January 25, 2008

HEADLINE

Supreme Court Reject Industry Challenge

Earlier this month, the U.S. Supreme Court refused to hear industry challenges to the Clean Air Act, letting stand the lower court decision on the Clean Air Act. The lower court ruled that in issuing a new, stricter pollution standard for ozone, EPA could not relax previous pollution standards.

EPA had proposed to relax some standards of the Clean Air Act in exchange for pollution emitting facilities making progress on ozone pollution. If allowed to move forward, the EPA policy would have allowed pollution emitting facilities to increase one type of pollution emissions in exchange for reductions in other pollutants. The U.S. District Court decision, which was upheld by the U.S. Supreme Court, held that EPA did not have the authority to relax emission standards in one program in exchange for improvements in other emissions control programs. The lower court decision was a victory for advocate of improving our nation's air quality.

The American Thoracic Society played an active role in the lower court ruling, filing an amicus brief in support of enforcing all the legislative requirements of the Clean Air Act. The lower courts decision, which was upheld by the U.S. Supreme Court, essentially adopts the ATS position.

ATS Comment on EPA Lead Standard

The ATS joined the National Resources Defense Council and several other organizations in comments to EPA opposing their proposal to eliminate the existing clean air standard for air bourn lead. While significant progress has been made in reducing lead exposure, research has shown that health effects of lead, in terms of lost IQ points, is occurring at levels below the existing EPA air bourn lead standard. The ATS comments also stated the existing lead standard of 1.5 ug/m3 is not protective of public health and should be tightened to 0.2 ug/m3.

SLEEP

ATS Comments on Proposed CMS Coverage for CPAP

In January, the American Thoracic Society submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding their proposed National Coverage Determination for continuous positive airway pressure (CPAP) devices for treatment of obstructive sleep apnea.

As reported earlier, CMS currently covers CPAP when OSA is diagnosed using a clinical evaluation and PSG performed in a sleep laboratory. CMS is proposing to expand the cover of CPAP for OSA diagnosed with a combination of a clinical evaluation and unattended home sleep monitoring using a Type II, III or IV device.

CMS is also proposing to provide a 12 week initial CPAP coverage period for Medicare beneficiaries. CPAP coverage beyond the 12 week period is limited to Medicare beneficiaries who have benefited from CPAPC treatment during the initial 12 week trial period.

The ATS comments strongly supported the CMS proposed coverage decision. While supporting the proposed decision, the ATS comments did seek additional clarification from CMS on what constitutes "patient benefit" during the 12 week initial coverage period. The ATS recommended that recorded patient use of CPAP be a significant factor in determining "benefit" and that benefit not be limited to only those patients who demonstrate clinical improvement. The ATS comments point out that CPAP can prevent disease in addition to treating existing disease. The ATS further recommended that physicians responsible for the performance and interpretation of sleep testing should provide evidence of training and expertise in polysomnography and portable monitor testing.

PUBLIC HEALTH

ATS Supports Vaccine Legislation

This week the ATS joined with the American Medical Association (AMA) and other medical societies in endorsing legislation to improve seniors' access to vaccines. The legislation, entitled the Medicare Improvement Act, H.R. 4992, sponsored by Rep. Waxman (D-CA), would move coverage of all preventative vaccines, such as the shingles vaccine, from Medicare Part D into Part B, as recommended by the Medicare Payment Advisory Commission (MedPAC) in 2007.

Under Medicare reform legislation enacted in 2003, preventative vaccines are covered under Part D. The Centers for Medicare and Medicaid Services (CMS) does not require reimbursement from Part D prescription drug plans for the costs associated with administering Part D-covered vaccines, which limits some beneficiaries' access to vaccines. In 2006, Congress attempted to fix the problem by requiring Medicare Part B coverage of Part D vaccine administration for 2007 and thereafter by Part D plans. While this measure addressed part of the problem, it created new administrative issues that required physicians to bill beneficiaries for the vaccine ingredient and administration. Medicare beneficiaries must currently pay out-of-pocket for the vaccine and file a Part D claim to receive reimbursement, which creates an access barrier for some beneficiaries.

The ATS Washington Office will monitor the Medicare Improvement Act's movement through Congress and alert members if their action is needed to support this measure.

ATS NEWS

The American Thoracic Society (ATS) and AMA conducting Physician Practice Information survey

For the first time in nearly a decade, the American Thoracic Society (ATS), the American Medical Association (AMA), and more than 70 other health care professional organizations have worked together to coordinate a comprehensive multi-specialty survey of America's physician practices. The survey will collect up-to-date characteristics of thousands of physician practices from virtually all specialties, and be used in efforts to positively influence national decision makers to ensure accurate and fair representation for all physicians and patients.

Getting our nation's policy-makers to understand today's landscape and the requirements for care is critical. These data will allow medicine to articulate the challenges of running a practice that provides expert patient care, while operating a business that is sustainable. The study results will not only help in the short-term but will allow future generations of doctors to continue providing superior care to their patients.

One particularly important section of the study pertains to practice expenses and the amounts that are attributable to you. The Centers for Medicare and Medicaid Services have indicated that the results of this study will be used to help determine physician payment. Please encourage your staff to make this information available as the survey's success depends on accurate and complete data. This information will remain confidential. The survey firm, Dmrkynetec, will not identify any individuals or entities participating in this research.

Dmrkynetec, a survey firm with extensive experience in the area of physician practice finance, has been retained to administer the survey. Dmrkynetec will contact randomly selected physicians and practice managers in order to collect their confidential responses. Dmrkynetec will not identify any individuals or entities participating in this research. Please watch for this survey and complete it thoroughly and accurately. Do your part to represent our profession.

Points of Contact