Dear Colleague,

“Call to action…”

The Centers for Medicare and Medicaid Services (CMS) 2010 Physician Fee Schedule contains numerous provisions that will prove devastating to cardiology private practices and patient access to quality care. On a broader scale, many private practitioners will no longer be able to see Medicare patients and will be forced to send their patients to hospital-based imaging centers for testing that previously was performed in the office setting. This is significant as hospital-based testing costs more to the government, taxpayers and the patient.  For example, a test done in the office that would carry a Medicare co-payment will likely have a significantly higher co-payment in the hospital. In addition, testing in the hospital is often more time consuming, produces longer commutes and wait times to receive care, and may cause life threatening delays in diagnosis and timely treatment of patients with cardiovascular disease.

Our profession is engaged in a fight for survival and every cardiologist in the United States must get personally involved in the fight to protect patient access. With the viability of outpatient cardiology and hence patient access to quality cardiovascular care at extreme risk, we cannot afford to stand silent. Because of your tireless efforts to date, we have succeeded in buying a little time – at least on the practice expense portion of the cuts. Since the rule phases in the practice expense cuts to cardiology over four years, we have mitigated the damage a bit. But these cuts, whether immediate or spread out over time are simply unacceptable. More than 550 members took advantage of ACC's all-member call on November 12, 2009 to learn more about the impact of the final 2010 Medicare Physician Fee Schedule and hear from ACC President Fred Bove and ACC CEO Jack Lewin about member resources and next steps. For those of you who could not make the call, slides are available.

So What Is Next?

We have a number of willing sponsors for a legislative approach and should know soon about whether we have someone who will champion legislation on our behalf. In the interim, ACC staff is lining up its communications in order to help you get the message out immediately to your members and your patients about how they can help. One way they're doing that is through the creation of a special Web site dedicated to the rule and next steps. This site is nearing completion and will be posted immediately after the Thanksgiving holiday.  Bill language may be introduced this week and then hopefully we will have something to rally around. We will be planning Congressional fly-ins and district visits to promote this legislative approach.

We are finalizing our approach to a legal remedy after vetting various high profile law firms in order to pursue a legal injunction, and will be seeking co-sponsor organizations among our cardiovascular society colleagues, Cardiology Advocacy Alliance (CAA), interested Chapters, and the other affected specialty societies that may be interested.

Dr. Lewin, Dr. Fasules and ACC Advocacy Staff are talking with key White House, HHS, Congressional, media, and consumer group contacts to educate about the unintended consequences of the cardiovascular aspects of the Rule. The ACC is highlighting the PPIS data used for cardiovascular practice cost estimates was wrong, and that it will disrupt access, increase disparities, greatly increase Medicare Part B costs by shifting services to hospital sites with higher diagnostic and imaging costs.

We need all members to help us take action. Our web site acc.org and PAC site will be reconfigured this week to direct members to contribute to these efforts. If you haven’t seen this week’s ACC Advocate, follow the following link now:  http://qualityfirst.acc.org/Documents/ACC%20Advocate%20FAX%2011.17.09.doc 

Many of you are asking what you can do. Donate to the Political Action Committee (ACCPAC) now. The College needs funding for these multifaceted advocacy efforts. Communications staff are developing a multi-dimensional communications plan to make this critical effort successful.  We need real practice data on how the cuts will affect care and services---and we have already collected data from several thousand practices, which is now being collated. Not only do you need to assess the impacts in order to know how best to plan for the coming year in terms of staffing, negotiating with health plans and meeting the needs of your patients, but you need this information for your members of Congress. We now need to prove to Congress and to CMS that these cuts will in fact impact access to care. We’re asking everyone to take advantage of ACC’s practice expense calculator to gauge the initial impacts. From there, you are strongly encouraged to send these results to advocate@acc.org, where ACC’s media and grassroots team stand ready to help you use these results in messages to Congress, to patients and to your local media.

Speaking of media, the ACC is launching a “media blitz” designed to put faces on the cuts at the state and local level. If your office is forced to lay off staff, or you have patients that will need to drive hours to the closest hospital for a test they used to get at your office … the ACC's media team is ready to help make sure these staff and patients are heard. The team can work with you on op-eds in local papers, radio interviews and even local television interviews. For more information, contact Ana Fullmer (afullmer@acc.org).

We're going to need a rapid response, unlike anything we've done before. Every cardiovascular professional in the U.S. must get personally involved in the fight to protect patient access. Here are the resources currently available, with the new website and the Practice Survival Toolkit coming soon!

• Get up to date on what's included in the final rule. Slides from ACC's Nov. 12 all-member call about the rule and its impacts are available.
• Read an overview of the rule.
• Assess the basic impacts of the cuts by using ACC's practice expense calculator. You can also get specifics on new coding changes, as well as answers to frequently asked questions, on the practice management section of ACC's Web site.
• Spread the message within your community and with your elected officials about the specific impacts of these cuts on your practice and your patients. Send a letter to your members of Congress asking them to stop the cuts. For help with letters to the editor or op-eds in your local paper, contact ACC's media relations team at advocate@acc.org.
• Help ensure the voice of cardiology is heard on Capitol Hill be contributing to ACC’s Political Action Committee. More information is available at www.accpacweb.org
• Get your patients involved Guarding Hearts Alliance: http://www.guardingheartsalliance.org  The website is administered through the Cardiology Advocacy Alliance and can be used to educate cardiac patients about the facts of health care reform and Medicare regulations.

We will be coming to you in the coming days and weeks with specific ways you can help influence regulatory and legislative efforts to minimize aspects of the rule. The College is exploring every single option including legal strategies to mitigate the cuts that we believe are based on flawed and unvalidated data and/or are excessive to the point that the consequences to important patient services like medical imaging are devastating.

For questions, please contact advocacydiv@acc.org.

Sincerely,

John Gordon Harold, M.D., F.A.C.C.
Chair, Board of Governors