August 21, 2006

2006

August 21, 2006

HEADLINE

District Judge Rules Against Tobacco Industry

Last week, U.S. District Court Judge Gladys Kessler ruled against the tobacco industry in a civil racketeering suit. The judge found that the U.S. Department of Justice had overwhelmingly proven that the tobacco industry had engaged in a decades long campaign of deceptive practices to sell tobacco products, including hiding from the public the known health effects of tobacco, deliberately manipulating nicotine content to enhance the addictive powers of tobacco products, and intentionally marketed tobacco products to children.

In the ruling, the judge outlined a series of “corrective measures” for prevent the tobacco industry from engaging in future fraudulent behavior, including:

§ Banning the use of “light” mild, low-tar, natural and any other term that implies a health claim

§ Place “corrective statements” in major media outlets

§ Publicly disclose tobacco industry documents

§ Publicly release marketing data for the next 10 years

In ruling, Judge Kessler stated she was constrained from issuing other corrective actions, such as financial fines, by a previous appellate courts decision regarding this case. When the case was first initiated under the Clinton Administration, the U.S. Department of Justice had sought $280 billion in disgorgement of illegal profits from the tobacco industry. Under the Bush Administration, the U.S. Department of Justice significantly scaled back the monetary damages to $14 billion to fund tobacco cessation and education campaigns.

The ruling, which was brought under the Racketeering Influenced and Corrupt Organizations (RICO) statute, marks the first time the courts have issued broad injunctive relief against the tobacco industry.

The ATS participated in this case as an “amicus curiae” or friend of the court filer. In the brief, the ATS join other medical and public health organizations in describing a range of options that Judge Kessler should implement in constructing the correction action part of her decision.

PHYSICIAN PRACTICE

ATS Signs Letter on Medicare Budget Neutrality Adjustment

The ATS joined over 30 medical organizations in a letter to the Centers for Medicare and Medicaid Services (CMS) expressing concern with how they are proposing to implement the results of the relative value, resources based update committee (RUC) 5-year review process.

After a lengthy survey and consultation process with the physician community, CMS is making a series of adjustments to physician work value in a number of CPT codes. Several high volume evaluation and management CPT codes, including the critical care CPT codes 99291 and 99292 are slated to receive significant increases.

However, all changes in the work values must be implemented in a revenue neutral way – i.e. no increase in overall Medicare spending. To offset the expected increase in Medicare expenditures from the increases in the evaluation and management and other CPT codes, CMS is proposing to all the physician work value of all CPT codes by 10 percent.

The ATS and others in the physician community are concerned that cutting the physician work value by 10 percent will have several negative impacts including, disrupting the relative value scaling within the CPT structure, will removed $200 million from the physician payment pool annually, and breaks with previous CMS policy of making budget neutrality adjustments to the Medicare conversion factor.

In the letter, the ATS and the rest of the physician community supports using the Medicare conversion factor as the most appropriate way to implement the RUC 5-year recommendations in a budget neutral fashion.

CLEAN AIR

EPA Begins Standard Setting Process for Ozone

This summer, staff at the Environmental Protection Agency (EPA) issued a document summarizing the existing scientific literature on the health effects of exposure to ozone. The EPA document marks the starting point for the standard setting process for ozone established in the Clean Air Act.

Under the Clean Air Act, every 5 years the EPA is required to review the existing standards for criteria pollutants and make any changes to the standard necessary to protect the public health, including vulnerable populations, with an adequate margin of safety. However, the EPA has failed to adjust the current standard for ozone on a timely basis and is under a court order to initiate and complete a review of the ozone standard by December 2007.

In drafting the report, the EPA staff made a number of important findings, including:

§ The evidence for an ozone standard is stronger today than it was in 1997 (the last time the standard was set).

§ In addition to the known respiratory effects, there is a growing body of research demonstrating on cardiovascular health effects from exposure of ozone

§ The standard should remain at least as protective as current standard (0.08 ppm)

§ The administrator should consider setting the standard between 0.07 ppm and 0.08 ppm.

Later this month, the Clean Air Scientific Advisory Committee (CASAC – a federal panel of experts on air pollution) will hear public comments on the EPA staff document. The ATS will be participating in the CASAC hearing.

Points of Contact

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