May 16, 2005

HEADLINE

ATS Hosts RUC Survey Response Site at the International Conference
ATS members will be able to complete the RUC 5-year survey at the May ATS International Conference meeting in San Diego. A special computer will be located at the ATS Clinicians Center for completing the RUC surveys and professional staff will be available to assist ATS members in understanding the survey process.

For those not attending the conference, surveys can be completed on line.

As you may recall, the physician community will be surveying a variety of current procedural terminology (CPT) codes as part of the 5-Year Resources Based Relative Value System Update process. The Centers for Medicare and Medicaid Services (CMS) is required by law to review the relativity of CPT coding system every 5 years. The "refinement" process is the physician community's opportunity to adjust work relative value unites (RVUs) for codes that are undervalued or overvalued. The survey results will be used to adjust relatively of the CPT coding structure and make adjustments to codes that are undervalued or overvalued.

To ensure that the pulmonary and critical care community is well represented in the survey process, the American Thoracic Society will join our sister societies in surveying the following pulmonary and critical care CPT codes:

• CPT 31622 - Bronchoscopy (rigid or flexible); diagnostic, with or without cell washing
• CPT 94010 - Spirometry, including graphic record, total and timed vital capacity, expiratory flow measures with or without maximal voluntary ventilation
• CPT 94657 - Ventilator assist and management, subsequent day(s)
• CPT 99291 - Critical care, evaluation and management of the critically ill patient: first 30-74 minutes
• CPT 99292 - Critical care, additional 30 minutes

In addition to the above codes, the American Thoracic Society will be collaborating with the American College of Physicians and other internal medicine specialty organizations to survey selected families of evaluation and management codes.

The data collected from these surveys will be aggregated and used to develop new RVU recommendations. These recommendations will be forwarded to the AMA Relative Value Update Committee (AMA RUC) and CMS for their consideration.

If you are interested in participating in the 5-Year Refinement Survey, please contact Gary Ewart of the ATS Washington Office. Mr. Ewart can be reached via email at (gewart@thoracic.org).

PHYSICIAN PRACTICE

House Bill Introduced to Fix Medicare Sustainable Growth Factor
This week, Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) introduced legislation to fix the formula used to calculate the annual updates for Medicare physician payments.

As you recall, the current flawed sustainable growth rate (SGR) formula ties increases in Medicare physician spending to growth in the U.S. gross domestic product, penalizes physicians for exceeding annual spending targets and includes Medicare covered prescription drugs expenditures as a physician expense. These combine flaws in the SGR formula have lead to projected annual cuts in Medicare physician spending 4% for the next several years.

The legislation introduced by Reps. Shaw and Cardin would (1) set the Medicare physician payment update for 2006 at no less than 2.7% and (2) beginning in 2007, implement Medicare Payment Advisory Commission's (MedPAC) recommendation to replace the current SGR with updates based on inflation in physicians' practice costs. It is expected that similar legislation will be introduce in the Senate.

Unless Congress takes action to either fix the SGR or override the update factor, physician are projected to see a 4% cut in Medicare physician payments in January 2006.

RESEARCH

House Appropriations Subcommittee Cuts VA Research
This week, the House Military Quality of Life and Veterans Affairs Appropriations Subcommittee passed is version of the fiscal year 2006 appropriations measure. The bill called for a $9 million cut (-2%) in VA Research funding for FY06. Compounding the cut was report language directing the VA Research program to spend 20% of its total research funding on mental health research. Meeting the goal of 20% mental health research would require significant transfer of funds out of existing VA Research programs.

In related activity, the subcommittee provided a $5.9 billion increase in medical care for VA Medical Care. This is an increase of $1.1 billon over the president's request.

VA Dear Colleague Letter Seeks Increase in VA Research Funding

In early May, 42 senators joined Jim Bunning (R-KY) and Daniel Akaka (D-HI) in a letter to the Senate Military Construction and Veterans Affairs Appropriations Subcommittee seeking an increase in funding for the VA Research program. The letter notes that the president's budget request recommends a $9 million cut in the VA Research program, which would result in a significant cutback in the number of grants funded by the VA.

CLEAN AIR

ATS Comments at EPA Ozone Public Hearing
On May 4, Adam Wanner, MD, past president of the ATS, presented comments on behalf of the ATS before the Environmental Protection Agency (EPA) Clean Air Scientific Advisory Committee (CASAC) regarding the health effects of exposure to ozone. The purpose of the CASAC meeting was to review the published literature on the health effects of exposure to ozone and to begin the regulatory process to review and potentially revise the EPA clean air exposure limits for ozone.

In his comments, Dr. Wanner complimented the EPA staff for preparing a comprehensive review and summary of the existing literature on the health effects of ozone. Dr. Wanner noted that current research demonstrates that adverse health effects occur at levels below the current EPA standard of 0.08 ppm. Dr. Wanner also pointed out that several nations including Canada, New Zealand, Australia and the World Health Organization in addition to California have set standards at levels below the current EPA standard of 0.08 ppm.

It is expected that the EPA CASAC will make recommendations by December 2005 on whether the current EPA standard for ozone needs to be revised.

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