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April 26, 2005

2005

April 26, 2005

HEADLINE

Bipartisan Asbestos Legislation Introduced

This week, Senators Arlen Specter (R-PA) and Patrick Leahy (D-VT), chair and ranking member of the Senate Judiciary Committee, introduced legislation to create a $140 billion trust fund and administrative settlement system for resolved claims from workers with asbestos-related disease. The bill would create an administrative system, with established medical criteria and compensation levels for disease, to resolve claims of workers with asbestos-related disease. In exchange for ending liability for asbestos related claims, insurance and asbestos-related industries would pay a tax to fund the $140 billion trust fund.

The Senate Judiciary Committee is expected to mark up the legislation as early as next week.

While several key labor, industry and insurance groups have endorsed the legislation, members from both the Republican and Democratic parties have expressed reservations with the legislation. It is expected that during Senate Judiciary Committee mark up of the legislation several amendments will be considered that may significantly alter the legislation and thereby erode some of the early support expressed for the bill.

The ATS does not have a position on the need for, merits of, or construction of asbestos litigation reform legislation. However, the ATS is committed to ensuring that appropriate medical criteria are used and applied in whatever legislative proposals move forward. The ATS worked closely with Republican and Democratic staff to provide input on the medical criteria used in the legislation.

PHYSICIAN PRACTICE

ATS Hosts RUC Survey Response Site at the International Conference

ATS members will be able to complete the RUC 5-year surveys 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 is 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 five 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 the 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 capcity, expirtory 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 five year Refinement Survey please contact Gary Ewart of the ATS Washington Office. Mr. Ewart can be reached via email at (gewart@thoracic.org).

CBO Releases Report on Cost of Fixing Medicare Sustainable Growth Rate (SGR) Formula

This week, the Congressional Budget Office (CBO) – a non-partisan congressional office charged with estimating the costs of legislative proposals – released a report estimating it would cost Medicare $154 billion over 10 years to fix the sustainable growth (SGR) rate flaw in the Medicare physician payment formula.

As has been reported previously, the flawed formula used to calculate the annual updates for Medicare payments to physicians and other providers limits physician payments to the growth in the economy and penalizes physicians for increases in Medicare. These provisions are known as the SGR formula. The flawed SGR formula has resulted in projected cuts in Medicare physician reimbursement in the order of 4.5 percent annually.

To avert these cuts, Congress passed legislation in 2003 establishing a 1.5 percent increase in Medicare physician reimbursement for 2004 and 2005. However, the legislation did not fix in the underlying flawed formula. Absent Congressional action, the flawed formula will result in annual cuts of approximately 4.5 percent starting in 2006.

The ATS will continue to work with Congress and the physician community to avert the projected cuts in 2006 and fix the SGR component of the physician payment formula.

RESEARCH

FY06 Budget Update

As Congress continues to debate the fiscal year 2006 (FY06) budget resolution, the Bush Administration insists that it wants to limit the growth of Medicaid funding to 2.2 percent as compared to a 7 percent increase in FY05. As reported earlier, the Senate FY06 budget resolution kept intact the entitlement spending dedicated to Medicaid whereas the House voted to cut Medicaid spending.

The budget process is stalled for lack of consensus regarding the Medicaid spending. Any budget resolution agreement hinges largely on getting a group of Senate moderates led by Sen. Gordon Smith (R-OR) to agree to Medicaid spending cuts. Senator Smith and the Administration have been discussing Smith’s proposal to form a commission to study Medicaid's rising costs.

In addition, the President’s FY06 budget proposes less than a 0.5 percent increase for the National Institutes of Health (NIH) and a 12 percent cut for the Centers for Disease Control and prevention (CDC). Like with the Medicaid funding, the proposed funding for the NIH and CDC voted upon by the House mirrors that of the President’s budget. However, like with the Medicare funding, the Senate voted to increase the NIH budget by $ 1.5 billion. Congress will have to reconcile the differences in the NIH, CDC and other discretionary spending as well as the entitlement spending such as Medicaid in order to pass the final FY06 budget resolution.

100th Anniversary Resolution Introduced in the Senate

Last week, Sen. Crapo (R-ID) introduced legislation (SR 114) to recognize the achievements of the American Thoracic Society on its 110th anniversary. A similar resolution has been introduced in the House of Representatives by Rep. Randy Cunningham (R-CA). Both resolutions recognize and celebrate the 100 years of contribution that the ATS has made to the prevention, detection, treatment and cure of lung disease.



Points of Contact

Gary Ewart Senior Director, Government Relations
Nuala Moore Senior Legislative Representative
Joe Kirby DC Office Administrator