 25 years*, an accomplishment that no other medical group can claim. We need to celebrate the work we have accomplished, the "miracles" that are performed everyday that are taken for granted and reassert our value to society. Most importantly, we need to persuade our legislators of our important role in the health care system and the dire consequences which may result if reimbursement is not restored or cuts continue. Write or call your legislators today and consider participating in local visits with us in the next several weeks. As always, I welcome your calls and feedback, Steve * According to the American Heart Association: from 1996 to 2006, death rates from CVD declined 29.2 percent.  Family Smoking Prevention and Tobacco Control Act The RI Chapter of the ACC has signed on as a supporter of H.R. 1108/S.625, “Family Smoking Prevention and Tobacco Control Act”. This legislation, which the ACC has long supported through our work with the Partners for Effective Tobacco Policy (PARTNERS), would give the Food and Drug Administration the authority to regulate the manufacture, distribution, sale, labeling, advertising and promotion of tobacco products to protect the public health. The legislation has moved further in this Congress than in the past and the goal is to achieve enactment this year. It has 55 Senate cosponsors and was approved by the Senate Health, Education, Labor and Pensions (HELP) Committee last summer. It has 218 House cosponsors and is expected to be marked up by the House Energy and Commerce Committee this spring. It is sponsored by Senators Edward Kennedy (D-MA) and John Cornyn (R-TX), and Representatives Henry Waxman (D-CA) and Tom Davis (R-VA). The legislation has a broad base of support from the patient and health professions community working to promote it. With the legislation moving closer to passage, the involvement of more supporters- including ACC chapters- can make a big difference. A fact sheet on the legislation is attached for your information. Click Here for FDA Coalition Sign on Letter Click Here for the H R 1108 Fact sheet Steven Fera, M.D. F.A.C.C. Governor, R.I. Chapter of the ACC ACTION NEEDED: Congress Looking at More Imaging Cuts The House and Senate this month are expected to consider legislation that could stop the expected 10 percent cut in the Medicare physician payment from taking place on Jan. 1, 2008. Unfortunately, this same legislation is likely to also include significant cuts to Medicare payments for office-based medical imaging as a means of offsetting the overall physician payment fix. The ACC is urging all members to call their senators and representatives throughout the month of July and ask them to stop the 10 percent Medicare physician payment cut without cutting Medicare payments for other physician services like imaging. Let them know that cuts in Medicare reimbursement threaten physicians' abilities to provide the highest quality care, particularly in light of increasing expenses for health IT, medical liability insurance and other practice costs. Act now! It's critical that Congressional leaders here from the cardiovascular community before it's too late. You can reach your members of Congress by calling the ACC's toll-free grassroots hotline at 800-210-7193. You can also visit www.acc.org/can to send emails or faxes. Sample letters and talking points are provided. Rhode Island Imaging Accreditation Bill Approved by House Panel, Awaits Floor Action The Rhode Island House Corporations Committee has approved HB 6033 which would add the Intersocietal Accreditation Commission (IAC)as an entity that can accredit magnetic resonance (MR) imaging laboratories. Under current Rhode Island law only MR diagnostic procedures done in laboratories accredited by bodies recognized by the state are eligible for reimbursement from private payers. HB 6033 has been placed on the House floor calendar and is expected to pass easily. The bill is strongly supported by the Rhode Island chapter of the ACC and the Rhode Island Medical Society. The Rhode Island Radiology Society does not object to HB 6033's passage.   Physician Quality Reporting Initiative (PQRI)   In December 2006, President Bush signed the "Tax Relief and Health Care Act of 2006", mandating establishment of a physician quality reporting system under Medicare and authorizing a payment incentive for voluntary participation in 2007. Medicare is calling this program, the Physician Quality Reporting Initiative (PQRI). This site is intended to assist ACC members in learning about and participating in the PQRI program. Click here for the latest ACC PQRI updates.