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Recent headlines from around the country on our efforts to stop the cuts

Private Sector ACO 'Collaborative' Lays Health Reform Groundwork

May 25, 2010

A voluntary, private collaboration of 19 clinically integrated health plans are getting a head start on health reform by forming an accountable care organization with an aim to better coordinate care, cut costs and improve health outcomes for patients.

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More Doctors Giving Up Private Practices

March 25, 2010 · The New York Times

A quiet revolution is transforming how medical care is delivered in this country, and it has very little to do with the sweeping health care legislation that President Obama just signed into law. But it could have a big impact on that law's chances for success.

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Rush Limbaugh takes a call on the CMS cuts

March 5, 2010

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Doctors, patients, staff members feel pain of 21 percent Medicare cut

March 1, 2010 · Palm Beach Post

Doctors who treat Medicare patients said they continued appointments as usual Monday, despite a 21 percent cut in their reimbursement that went into effect because of a Congressional stalemate. But if those Medicare cuts stick, all bets are off, doctors cautioned.

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Reimbursement cuts hitting hard at local cardiology offices

February 15, 2010 · KENS 5 San Antonio

Several private cardiology practices in San Antonio are having to lay off employees. They say declining reimbursements from the government are making it harder and harder to recover the costs of doing business. Dr. Charles Rabinowitz is a cardiologist. He loves his job, loves taking care of patients, using the knowledge and skills he's honed from years in school and years in business to help save people's lives.

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Medicare cuts rile local cardiologists

February 14, 2010 · South Bend Tribune

A carton of name-brand cigarettes costs about $55 these days. Thanks to existing and coming Medicare reimbursement cuts for cardiology services, the federal insurer of the elderly and disabled will soon reimburse Indiana physicians close to the same for a cardiac stress test performed in their offices. Local independent cardiologists say these cuts could drive them to go to work for hospitals or perhaps even out of business altogether.

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http://www.bizjournals.com/kansascity/stories/2010/02/15/focus1.html

February 12, 2010 · Kansas City Business Journal

Hearts are aflutter among local cardiologists. The cause of the palpitations is a new Medicare payment schedule that cut reimbursements so dramatically that the American College of Cardiology is warning practices that they might see revenue decrease by as much as 25 percent. A four-year phase-in of the schedule began Jan. 1.

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Help Us Keep Hearts Healthy This Valentine's Day

February 11, 2010 · Huffington Post

As Valentine's Day 2010 approaches, there is both good news and bad news for heart patients in New York. First, the good news. Over the last decade, the mortality rate for cardiovascular disease in the U.S. has dropped an unprecedented 30%. This tops the progress made in the fight against all other illnesses, including cancer. Cardiologists are successfully preventing heart attacks, and returning cardiac patients quickly to normal activities.

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TEST POLICE: Insurers hire help to monitor doctors' testing

February 8, 2010 · WHO TV

In Washington, the debate continues over the government's role in health care. But doctors say there's already someone playing a role in your care, you probably don't know about. You won't ever meet them, but they could have the final say in your health care decisions.

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Cardiologists Contest Medicare Cuts

January 13, 2010 · Kaiser Health News

A cardiologists' lobby filed suit against Health and Human Services Secretary Kathleen Sebelius, claiming cuts to heart care services, especially diagnostic tests, are unjustified, The Philadelphia Inquirer reports. A judge has already ruled that he can't intervene on the cardiologists' behalf, leaving the doctors to go through the government's complaint process "before considering a suit." The president of the American College of Cardiology "contends the pay cut will make doctors give up their private practices and work for hospitals," which could limit access to some services for patients, and end up costing more, since hospitals charge more for the same services.

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Cardiologist on front lines of medical-fee battle

January 13, 2010 · Philadelphia Inquirer

As president of the American College of Cardiology, Bove is point man in a contentious campaign to protect pay for its 37,000 members as the government makes cuts that would shift money from heart specialists like himself to primary-care doctors.

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Some local cardiologists fighting Medicare cuts

January 12, 2010 · Ventura County Star

Senior citizens with heart problems may have trouble getting the tests or cardiologists they need unless a federal judge blocks new Medicare cuts, according to Ventura County doctors embroiled in a national struggle over reimbursement.

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Doc groups wanting payment system fixed before reform

January 11, 2010 · Modern Healthcare

Meanwhile, the American College of Cardiology and several other professional medical associations have filed a lawsuit against HHS Secretary Kathleen Sebelius in an attempt to permanently block the Medicare reimbursement rate reduction for cardiology services that was scheduled to take effect Jan. 1. The complaint, filed in U.S. District Court in Fort Lauderdale, Fla., charges that Sebelius used a flawed Physician Practice Information Survey, which gathers information about practice expenses, to help determine the rate reduction.

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National Law Journal, Cardiologists file last-ditch suit to stop cuts in Medicare reimbursement

January 4, 2010 · The National Law Journal

The clock is ticking for heart specialists who have sued the federal government over pending Medicare cuts. The cuts, which will reduce reimbursements to private cardiologists by almost 40%, are scheduled to go into effect on Jan. 15. In a last-ditch effort, the American College of Cardiology is seeking to enjoin implementation of the cuts in a lawsuit filed last week in federal court in the Southern District of Florida. In its Dec. 28 complaint, the ACC, along with several co-plaintiffs, alleges that the proposed cuts by the Centers for Medicare and Medicaid Services are based on faulty information and will limit patient access to critical tests.

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Radio Success in Delaware

January, 2010

Click here to hear the Audio News release that reached over 29,300 listeners in Delaware!

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Radio Success in New York

January, 2010

Click here to hear the Audio News release that reached over 1,612,360 listeners in New York!

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Radio Success in New Jersey

January, 2010

Click here to hear the Audio News release that reached over 233,300 listeners in New Jersey!

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Dr. Fasules on Newsradio 570's Healthcare Roundtable

December 31, 2009

Four members of the health care industry discuss some of the fallout from the proposed health care bill.

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ACC Sues HHS Secretary Over Payment Cuts

December 31, 2009 · Dotmed.com

The American College of Cardiology filed a lawsuit against the Department of Health and Human Services Secretary Kathleen Sebelius on Monday to halt upcoming Medicare payment cuts to doctors they say will drive cardiologists out of private practice. The complaint, filed in the U.S. District Court in the Southern District of Florida, hopes to block the 2010 Medicare Physician Schedule from going into effect on January 15, 2010. ACC believes the Center for Medicaid and Medicare Services (CMS) schedule change, which cuts Medicare reimbursements to cardiologists by almost 40 percent, is based on faulty data and will limit patient access to critical diagnostic tests.

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Medicare cuts cripple access to cardio care

December 31, 2009 · Passiac Valley Today

Beginning Jan. 1, 2010, Medicare patients throughout New Jersey will find it more difficult to receive potentially life-saving heart tests and treatments. The cause: a cut in the federal reimbursement system that compensates private cardiovascular clinics for serving Medicare patients. "Heart disease is the nation's number one killer, but instead of dedicating new resources to fight this terrible disease we are on the verge of severing patient access to care," said Dr. Louis Evan Teichholz, chief of cardiology at Hackensack Medical Center and New Jersey governor of the American College of Cardiology. "Private cardiovascular clinics are an essential part of the health care delivery system. Yet, these cuts will make it exceptionally difficult for them to continue treating Medicare patients."

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Cardiologists sue HHS Secretary over PFS payment rates

December 31, 2009 · CCH Research News

On December 28, 2009, the American College of Cardiology (ACC) filed a complaint against HHS Secretary Sebelius alleging that Sebelius, in her capacity as HHS Secretary, unlawfully adopted the payment rates for cardiology services in the 2010 Medicare Physician Fee Schedule (PFS) Final rule by using the Physician Practice Information Survey (PPIS), despite the presence of clear defects in the PPIS data, and therefore violated the Medicare statute and the Administrative Procedures Act.

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Cardiologists, Other Groups Sue HHS Over Reduced Reimbursement Rates for 2010

December 31, 2009 · BNA's Health Care Daily

The American College of Cardiology Dec. 28 filed a civil lawsuit in federal court in Miami alleging Health and Human Services Secretary Kathleen Sebelius unlawfully adopted reduced payment rates for cardiology services in the 2010 Medicare physician fee schedule ( American College of Cardiology Inc. v. Sebelius, S.D. Fla., No. 09-CV-62034-Dimitrouleas-Snow, filed 12/28/09). The reduced payments threaten patient access to care while "precipitously" increasing medical care costs, the ACC said in a written statement.Cuts for cardiologists could be reduced by as much as 42 percent for 2010, Amy Murphy, a spokeswoman for ACC, told BNA.

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Cardiologists sue federal government over proposed Medicare payment cuts

December 30, 2009 · Naples Daily News

The new year won't be a happy one for cardiologists because of Medicare payment cuts scheduled to take effect Friday for preventive and diagnostic services to patients. If the American College of Cardiology isn't successful in getting an injunction against the federal government to put the cuts on hold, private-practice cardiologists say they have no choice but to drastically scale back tests on patients, reduce the number of Medicare patients they treat and lay off employees.

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ACC Files Complaint Against HHS Secretary For Adopting Unlawful Cardiology Payment Rates

December 30, 2009 · Becker's Hospital Review

The American College of Cardiology has filed a complaint against the Department of Health and Human Services Sec. Kathleen Sebelius in United States District Court alleging that Sec. Sebelius, in her capacity as the HHS Secretary, unlawfully adopted the payment rates for cardiology services in the 2010 Medicare Physician Fee Schedule by using an invalid Physician Practice Information Survey in a manner that threatens access to care for patients and precipitously increases medical care costs

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Cardiologists Sue Federal Government

December 30, 2009 · The Ledger

The American College of Cardiology filed a lawsuit Dec. 29 against the federal official in charge of the U.S. Department of Health and Social Services in an effort to block the upcoming payment cuts.

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Groups sue over impending reimbursement cut

December 29, 2009 · Modern Healthcare

The American College of Cardiology and several other professional medical associations have filed a lawsuit against HHS Secretary Kathleen Sebelius in an attempt to block a Medicare reimbursement rate reduction scheduled to take effect Jan. 1. The complaint, filed in U.S. District Court in Fort Lauderdale, Fla., charges that Sebelius used a flawed Physician Practice Information Survey, which gathers information about practice expenses, to help determine the rate reduction. Those flaws include using information from a sample of only 55 cardiologists, which the plaintiffs allege is too small and unrepresentative of the 37,000 cardiologists now practicing throughout the country.

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Cardiologists sue government to enjoin new Medicare rule

December 29, 2009 · Examiner

In what many observers suspect is a harbinger of legal challenges to come, the American College of Cardiology (ACC) today sued the federal Department of Health and Human Services in an effort to block implementation of a new reimbursement rule that, the doctors say, will make critical diagnostic and other cardiology services unavailable to the patients who need them most

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ACC Sues HHS over Medicare Rate Cuts

December 29, 2009 · MedPage Today

The American College of Cardiology (ACC) has filed suit against U.S. Department of Health and Human Services Secretary Kathleen Sebelius charging that the 2010 Medicare Physician Fee Schedule was adopted unlawfully.

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ACC Sues Sebelius Over Medicare Fee Cuts

December 29, 2009 · Diagnostic and Invasive Cardiology

The American College of Cardiology (ACC) today said it filed a complaint against the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, in United States District Court.

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Cardiologists sue Sebelius over Medicare fee cuts

December 29, 2009 · USA Today

Heart specialists on Monday filed suit against Secretary of Health and Human Services Kathleen Sebelius in an effort to stave off steep Medicare fee cuts for routine office-based procedures such as nuclear stress tests and echocardiograms.

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Denver Doctor: Cardiologists Bear Brunt Of Medicare Cost Cuts

December 28, 2009 · Denver 7NEWS

Two of Denver's largest cardiovascular care facilities are sounding the alarm about the effects of impending cuts in Medicare reimbursement. Although Congress has placed a hold on a planned across the board cut of 21 percent for all doctors, the American College of Cardiology said it appears that additional cuts for cardiology services will take effect Jan. 1.

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Rate cuts strike at heart of health care; Medicare reimbursement losses put local cardiology services on critical list

December 26, 2009 · Catskill Daily Mail

With the fight over health care reaching a fever pitch in Washington and the big insurance companies getting pretty much everything they want from the Senate, Medicare reimbursement rates for important cardiology tests are being drastically cut. The American College of Cardiology, a 37,000 member non-profit medical society, feels much of this drop is due to recent rapid advances in medicine and medical technology which, in turn, results in improvements to the quality of care. Beginning Jan. 1 the Centers For Medicare and Medicaid, the federal agency that runs Medicare, will cut Medicare payments to cardiologists by as much as 27 percent for cardiology private practices and according to the ACC this could severely curtail the gains made over the last decade. About 90 private practice cardiologists from Schenectady to Hudson fear that these cuts to Medicare reimbursements will affect patients' access to care, especially in the use of diagnostic tests such as nuclear stress tests and echocardiograms, which the ACC says are vital in helping to diagnose the onset of heart disease.

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Radio Success in Tennessee

December 22, 2009

Click here to hear the Audio News release that reached over 513,200 listeners in Tennessee!

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Radio Success in Florida

December 22, 2009

Click here to hear the Audio News release that reached over 571,957 listeners in Florida!

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Radio Success in Alabama

December 16, 2009

Listen to the audio news release that was aired reaching over 450 thousand listeners!

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Radio Success in Illinois

December 16, 2009

Listen to the audio news release that was aired reaching over 650 thousand listeners!

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Radio Success in Colorado

December 10, 2009

Listen to the audio news release that was aired on over 30 radio stations and reached over 375 thousand listeners!

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Guest commentary: Medicare cuts in health-care bill will cost seniors

December 9, 2009 · Naples Daily News

On Dec. 3 the U.S. Senate voted to keep significant Medicare cuts in the health-care overhaul bill despite polls showing seniors are concerned about their benefits. Senators voted 50 to 42 to reject an amendment by Sen. John McCain, R-Ariz. that would have stripped more than $400 billion in Medicare cuts from the health-care bill. The measure would have sent the health-care bill back to the Finance Committee for redo.

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Medicare: Cuts will hurt heart disease fight

December 9, 2009 · Florida Times-Union

On Jan. 1, Medicare patients in Florida will confront a new reality in cardiovascular care. The Obama administration has released the final 2010 Medicare fee schedule, severely cutting reimbursement for Medicare cardiovascular services by as much as 40 percent to 60 percent.

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Medicare cuts threaten heart care

December 6, 2009 · Bradenton Herald

On Jan. 1, 2010, Medicare patients in the state of Florida will confront a new reality – increased difficulty in access to cardiovascular care. The Obama administration released the final 2010 Physician Fee Schedule on Nov. 1, severely cutting cardiovascular services – some by as much as 50 percent.

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Cardiology centers, Delta Dental feverish over reform

December 2, 2009 · Denver Business Journal

Count area cardiology centers and Delta Dental of Colorado among the legions who are jittery about Washington's health care efforts. Two of Denver's larger cardiovascular care practices say they could be forced to cut back on patient services – including closing clinics and reducing staff – due to Medicare reimbursement cuts scheduled to go into effect January 2010.

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Heart specialists concerned about 2010 Medicare payment cuts

November 26, 2009 · Wilmington Star News

Earlier this year, the Centers for Medicare and Medicaid Services released its updated plan for how it would pay physicians for their services to those patients in Medicare, the government insurance program for the elderly and disabled. In the fee schedule, cardiologists saw steep reductions in the payments for imaging and diagnostic services as well as the dropping of consultation fees. This comes on top of a 21 percent cut in Medicare reimbursements facing all physicians because of a growth rate formula. The House recently passed a bill to address that issue. The new payment rules, to be phased in over the next four years, would reduce payments for cardiovascular-related services by an average of 27 percent for private practices, according to the American College of Cardiology.

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AHA: Cardiologists Face Major Payment Cut But Still Back Reform

November 15, 2009 · MedPage Today

In this exclusive MedPage Today InFocus video report, the vice president of the American College of Cardiology sounds an alarm about the potentially devastating effects of planned Medicare payment cuts to its cardiologists, but but he says payment concerns are unlikely to weaken the ACC's longstanding support for healthcare reform.

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CMS cuts could make hospitalists out of cardiologists

November 5, 2009 · Cardiovascular Business

Since the Centers for Medicare & Medicaid Services (CMS) issued its 2010 physician fee final rule last week with cuts to cardiology practices averaging 27 percent, the American College of Cardiology (ACC) has expressed adamant opposition, and its CEO, Jack Lewin, MD, said that this will cause the shuttering of practices.

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CMS set to cut Medicare physician fees for cardiovascular imaging

November 3, 2009 · TheHeart.org

Against a chorus of opposition from cardiovascular imaging specialists, the Centers for Medicare and Medicaid Services (CMS) is planning to make significant cuts to physician payments for several cardiovascular imaging services. Dr Jack Lewin, CEO of the American College of Cardiology (ACC), agrees that that impact of the cuts could be devastating for private practices. "This is truly a black day for cardiology. There has never been an assault of this magnitude on cardiology, ever." Lewin fears "private-practice cardiology will cease to exist as viable, and cardiologists will shift to hospitals or integrated systems."

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Proposed Cutbacks to Medicare May Threaten Rural Cardiac Centers

November 2, 2009 · Cardiology Today

Cardiologists very much support improved pay for primary care physicians, but not at the expense of reduced echo and nuclear services. The American College of Cardiology, together with specialty imaging societies including ASE, ASNC and SCCT, have long supported aggressive approaches to ensuring that imaging is used appropriately and overutilization is reduced selectively, but not by reducing access to appropriate care using a blunt instrument of reducing payment for services to an untenable level.

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Doctors battle Medicare formula

November 1, 2009 · The Arizona Republic

The American College of Cardiology, for example, warned that the Medicare cuts along with previous cuts are a "grave threat to cardiology practices and the patients they serve."

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Proposed cutbacks to Medicare may threaten rural cardiac centers

November 1, 2009 · Cardiology Today

The American College of Cardiology, together with specialty imaging societies including ASE, ASNC and SCCT, have long supported aggressive approaches to ensuring that imaging is used appropriately and overutilization is reduced selectively, but not by reducing access to appropriate care using a blunt instrument of reducing payment for services to an untenable level.

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Medicare Eases Next Year's Cuts for Heart, Cancer Specialists

October 31, 2009 · Bloomberg

The phase-in means "a slow death" for heart doctors, said Jack Lewin, chief executive officer of the Washington-based American College of Cardiology, in a telephone interview yesterday. "Most cardiologists will still see the handwriting on the wall" and elect to leave the practice. Specialists will appeal to Congress, said Lewin, who had pledged the "tooth and nail" effort. Lawmakers have 60 days to let the cuts take effect Jan. 1 or order changes.

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Docs Slam Medicare Payment Rule

October 30, 2009 · Congressional Quarterly HEALTHBEAT

"While CMS has attempted to mitigate the impacts of these cuts by spreading them out over a four-year period, the bottom line is these cuts will cripple the nation's ability to treat cardiovascular disease," said Jack Lewin, an ACC official. "People will needlessly suffer and patients will die as a result of what CMS did today."

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The War on Specialists

October 6, 2009 · Wall Street Journal

The chunks Team Obama took out of cardiology RVUs are especially drastic. The basic tools of heart specialists–echocardiograms (stress tests) and catheterizations–are slashed by 42% and 24%, respectively. Jack Lewin, who heads the American College of Cardiology, said in an interview that the crackdown will cause "a horrible disruption" that will force many community and independent practices to close their doors, lay off staff or make senior patients wait days or weeks for tests and services.

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Q&A with Jack Lewin

September 15, 2009 · The Hill

Groups representing consumers, physicians, drug companies, insurers and many other stakeholders are closely monitoring the debate to overhaul the nation's healthcare system. The Hill recently interviewed a major player in the evolving debate, Jack Lewin, CEO of the American College of Cardiology (ACC).

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The Corporate "Alliance" For Health Care Reform: V - Organized Medicine

September 9, 2009 · Huffington Post

In July 2009, the Administration proposed a plan to cut Medicare payments to cardiologists and oncologists by more than 10 percent each while increasing reimbursement to family physicians by 8 percent and nurses by 7 percent. This prompted leaders of the American College of Cardiology to warn that "The cuts could have the unintended consequences of rationing care, especially in rural regions with a large number of Medicare patients. In other areas, specialists may decide to pull out of Medicare, or ask patients to make up the difference with higher out-of-pocket payments."

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Cardiologists Crying Foul Over Obama Medicare Cuts

August 28, 2009 · Bloomberg

"Our 37,000 members are fighting tooth and nail on these other issues rather than fighting thoughtfully for expanding access," said Jack Lewin, 63, chief executive officer of the Washington-based American College of Cardiology.

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Cardiologists fuming over proposed cuts to Medicare

August 23, 2009 · Daily Commercial

"These proposed cuts are based on the incorporation of a few esoteric pieces of data into a complex formula," stated Dr. Alfred Bove, president of the college, in a press release. "The focus on this formula completely ignores the very important issues of access that are certain to be created by these huge slashes in payment." Cardiologists wouldn't be the only physicians affected by the proposed cuts, if they are approved.

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A Basis Is Seen for Some Health Plan Fears Among the Elderly

August 20, 2009 · New York Times

"Cuts of this magnitude could cripple cardiology practices and threaten access to services for millions of patients," said Dr. John C. Lewin, chief executive of the American College of Cardiology.

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CMS Announces New Payment Rules that Benefit Primary Care Docs

July 2, 2009 · MedPage Today

Cardiologists, meanwhile, expect an 11% cut in reimbursements, according to the American College of Cardiology (ACC). "The American College of Cardiology is shocked that CMS has proposed to cut payments to cardiology services by 11 percent in a single year," Alfred Bove, MD, president of the ACC, said in a release.

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Medicare Plans to Cut Specialists' Payments

July 2, 2009 · Wall Street Journal

Payments to cardiologists would be trimmed by 11% overall, but certain procedures they perform would see steeper reductions. Alfred Bove, president of the American College of Cardiology, figured that cardiologists would receive 42% less for an echocardiogram and 24% less for a cardiac catheterization.

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Private Sector ACO 'Collaborative' Lays Health Reform Groundwork

A voluntary, private collaboration of 19 clinically integrated health plans are getting a head start on health reform by forming an accountable care organization with an aim to better coordinate care, cut costs and improve health outcomes for patients. In an interview with Inside Health Policy, Premier health care alliance President and CEO Susan DeVore said that as the ACO provisions of the health reform law come online in 2012, the Premier participants will have the infrastructures in place to capitalize on the program.

The initiative, according to the Premier healthcare alliance, will involve 1.2 million commercially insured patients in 15 states. Premier, which has worked with CMS and its members on various quality improvement demonstration projects, unveiled the initiative last Thursday with the support of several lawmakers, including Senate Finance Chair Max Baucus (D-MT), who pushed delivery system reforms as part of the health reform bill (see Inside CMS, March 8, 2007).

The ACO strategy, a key component of health reform, includes a variety of elements: coordinating care, limiting the fragmentation in the current system, limiting admissions, focusing on preventive care, breaking down reimbursement and treatment "silos," and improving quality and outcomes.

Under the ACO concept, a health care provider organization is accountable for meeting the health needs of a defined population, including the total cost of care and the quality and effectiveness of services.

"It really is a sea change I think, across the whole continuum" of the health care system, said DeVore of Premier healthcare alliance, which includes 2,300 hospitals and 66,000 other healthcare sites devoted to quality improvement. "Medicare is going to join existing ACOs that have this infrastructure and that can improve quality," DeVore said, adding that this isn't a "demonstration" but "a real program" that CMS is beginning to write regulations for.

"Our intent here is to keep doing what health systems have always done: to try and help communities. But also to build, test and scale some of these new models and new measures that might help inform where the regulation around ACOs ultimately needs to go," DeVore said.

The new initiative involves strange bedfellows. Among the 19 groups that have signed on so far are:

  • Atlantic Care, based in Egg Harbor, NJ, brings with it patients from three casinos and a union.
  • Summa, a health plan based in Akron, OH.
  • Methodist Medical Center of Peoria, IL, which brings with it Caterpillar Inc. employees.

DeVore said the initiative was launched shortly after passage of health reform and is only six weeks old. The 19 systems that have joined the collaborative -- and an alliance source suggested there may be more joining in very soon -- "have to be ready to implement," she said.

The members of the Premier ACO Implementation Collaborative are bringing a variety of specific tools that will help the program succeed, DeVore said, including:

  • An electronic health records system that is interoperable and that can "share data among multiple technologies."
  • A robust primary care physician network -- whether an "employed model (or) contract model, (it) might be a really strong physician/hospital organization or an IPA," DeVore said.
  • The groups have all agreed to "bring a payer ... that is transparent with the collaborative," DeVore said. This can be a hospital-owned payer or a payer associated with an employer or a commercial payer that the groups partner with, she said.
  • The collaborative is also requiring that each partner bring "at least 5,000 Medicare equivalent lives" because, she said, "we need enough critical mass in the patient population to help build the ideas."
  • The members have all agreed to be transparent and are willing to accept standard measurements, including hospital and physician measures.

"So you can see that this sort of starts to thin out the numbers of health systems across the country that can say 'I have all that, I'm willing to be transparent with all that and I'm willing to go forward with 18 others to build measurements that I can be measured on,'" DeVore said.

The health law allows current participants of the Physician Group Practice Demonstration project to transition into Medicare ACOs (Sec.1899 of the Social Security Act). And two of the PGP demo participants -- Geisinger Health System and Billings Clinic -- have also partnered with Premier's collaborative.

"It's a very smart thing to do. This gain sharing provision is one of the more important provisions for bending the cost curve. Ultimately to make this work, every organization has to go through the re-engineering process to figure out how they get things done better and cheaper," said one health system source.

"The real controversy is between the public objective of improving quality and engaging the high-cost, high-volume areas, to change their trajectory and cost growth," the source said. "It's enormously politically difficult to get high cost areas to change their culture," the source added.

Baucus called the delivery system reforms "stealth reform," because of the little fanfare that the provisions received, before, or after, the passage of health reform. These include the ACO pilots, bundled payments, the Patient Centered Research Institute, as well as provisions to limit healthcare-related infections and hospital readmissions.

"I think, generally, that this is the most important part of health reform -- delivery system reforms ... and Accountable Care Organizations are a part of it," Baucus said.

Baucus suggested that the delivery system reforms got short shrift during the extended negotiations related to the health reform bill because most of the emphasis was on expanding coverage to the uninsured -- which he said is important -- but "delivery system reform was not discussed really at all." He suggested that because it was innovative, it didn't draw a real favorable score from the CBO, but he does expect it to save money.

He also praised Premier as being on the "cutting edge of delivery system reforms, along with CMS." He said the goal is simple: "to move reimbursement to providers on the basis of quality, not quantity, not volume."

Baucus mentioned that much of the criticism he heard about the bill is that it didn't do enough to control the rate of cost growth. "I tend to agree. I think we could have done a bit more," Baucus said. But now that the bill is law he said he intends to see that it is implemented effectively.

Baucus told Inside Health Policy that CMS "will need more money" and, although he isn't clear on what is in the president's budget in 2011, he said he plans to "ensure that Medicare remains solvent."

He also mentioned a potential pitfall: fraud and abuse. "We wanted to set up a system that people aren't able to game it," he said. "There are some providers in the country, when they see an opportunity" to game it, will take it, he said. Baucus said he plans to hold oversight hearings and follow implementation of the bill closely so that doesn't happen.

Another fear is that well-reimbursed specialists will shun the ACOs. In answer to a question, one Premier participant addressed the reluctance of specialists to join an ACO. The best way that specialists could maintain their "levels of income is by leaning into this opportunity," said Jim Hinton, CEO of Albuquerque, NM-based Presbyterian Healthcare Services. "If they don't, it seems like death by fee-for-service or rationing," said Hinton. He predicted that as reimbursements rates fall or remain stagnant in fee-for-service, physicians do more services to compensate. "This is counter intuitive to the goals of the ACO," he said.

Cardiologists in particular have been hit with double-digit reductions in payments through practice expense changes incorporated as part of the physician fee schedule this year, on top of the elimination of consult codes and reductions in reimbursement for imaging equipment that many in the specialty own, sources note.

There has been some anecdotal evidence of an acceleration in the trend of some specialists -- ie: cardiology and imaging -- selling their private practices and becoming hospital employees, according to Jason Greis, a health care attorney at McGuireWoods.

Rep. Earl Pomeroy (D-ND) -- the 5th ranking Democrat on the Ways and Means health subcommittee -- said the collaboration comes at the right time. "I think their possibilities of success are excellent. I believe that they are going to be saluted across the town for advancing the collaborations that they have advanced," he said. "This is the best of private sector innovations leading the way to making the provisions of the health reform law work as they phase in. Accountable care organization provisions relate to Medicare. This is being advanced in a non-Medicare context. Well, we need the systems [for] ACOs ... to allow them -- by the time the Medicare provisions are implemented -- they are ready on day one to do it," he told Inside Health Policy.

"It's precisely the private sector leadership we need, that's going to help implementation of the bill," he added.

Pomeroy, a former insurance commissioner, downplayed potential roadblocks like the Sherman Anti Trust Act. He said if the members of the collaborative hit barriers as they move forward, lawmakers are going to investigate. He said that the law provides a state action exemption to the anti trust laws that will also be useful as groups, hospitals and health plans form ACOs.

"What is the nature of the barrier? Are these excuses? Are they well founded? If it is clear, hard, provisional law that's the problem, [a] technical correction," might be called for, he said. But he stressed that the congressional intent of the law is clear: "We want greater collaboration and reimbursement innovations, along the lines of accountable care organizations. If that can't be achieved in an antitrust context, then we need to make sure that it can be," Pomeroy said.

A Premier member asked Baucus what information Congress will need as the group moves forward with its project. Baucus mentioned they should bring anything they learn to his staff's attention and mentioned issues with the Stark anti-kickback and self-referral laws.

Rep. Charles Boustany (R-LA), also on Ways and Means, talked about his work as thoracic surgeon for 14 years and explained that he participated in early initiatives to standardize care that showed promise. He mentioned the Society of Thoracic Surgeons' clinical database, which he said he and his colleagues used to lower morbidity and mortality rates, lengths of stay and admission rates.

And while he praised Baucus for his attempt with the "Gang of Six" to build bipartisan support for the bill, he was ambivalent about the bill itself, which he said could have gone further to "coordinate care, align incentives to improve quality and lower cost." Boustany voted against the legislation, as did all House Republicans. "I think we're going to have a lot more work to do in this area." He predicted further access problems linked to physician payment under fee-for-service.

Pomeroy said he has embraced the accountable care organization concept "as a way to elevate and advance patient care and achieve cost saving delivery all at the same time. Win, win, win all the time." He said much of the current data and research indicate that the idea of "volume and quality appear to be directly at odds."

The ACO concept, he said, moves "patient care at the forefront, achieves more cost effective means of delivering services."He added, "I think ACOs represent a distinct step forward from the managed care styles of the 80s and 90s."

One difference with the 1980s-era HMO style capitation model, and what lawmakers are trying with the ACOs, is science and data, said Nicholas Wolter, a family physician and CEO of the Billings Clinic. Wolter said the science of delivery of health care has come a long way. He gave as an example Peter Pronovost, the Johns Hopkins University professor (anesthesiology, critical care medicine, surgery and health policy) who is noted for his "checklist" approach to improved delivery of care in the ICU, specifically, and hospitals, in general.

"We know more about quality and patient safety than what was known in the early 1990s," he said. "We now need to make an investment in helping health care delivery change itself, so that patient outcomes are improved," added Wolter. He predicted "course corrections in both law and regulation" but said it eventually will work.

He offhandedly mentioned that as part of the PGP demo, Billings had reduced admissions by 40 percent since the demonstration was launched in 2006. Final data from the demonstration is due in August.

"For the first time in my career, we finally, finally have the resources," Michael Bryant, president and CEO of Methodist Medical Center of Illinois, said during the briefing.