News & Resources A Closer Look at 2012 Coding Changes The 2012 Medicare Physician Fee Schedule final rule included several coding changes for 2012 in the field of cardiology. The most extensive changes in the field occur in two areas: renal angiography and pacemaker/implantable cardioverter-defibrillators. For more information on the coding changes, check out the January/February issue of Cardiology. In addition, the new CPT® Reference Guide for Cardiovascular Coding is available for purchase. For questions on specific coding issues, contact coding@acc.org. Also don’t miss the special session on coding at ACC.12. ACC Investigating Allegations of Incorrect Bundling The ACC is investigating complaints regarding numerous health plans incorrectly bundling the reimbursement for interpreting echoes into the inpatient E&M procedure codes based on claims management software developed by McKesson. The ACC with American Society of Echocardiography and American Medical Association have sent letters of opposition to McKesson and several health plans including Aetna, Blue Cross Blue Shield of Texas, and Horizon Blue Cross Blue Shield of New Jersey. McKesson and Aetna responded that they agree both services should be separately reimbursed when the services meet CPT® reporting standards. However, payers report that medical record reviews have routinely seen physicians bill both services without completing the documentation requirements, namely the separate written report for the echo interpretation. McKesson and Aetna have concluded that when the reporting standards are met, the use of a modifier -25 (significantly, separate identifiable E&M service) or a modifier -59 (distant procedural service) will be recognized. For the full reporting standards, consult the ACC/AMA CPT Reference Guide for Cardiovascular Coding. The ACC reminds members to fully and completely document services rendered in the patient’s charts for accurate claims submission. United Healthcare Modifies Cardiology Notification Program Following complaints from the ACC and numerous cardiovascular practives, United Healthcare has extended the timeframe to submit Retrospective Notification for the Cardiology Notification Program from 14 to 30 calendar days. Effective Nov. 1, 2011, diagnostic cardiac catheterizations and electrophysiology (EP) implant procedures performed on an emergent basis, or during the course of an inpatient stay, can be submitted within 30 calendar days of the date of service. The UHC Cardiology Notification Program requires ALL diagnostic cardiac catheterizations and EP implant procedures to be pre-notified regardless of setting. For emergent and hospital inpatient cases, notification must be sent with 30 calendar days of the date of service. The ACC continues to work with UHC to express our concerns with the administrative burden and clinical criteria. Feel free to contact ACC Advocacy at 800.253.4636 with feedback on this program. Key Points to remember: The UHC Cardiology Notification Program currently only includes diagnostic cardiac catheterizations and EP implant procedures (pacemakers and ICDs). Notifications for cardiovascular imaging tests, such as nuclear cardiology, cardiac computed tomography, and cardiac magnetic resonance, are separate and listed under the UHC Radiology Notification Program. For more program details, visit UHC Cardiology Notification Program website. The North Carolina Chapter Plays Critical Role in Stunning Improvements in D2B Times in the US Cooperation and coordination between American College of Cardiology physicians and cardiovascular teams are reaping benefits for North Carolina patients, in a study released recently. For patients suffering heart attacks, the faster they reach the hospital door, and undergo balloon opening of the artery, the better the results. In this study, median door-to-balloon (D2B) times for heart attack patients undergoing percutaneous coronary intervention (opening of blocked artery) following an acute myocardial infarction (heart attack) have declined from 94 minutes in 2005 to 64 minutes in 2010, a study published on August 22 in Circulation reports. The improvements represent a more than 30 percent decline in D2B times. The percent of patients with D2B times less than 90 minutes increased from 44.2 percent to 91.4 percent from 2005 to 2010, as did the percent of patients with D2B times less than 75 minutes (23.3 percent to 70.4 percent). The study uses the Centers for Medicare and Medicaid Services data from Jan. 1, 2005, to Sept. 30, 2010. (Quote from chapter governor, or appropriate CV member for local use…ie: “All Oregon hospitals performing this life-saving procedure participated in this landmark study,” Dr. Sandra Lewis, Governor of the Oregon Chapter of the American College of Cardiology, noted.) The paper notes the important role that ACC’s D2B Alliance had on improving times by promoting the integration of proven strategies into practice. The D2B Alliance was launched in 2006 to provide clinicians, administrators, other health care professionals, hospitals and other partners with key evidence-based strategies and support tools to not only reduce D2B times to meet the guideline-recommended time of 90 minutes or less, but sustain these gains over time. Since its creation, more than 1,000 hospitals have enrolled in the D2B Alliance. In North Carolina, 31 hospitals participated in the D2B Alliance. This participation, along with the participation of hospitals in surrounding states, led to an increase in the percent of patients with D2B times of less than or equal to 90 minutes from 40% in 2005 to 90% in 2010 in the Mid-Atlantic census region (see chart below for data). According to the authors of the paper, the improvement in D2B times "demonstrates the results that can be produced by collaboration among health care professionals, hospitals, federal research agencies, and national organizations interested in patient care toward the achievement of a share goal." The collaboration should serve as a template for future quality efforts, they write. To read a summary of key points of the study, access the CardioSource journal scan. For a perspective piece from study author and ACC Board of Trustees member Harlan Krumholz, MD, FACC, visit the ACC in Touch Blog. For information about the D2B Alliance and additional quality improvement programs that help hospitals demonstrate performance, visit CardioSource.org/QualityPrograms. The level of care demonstrated by the D2B study’s findings shows that registry participation combined with dedication to programs like D2B and Mission: Lifeline leads to substantial improvements in the quality of care delivered. By measuring patient care in an appropriate and actionable way, registries bring to light the invaluable improvements being made by physicians and clinical care teams. Learn more about the ACC's suite of hospital and practice-based registries at NCDR.com. Census region data (Data for every year can be found on pages 5 & 6 of the paper, as well as % of patients with D2B Times <75 mins): Mean % of Patients with D2B Times East North Central: 46 (2005); 92 (2010) East South Central: 40 (2005); 94 (2010) Middle Atlantic: 40 (2005); 90 (2010) Mountain: 45 (2005); 92 (2010) New England: 47 (2005); 93 (2010) Pacific: 45 (2005); 93 (2010) South Atlantic: 41 (2005); 92 (2010) West North Central: 53 (2005); 93 (2010) West Sound Central: 40 (2005); 92 (2010) U.S. territories: 5 (2005); NA (2010) BCBSNC Imaging Update Just writing to update colleagues on a Blue Cross Blue Shield of North Carolina plans regarding imaging. Likely by 2012, BCBSNC will extend their current American Imaging Management (AIM) radiology benefits management requirement to echocardiography including rest and stress echo. Dr. Thomas Powers, MD, MRCPI (Membership of the Royal College of Physicians of Ireland), the Medical Director for AIM, attended the meeting and provided some further insight. He indicated that the AIM program generally follows ACC appropriateness guidelines with a few exceptions [J Am Coll Cardiol. 2007 Jul 10;50:187-204]. He noted as an example that the guidelines do not support “routine (yearly) evaluation of a patient with a prosthetic valve in whom there is no suspicion of valvular dysfunction and no change in clinical status.” Regarding impact, gross estimates from other regions include a 3% fall in resting echocardiography volume and a 15% fall in stress echo volume. Dr. Jack Newman, MD, FACC and I reiterated concerns including interruption of patient care and the possible need for our patients to make two trips to the office, the intrusion into medical and cardiology practice, the added administrative burden without corresponding compensation, and whether the extension of the program will significantly improve patient care or costs, particularly for resting echocardiography. Similar to nuclear perfusion imaging, the new program will be available through the AIM website with approval available in minutes for most patients. We also discussed opportunities to improve patient care and the application of imaging services in a manner more integrated with medical practice including the PINNACLE (Practice Innovation and Clinical Excellence) Registry and incorporation of the precertification into electronic medical record systems. A second portion of the discussion involved the evolution of new businesses that assist referring physicians in obtaining approval for imaging services. In other fields, I understand that imaging facilities assist referring physicians in obtaining approval through such services. The Office of the Inspector General has reportedly found this practice to be permissible and not in violation of Stark Laws. There was discussion about the possible violation of BCBSNC contracts regarding third party access to the internet portal, the added administrative burden for AIM and BCBSNC of telephone calls from these agencies, and the potential for gaming the approval system. James G. Jollis, MD, FACC Governor, North Carolina Chapter of the American College of Cardiology BCBSNC Physician Designation Program Development of a specialist designation program which differentiates identified specialty practices into specific levels based on the quality and cost efficiency data of the practice. BCBSNC CareTouchPoints Program Blue Cross Blue Shield of North Carolina is implementing the CareTouchPoints program. Available to all commercial members, this program uses health care data concerning treatment and medications to identify potential opportunities to improve evidence-based care. The program is based upon 22 recognized cardiac and Healthcare Effectiveness Data and Information Set (HEDIS) measures. Coronary artery disease, congestive heart failure, and diabetes are included in the program. Patients are receiving letters and calls from case managers, health coaches, and pharmacists identifying potential opportunities, instructing them to follow up with their physicians. Physicians are receiving materials explaining the program, performance reports related to their patients, and instruction on how to access the system electronically. As part of the program, physicians will be able to correct inaccurate data. Dr. Genie Komives, Senior Medical Director of Blue Cross and Blue Shield of North Carolina reviewed the program with NC ACC representatives and has provided the following background materials. Provider Performance Analytics Patient Care Summary Sample Quality Performance Measure Report Care Touch Points Newsletters & Updates Fall 2011 Newsletter Spring 2011 Newsletter Ask Your Representative to Cosponsor H.R. 6459! Fall 2010 Newsletter Summer 2010 Newsletter Action Alert! Visit your Congressperson Today Action Alert! Your Help is Needed The Final Stretch....Take Action for Access December 2009 Winter 2009 Newsletter Fall 2009 Update - Final Rule Includes Phased in Cuts for Cardiology Fall 2009 Newsletter Summer 2009 News Update - CMS Cuts Threaten Patient Care Summer 2008 Newsletter Fall 2007 Newsletter Summer 2006 Newsletter Spring 2005 Newsletter Summer 2002 Newsletter Summer 2001 Newsletter The Geographic Practice Cost Index (GPCI) Medicare is statutorily required to adjust payments for physician fee schedule services to account for differences in costs due to geographic location. There are currently 89 different localities which have not been revised since 1997. Medicare has been looking into revising GPCI system for several years, but has not finalized any proposals. CMS contracted a consulting firm to study alternative GPCI systems and released an interim study. Physician Fee Schedule Resources American Imaging Management Clinical Information Worksheet UHC: Premium Physician Designation Program WSJ Editorial - The War on Specialists