Some post-ACC.10 blog coverage to look forward to: Our ACC member bloggers will be giving their take on the differences in the US & UK health system in the form of two hypothetical CV patients, Thurgood Powell and Mortimer Schnerd. From Dr. Fisher:

We thought it would be interesting to compare and contrast two heart patients - one with insurance and one without insurance - from our two health care systems, to illustrate how these patients obtain health coverage, might be managed, and how things look from the patient's perspective.

...

For the purposes of the exercise, we'll take two patients, Mr. Thurgood Powell, a highly successful 57 year-old businessman making $250,000 (£166,128) per year with his company PoshPosh Entertainment, and Mortimer T. Schnerd, a pleasant 43 year old man who is unemployed but working part-time in the local K-mart, earning $17,400 (£11,562) per year. Both men will experience heart attacks, both men will present to Emergency Rooms in both countries, and both men with require 4-day ICD stays and require the implantation of an automatic defibrillator and follow-up for the first year after the heart attack. Beyond that, heck, who knows. But that will at least give us a starting point to discuss the good, the bad, and the ugly of both health care systems and to compare and contrast the two systems. We will purposely refrain from political commentary in our posts (that's for you to do in the comments section!). We only ask that the commentary discussion be respectful and civil. I would be thrilled to hear what the British think of their health care system/costs/etc. over on Sarah's blog and the U.S. perspectives on this blog.

So there you have it. Look to their blogs (Dr. Clarke and Dr. Fisher) for the full discussion, and I'll be posting my response here as well. 

Other posts from Dr. Clarke today:

• Want to know more about AF??!! See this new website and other trial results from the ACC!: The ACC and Heart Rhythm Society have launched a new website just for AF !!! Take a look!
  
  
• DAT post DES…how long??: The aged debate goes on! How long should we be giving dual anti-platelet therapy (DAT) after DES? Current guidelines suggest 12 months….
  
  
• Cryoablation for PAF: STOP-AF: Whilst anti-arrythmic drugs (AAD) are not without morbidity or mortality, and radiofrequency ablation requires mutliple lesions and can be associated with complications, cryoablation offers PVI with a single continuous cryolesion. But what are the complications?

Take a look at this nonpartisan, patient-centric ad that ACC is running in all of the news venues in front of Congress, the administration and the whole array of consumer and business lobbying entities in Washington, D.C., the rest of this week. Note that the ad does not take sides with either side of the aisle; it does not mention the Senate bill or reconciliation or any specific legislation; it emphasizes that the only real cost containment will come by getting physicians engaged in meaningful payment reform, including tort reform; and it asks that Medicare, Medicaid and the Secretary receive sufficient funding to hire the expertise to meaningfully engage in such new payment systems (given the truly outdated culture that is currently theirs).  Take a look — this lets all those constituencies know we still care about making sure that every American has access to quality care in a timely fashion!

Click on the ad to view it larger.

Not to be outdone by the White House and their televised summit on health care reform (which I'll talk about further over the next couple of days), the ACC is holding a similar meeting of the party minds at ACC.10. I hope many of you will be there in Atlanta and able to attend this special session. “ACC.10 Health System Reform: Where Are We Headed?” takes place on Sunday, March 14, from 12:15 to 1:45 p.m. in Hall B100 of the Georgia World Congress Center. The session will bring together a policy leader on health care from each party. House Republican leader Paul Ryan and Democratic strategist and former Clinton White House advisor Chris Jennings will define and debate the issues and give us the latest update on health care reform. Then, we’ll have the unique opportunity to advocate on behalf of our patients and the entire cardiovascular specialty as we share our ideas with them.

President Fred Bove, Jim Fasules, ACC member Douglas Wood and I will offer our input on the importance of patient access to care and discuss ACC quality initiatives, our perspective on health care reform and physician payment reform. Plus, Richard Anderson, MD, CEO of the Doctors Company, will offer his perspective on the need for tort reform as part of health care reform. Be there. I think this will be a very compelling session, and one that should demystify the health policy issues for you. Of course, ACC.10 is also the premier scientific and clinical care venue in cardiovascular care anywhere worldwide. Don't miss it.

We are continuing unabated in advocating in Congress for mitigation of the horrendous effects of the Medicare 2010 Rule.

We know people think our concern is all about cardiologist incomes. They don’t get it. The cuts will eliminate diagnostic testing, essential staffing, and office services, effectively killing off private practice. While some cardiologists will quit or retire in response, most will adapt quickly, and a majority are moving to hospital employment and selling their practices to hospitals, which will have seriously negative effects on patients, care management, and increase medical costs in Medicare.

The message on the Medicare Rule is that it is already:

• Drastically decreasing patient access to cardiology care (dangerous);
• Tripling costs for outpatient care in Medicare Part B (dumb); and
• Resulting in the laying off of the clinical professionals who work in cardiology practices (nurses, sonographers, technicians, etc).

In many states, the circumstances are heading for melt down already for private practice as people scramble to sell their practices. Florida reports veritably every practice scrambling to be acquired by hospitals or larger systems before reaching insolvency in the very near future. Twenty-one major cardiology groups have already sold in Ohio. It’s really ugly. The impassioned stories from patients still are not happening in large numbers yet because members are still struggling to take care of their patients. But more and more, consumer groups and others are beginning to recognize how serious a problem this is.

We continue to have additional members of Congress signing on to sponsor the Gonzalez bill, and some members of Congress are asking for alternatives as to how we could reduce the impact on cardiology practices by seeking sources of funding from other elements of health care (internal reallocation) so as to address our problem without seeking new funding. We need the new resources if other specialties will be held harmless. We’re building the constituency of support locally while all of you out there are hopefully talking to your members of Congress.

The ACC this morning held a press conference on health care reform as part of the National Coalition on Health Care, of which the ACC and a number of other specialty societies and consumer groups are members. Ralph G. Neas of NCHC, Ron Pollack of Families USA, Mary Andrus of the Consortium for Citizens With Disabilities, Terry Gardiner of the Small Business Majority, Mary Wilson of the League of Women Voters, and Richard Kirsch of Health Care for America Now and I were the featured speakers. From today's Advocate:

The press conference was in keeping with the College's ongoing efforts to work with multiple stakeholders to enact health care reform that protects patient access, addresses tort reform, improves quality/coordination and reduces disparities in care. The ACC had the opportunity to highlight the cardiology community's concerns with the current legislation and urge the elimination of provisions that have reduced public trust and increased partisan rancor.

Even more importantly, it also placed us front and center with key consumer groups who have the ability to help us not only with crucial elements of reform, but with mitigating the impacts of the 2010 Medicare cuts. ACC leadership was also able to individually educate the media in attendance on the impacts of the CMS Medicare cuts on the practice of cardiovascular medicine and patient access to quality care.

Your ACC continues to navigate a critical path through the reform quagmire that truly meets the needs and goals of the cardiology community, while also protecting the patient-physician relationship. Click here to read the ACC's recent letter from ACC President Alfred Bove to House and Senate leaders outlining both the College's areas of support and areas of concern.

In other news, efforts continue to fight the cardiology payment cuts included in the Rule. Please take a few minutes to call or write your representatives and urge them to cosponsor legislation (H.R. 4371) introduced by Rep. Gonzalez (D-TX). We've set a goal of 100 more cosponsors -- contact your member today (so far we're at 77 -- but we'll need a lot more to force some action). To see if your member is already one of the 77 cosponsors and to say thank you, click here. ACC staff is working on generating similar legislation in the Senate. For more on ACC's efforts related to Medicare payment reform, go to http://www.campaignforpatientaccess.org.

We’re about to take another slap if the recent deliberations of MedPAC become real. They’re bound and determined to kill off in-office imaging for all specialties, not just cardiology. To force by public policy all imaging to hospital sites is going to cause quite a problem for patients, both in inconvenience and in increased overall cost. (ACC President Fred Bove has a great President’s Page on the democratization of imaging in the next issue of JACC; watch for it.) Nonetheless, our current version of the IPAB (Independent Payment Advisory Board) is MedPAC, and here’s what they’re doing:

MedPAC staff recently made a presentation to the MedPAC commissioners regarding the “in-office ancillary services” exception (commonly known as the “group practice” exception) to the Stark Law (see the MedPAC slides).  It is this exception that enables private practice cardiologists to provide echocardiography services to their patients.

At the meeting, MedPAC staff suggested that the Commissioners consider three options for addressing the increased utilization that ostensibly results from this exception, especially in the area of clinical lab services, radiation therapy services and diagnostic imaging:

1. Excluding certain services from the group practice exception, such as outpatient therapy and radiation therapy and diagnostic tests that are not usually provided at the time of the office visit.  (According to data presented by MedPAC staff, ultrasound is provided on the same date as the office visit less than 30 percent of the time, so echo likely could not be provided by group practices if this test were adopted.)
   
   
2. Payment tools such as reducing payments for self-referring physicians, packaging services and bundling services.
   
   
3. Establishing a prior authorization program for physicians who self-refer.

In case you’re not watching closely, I need to alert you to the fact that the entire payment system — in both the public and private sector — is in severe disarray. If most doctors are working for hospitals in order to remain viable in the near future, which might be administratively simpler for Medicare and the insurers, the need for payment reform and for physician involvement in it will become even more pressing, because hospital-based costs are going to drive health care costs up. And then, next year, the thrust will be to slash hospital reimbursements. The status quo of the current payment systems, as exemplified by this entry, needs to be changed. Price controls don’t work. When do we wake up here? This is a bad dream.

Nobody seems to know what’s going to happen next or what the actual chances of getting reform legislation passed might be. I don’t know about you, but considering all the pimples, warts and wrinkles in HR 3962 and 3590, there is an impulse to breathe a sigh of relief over the opportunity to push the reset button and get this more effectively. On the other hand, the real potential of a complete derailment is really worrisome.

Here’s the reason to keep the champagne corked about the prospects of a prolonged logjam in getting health reform passed: The access to care problems are growing and cost a lot of money in EMTALA and uncompensated care costs; despite the fact that at its best, U.S. health care is the best, quality is uneven and coordination of care is seriously messed up; and most disturbingly, costs are rising more than twice as fast as GDP and our ability to pay for health care. Allowing the status quo to drift forward will mean draconian measures for rationing and tiering of care for most Americans sometime in the near future; and it will most certainly mean ongoing reductions in physician practice revenues and practice and hospital viability. Medicare is moving rapidly toward overt bankruptcy.

Senate Minority Leader McConnell said the Massachusetts election made clear that the voters didn’t want government taking over health care. Whaaaat? The Massachusetts universal coverage law is in many ways not too different from what the Senate proposes -- and Sen. Scott Brown (D-Mass.) voted for it and doesn’t want it repealed. Maybe the voters were fed up with back room deals like giving unions a free ride exemption from the ‘Cadillac plan’ tax (when they are the only ones with such plans), and with stinky deals like Ben Nelson’s and Chris Dodd’s state bonanzas. Maybe we didn’t need 2000 page bills with so much complexity they created distrust. Whatever, they’re all running around crazily bumping into each other here in the Capitol. It’s absolute chaos. 

Pelosi is right that she has nowhere near the votes in the House to simply pass the Senate bill. That ain’t happening. And using the “reconciliation” process to jam something through with 50 votes to avoid a filibuster is not a likely strategy now, because the public won’t like it. One can only hope that Congress can muster a smidgeon of bipartisanship to create a much simpler solution than what is proposed for reform that addresses the access problem, improves coordination and quality with the participation of the profession, and slows the cost curve toward sustainability. We should all be committed to that as a nonpartisan, necessary thing to protect both the economic and social viability of this country.

So, this is not a time for either chest-pounding or antidepressants. Rather, we have another window of opportunity during this whole congressional season to shame both parties in Congress into acting more responsibly. We can do better than this.

As our attorneys, ACC's witnesses, staff, and I were about to board our flights to Florida for the scheduled hearing on our preliminary injunction and expedited discovery motions related to the Medicare 2010 Payment Rule, Judge William Dimitrouleas of the US District Court Southern District of Florida denied our motions. Basically, he refused to hear our case.

We are deeply disappointed in the judge’s decision not to hear our case based on his opinion that the federal courts do not  have jurisdiction to review Medicare physician payment determinations.  Nevertheless, we continue to believe in the well-documented merits of our case.  The ACC will continue advocating for real payment solutions based on quality outcomes and patient care.

What is deeply troubling about today’s ruling is that it sets the precedent that CMS has complete and unchecked control over physician reimbursement for patient care even where its determinations are based on faulty data.  This only begs the question: Who's next?  Today’s ruling should be a warning to all physicians that anyone is susceptible to falling into CMS’s crosshairs unfairly and without recourse.

Ironically, this rule will increase Medicare costs by shifting cardiologists and their patients to more expensive hospital settings. These cuts are a perverse ‘reward’ for the amazing work cardiologists have done over the past decade in reducing heart disease deaths by thirty percent.

Today’s decision is counted as a loss; however, we stand behind our position that the system erred. The practice expense data used to determine this rule was inaccurate and incomplete.  Reliance on this data will negatively impact patients' access to care.

We have introduced legislation and we remain hopeful that Congress will get the message that these cuts represent bad public policy.

Our ongoing campaign for patient access is about making quality cardiovascular care accessible to the millions of Americans who are battling our country’s number one killer, heart disease. We will continue to fight on behalf of our patients to protect their access to quality care. I encourage you to visit CampaignforPatientAccess.org for more.

We know at the ACC we can’t sue our way to greatness, but this lawsuit against Secretary Sebelius and HHS had to be filed. As I hope all of you know, it has. The judge has scheduled a preliminary hearing for early January already, and we are in expedited “discovery” involving CMS and HHS, AMA and others. The federal court in Florida, where many affected Medicare patients and physicians reside, is taking this seriously it appears.

If you haven’t actually read the complaint, you NEED to. It is prominently located on the ACC's Campaign for Patient Access Web site (www.campaignforpatientaccess.org). Read it, and you’ll understand why the College, joined by ASNC, ASE, ABC, The Cardiology Advocacy Alliance (CAA), the Florida Chapter of the ACC, a coalition of California cardiologists had to move forward with this in addition to our on going legislative, regulatory, and media efforts. Reading the complaint will make it crystal clear why we need to do this. It’s even in the best interest of CMS itself! The Rule will hurt access to care, and particularly for disadvantaged populations, and it will drastically increase Medicare costs by shifting services to the hospital setting. We well understand that federal courts defer hugely to federal agencies, but we believe we have a very compelling case, and we are going to pursue it with vigor.

The announcement made major media coverage, including prominent first section story in USA Today, and widely across the AP and other news networks. Fox News covered it live with an interview with ACC SVP of Science and Quality Janet Wright, FACC (which I'll post when I have the link). BTW, I was impressed with the comment in USA Today by Deputy Administrator of CMS, Jonathan Blum (generally a very good guy), who blamed our cut on a need to improve financing of primary care. We are on record everywhere as supporting primary care -- but, the agency was supposed to use valid data to make calculations on payment based on a very explicit regulation process created by Congress, not based on a political philosophy, no matter how valid. And, most of the reallocated money in the Rule is going to other specialty care, not primaries.

We will keep you all up to date on this process.

As I promised before leaving for the holidays, ACC staff has been hard at work fighting the final 2010 Physician Fee Schedule, which is just days from going into effect. On Monday, the College filed an injunction against Secretary Sebelius alleging that she unlawfully adopted the payment rates for cardiology services, in a manner that threatens patient access to care and increases Medicare costs. From the ACC Advocate:

December 29, 2009

The time for legal action is NOW! Yesterday, the ACC filed a complaint, as well as motions for a preliminary injunction and expedited discovery, against Health and Human Services (HHS) Secretary Kathleen Sebelius, in U.S. District Court in Florida. The complaint alleges that Sebelius, in her capacity as HHS secretary, unlawfully used an invalid physician practice information survey (PPIS) to set the payment rates for cardiology services in the 2010 Medicare Physician Fee Schedule in a manner that threatens patient access to care and precipitously increases Medicare costs by driving cardiologists out of community practice.

According to the complaint, clear and critical defects exist within the PPIS, which was used to justify cuts to Medicare reimbursements rates for cardiology and which directly undermines the viability of community practices. Your ACC, along with the Florida ACC Chapter, American Society of Nuclear Cardiology, the Association of Black Cardiologists and the Cardiology Advocacy Alliance, are seeking a preliminary injunction against the implementation of the 2010 fee schedule rates for cardiologists and asking the court to rule it invalid and order HHS to use more reliable data that is available or commission a new practice expense survey. Read the complaint! It will make you even more determined to work with us until we prevail.

The lawsuit is filed. What's next? We hope the court will schedule a hearing on the College's motion for a preliminary injunction prior to Jan. 15, before any 2010 Medicare payments are actually issued. We also hope the court will grant our motion for expedited discovery of CMS and others involved in the development and analysis of the PPIS. Of course, the court may decide not hear our motions prior to implementation of the fee schedule and/or not grant either motion. Should the government try and have our right to bring this suit blocked by the court we will vigorously contest that effort.

While the probability of success in any legal action can be difficult to gauge, the College would not have taken this action, if we did not believe strongly in the legitimacy of our claims. We can confidently say that we have fully pursued all regulatory and legislative options in an attempt to reach a reasonable compromise before having to resort to a lawsuit to protect practice viability and access to cardiovascular care. Unfortunately, despite the best efforts of many in Congress, there is no sign of a reprieve before the Jan. 1, 2010 deadline.

Our expectations are realistic, and we are aware that the Federal courts' general inclination to defer to the executive agencies in the implementation of their statutes and regulations with certain laws that protect aspects of the Medicare law from judicial involvement. But, we believe these do not preclude our challenge to the use of the PPIS. Also, should our legal efforts not succeed rest assured that the College will continue its legislative and regulatory efforts. Thanks to the tremendous grassroots efforts of the entire house of cardiology, we have made great strides in building a strong framework for fighting these cuts in 2010. We will continue to work with Congress, CMS and the Obama administration to resolve this issue and find a reasonable solution that minimizes the impact to other specialty societies, while addressing the unjustified and unreasonable cuts to cardiology.

We understand that the Medicare cuts are already having irreparable effects on cardiology practices across the country. On behalf of our patients and the future of cardiology, we will not give up until this injustice is rectified. For more on ACC's efforts, go to the Campaign for Patient Access Web site.

Also, our CVN studios has released the video below explaining the legal action. UPDATED: Full version of the video. UPDATE 2: Correct co-plaintiffs.

The Senate has been all over the place these last couple days. It sure looked like they weren’t going to get anything done before the Christmas recess, with the Republicans invoking the weird Senate rules to require that the clerks read all 2,000 pages of the HR 3590 and the thousands more pages of amendments out loud to delay everything and block a vote on cloture. They've gone through two of the three procedural votes needed to vote on the bill, hopefully on Christmas Eve. The third procedural vote is scheduled for tomorrow. It looks like the Senate health reform bill is going to happen.

That said, the Washington pundits are loudly emphasizing the fact that 61 percent of Americans in the most recent polls are leery of the Senate’s proposal, and more and more observers are concerned about the costs in view of a likely lingering large number of uninsured persons that would result from the holes in their measure. Even Howard Dean has come out against the bill

There’s a lot not to like and to be concerned about in what they’re doing, but I personally believe that the nation will be better off if we achieve a clumsy commitment to universal access, to improving quality and coordination of care, and to successfully reducing the slope of cost increases in health care. If we don’t, we will soon bankrupt Medicare and the federal budget and make health insurance premiums unaffordable for most families and businesses. Doing nothing isn’t much of a responsible action, even with the goofy elements of the Senate and House bills. Since the House version doesn’t kick in until 2013, and the Senate is likely to delay implementation another year to 2014, I think that whatever messy, 2,000-page bill is passed can be amended and fixed over the next three years.

I fully understand the views of those who want to reboot and start over. But, we’ve been saying that we will do that for 30 years. Just having a sense of direction is important. Just think about how dysfunctional the current Medicare payment formulas are, for example. We need to embark upon a process to reduce the administrative waste in our system, fix the Wall Street-based insurance injustices and design a more coordinated delivery system. It doesn’t have to be one that impoverishes physicians and nurses — in fact, a truly reformed system is going to need to empower health professionals to be effective. So, while I fully understand and empathize with the physicians, the professional societies and the members of the public who would rather do nothing and reboot the process, I honestly believe a little momentum — even with the severely flawed proposals before us — is needed. And, there will be time to try to get tort reform inserted in the process in January I suspect, and we are poised to attempt that. What else are we going to do for the next three years?

This week the Medicare Payment Advisory Commission (MedPAC) laid out its recommendations for the 2011 Medicare physician update (we haven’t survived 2010 yet!). The draft recommendation was that Congress should update payments for physician services in 2011 by 1 percent, and that while this would increase overall Medicare spending as well as increasing beneficiary cost sharing, it would help maintain supply and access to physician services. However, a 1% increase isn’t going to cause a flood of new med school applicants!

The Medicare Payment Advisory Commission (MedPAC) also heard an update on enrollment and payment data for Medicare Advantage (MA) plans. MedPAC staff said enrollment grew to almost 11 million over the previous year and now accounts for 1 in 4 Medicare beneficiaries. Plans offerings continue to be widespread, but choices of private fee-for-service (PFFS) plans shrank as impending networking requirements began to lead to market withdrawals from some plan sponsors. With respect to payments, MedPAC’s preliminary estimate is that 2010 payments will average 113% of fee-for-service – though that figure could be adjusted lower if Congress prevents a cut in physician payments and thereby increases Medicare FFS spending. The discussion comes as Congress is considering sizable cuts to MA as part of health reform

Over 80 ACC members went to Capitol Hill last week to talk to their lawmakers about the devastating effects that the CMS cuts will have on their patients’ access to care. Here’s what a few had to say. 

From Jacqueline Hollywood, MD, FACC:

Wow! What a marathon, I have blisters from all the running we did on the Hill this week.  It truly is a marathon and not a sprint, because we still have a long way to go.  It was amazing to see cardiologists from all over the country come together to protect patients and the future of the practice of cardiology.

We met with members from both the House and the Senate. Some were aware of the threats to cardiovascular care and some were not. Most were not aware of the devastating impacts of these cuts.  Decreased access, significantly increased costs and layoffs are not a prescription for health care reform. One representative we met with commented, “This was the first he was hearing of these cuts and how come doctors and patients were not calling him?”  I know many of us feel that no one is listening and that we have no control.  I can tell you this week on the Hill they were listening but we need our voice to be louder.

Call, e-mail your senators and ask your congressmen to co-sponsor the bill from Rep. Gonzalez to halt the cuts.  Make patients aware of the very real threat to their cardiac care and have them contact Congress as well. We need to make our voices heard, the time is NOW.

From former ACC President Douglas Weaver, MD, MACC: 

Staffers were not just polite, they were genuinely interested in our message. Members of Congress are so engaged with health reform, that they weren't aware of the Final Rule. I found a willingness from both sides of the aisle to help. Now it's whether or not we can get something done.

From Florida Chapter President Alberto Montalvo, MD, FACC:

Today the Florida Chapter of the American College of Cardiology had between thirty-five and forty cardiologists visiting our Congressional delegation to specifically discuss the 2010 CMS Physician Fee Schedule and the Gonzalez legislation that would temporarily fix the unsustainable cuts.  All members reports back that we were well received and that our lawmakers understood the problems that the CMS rule would create for patients and practices.   Our delegation was unanimously supportive of our effort and stated their support of this legislation. Overall our elected officials were impressed with the gravity of the problem especially when were confronted with so many cardiologists who had left their practice to come to Washington on this issue.  Of particular interest: 

• Congressman Vern Buchanan raised concern that so many Sarasota-Bradenton cardiologists were in Congress. He hoped there were still some behind to take care of emergencies.
• Congresswoman Debbie Wasserman Shultz expressed her support and discussed at length many health care concerns. The interaction with the large delegation was lively and resulted in better understanding of the issues.
• Congressman Mario Diaz-Balart, John Mica and Congresswoman Ileana Ros-Lehtinen were also very supportive.

The Florida delegation was energized by the visits because they were very productive. We left with measured optimism that we mad made an impact and hopeful in the success of pending legislation.

From Board of Trustee member Kim Allan Williams, MD, FACC: 

The visits to Capitol Hill were enlightening, yet difficult.  I am frequently surprised at the varied levels interest and understanding of Medicare payment structure in the congressional health staff, particularly as it relates to the differences between the HOPPS and the Medicare Fee for Service reimbursement, and the differences between the Medicare Final Rule issue and the overall health system reform legislation currently being debated on the Hill.  However, we regarded these issues as teachable moments and listened carefully to the few staff members who were already up to speed. 

Each office was sensitive to the message of preserving cardiology access.  I described the possible closing of cardiology practices and shift to hospitals to each of them as "an inconvenience for the wealthy, a problem for the majority, and a disaster for the underserved."

As you can see from their comments, it was both a positive experience and one that highlights the need for additional efforts to educate members of Congress about what will happen to your practice Jan. 1. Take action now with ACC’s online grassroots system or call the toll-free grassroots hotline (800-210-7193) to be connected to your lawmakers by phone.

Image credit: http://www.flickr.com/photos/wallyg/ / CC BY-NC-ND 2.0

The ACC has signed on to support a Consumers Union consensus statement that urges the Senate to retain the Patient-Centered Outcomes/Comparative Effectiveness Research (CER) provisions in health care reform. The good news is how broad and basic it is — amazingly, they got good support from health plans on this.

Both chambers of Congress have different view on CER, including whether to follow the "Federal Reserve" model, in which the research is relatively independent of government, or the government approach, housing the research center within AHRQ. Who will sit on the review board is a bit of an issue, too, but both chambers are looking at a good cross-section of the whole health care community, including government, industry, patients, physicians, researchers and similar stakeholders. 

One of the big fears out there — which it seems is being addressed very carefully in all the legislation I've seen (but that doesn't stop naysayers from hyperventilating about it) — is that the government will use CER as a basis for cost-containment and restrictive coverage decisions. Critics are using the recent mammography guidance as an example of rationing through CER. To be clear, the ACC and Consumers Union wholeheartedly support CER that separates cost efficiency from clinical effectiveness.

Our ACC Medical Directors Institute this year focused completely on CER, and we'll continue to delve more deeply into some topics, such as shared decision-making with patients/providers and helping IOM and the Federal Coordinating Council for CER in action plans related to their research priorities.  It will be interesting to watch this unfold!

As part of the ACC's Campaign for Patient Access, we are working with passionate members and various practices across the country to gather personal stories and pitch local media in their areas.  Watch this video of Dr. John Rosenbaum on NBC News in Colorado Springs, talking about the rule's impact on his practice. Go to the Newsroom section of the new Campaign for Patient Access Web site to see the press releases that have gone out for various regions, including Chicago on Friday. There's also the ad from yesterday/today/tomorrow.

Below is a great example of collecting personal stories from Fred Aueron, FACC, who send in this video from his patient, Hilding Lindquist (see Mr. Lindquist's blog posts on the New York Times' "The Local").

Also, don't forget this week is Take Action for Access Week. ACC Board of Trustees' members, members of the Florida Chapter and other ACC leaders are here today on Capital Hill talking to their lawmakers. Specifically, they're asking House members to sign-on as original co-sponsors to legislation by Rep. Charlie Gonzalez (D-TX) that would hold cardiology at 2009 practice expenses at the current rates, while allowing other specialty practices to operate at 2010 physician practice information survey (PPIS) values. Rep. Gonzalez expects to introduce the bill later this week.

In that spirit, today's action for Take Action for Access week: Make a virtual visit to the Hill by calling or e-mail your lawmakers. The Campaign for Patient Access Web site provides easy access to your lawmakers.