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March 11, 2011


Washington Letter
March 11 , 2011

ATS Needs Your Input on PFT Code

The American Thoracic Society needs physicians (U.S. based MDs/DOs) to participate in a survey to help develop the physician work values for newly established pulmonary function test CPT codes. Without additional survey participation, the ATS will have a difficult time advocating for the appropriate physician work value for these codes. This survey is important to you and to other physicians because these values determine the rate at which Medicare and other payers reimburse for these procedures.

We encourage ATS members who perform PFTs to participate in the survey. The online survey that takes approximately 30 minutes to complete. As part of the survey, you will be asked to read the PFT CPT code description and a vignette of the typical patient receiving a PFT. The survey will then ask a series of questions to get your best estimate about the time, intensity and medical decision-making involved in administering and interpreting a PFT. All data will be aggregated to develop final recommendations
The deadline for completing the PFT surveys is Tuesday, March 15.
If you are willing to participate, please send an email to (codingquestions@thoracic.org). Please include "PFT Survey" in the subject line. In the body of the email, include your full name, practice address, telephone number (including area code) and e-mail address.

If you have questions or need additional information about the survey process, please contact Mr. Gary Ewart, senior director of ATS government relations at gewart@thoracic.org.


CMS Warns of 29% Cut in 2012 Medicare Physician Payment --ATS Urges Swift Action on SGR Fix

This week, the Centers for Medicare and Medicaid Services sent a letter to the Medicare Payment Advisory Commission estimating the Medicare physician payments for 2012 will be cut by 29.5 percent under the current Medicare sustainable growth rate formula (SGR). Earlier projections had estimated a 25 percent cut.

President Obama had reserved $62 billion in his proposed budget to pay for a two-year freeze in Medicare physician payments; however, the new projections raise the price for even a payment freeze by several billion dollars.

CMS's projections underscore the urgency of developing a permanent solution to the SGR payment crisis.

Also this week, the ATS joined over 100 physician organizations in a letter to Congress urging swift action to avert the future cuts in Medicare payments. The letter points out that last Congress passed five separate short-term extensions--in some cases as short as one month--before agreeing to a longer extension. On three occasions, the cuts were actually implemented before Congress enacted legislation to retroactively fix the problem. The letter notes, "(t)hese payment uncertainties and delays created serious problems for many physician practices and jeopardized seniors' access to care. Ultimately, Congress and the Administration worked together in a bipartisan manner to develop offsets and pass the "Medicare and Medicaid Extenders Act of 2010," which stabilized Medicare physician payments through 2011. It is our hope that Congress can again work together this year to end the cycle of temporary patches and develop a long-term and meaningful solution to this issue."

The ATS will continue to urge Congress and the Administration to develop a permanent fix to the SGR crisis.


House Subcommittee Prevents EPA Carbon Regulation

IThis week the House Energy and Commerce Energy and Power Subcommittee in a partisan vote approved legislation to strip the Environmental Protection Agency of its authority to regulate carbon emissions and all other greenhouse gases. The legislation, introduced by Rep. Upton (R-MI), bars the EPA from issue greenhouse regulations that control emissions, or even require public reporting of emissions.

The legislation effectively overturns the U.S. Supreme Court rule in Massachusetts v EPA, in which the court ruled that the EPA had the authority and obligation under the Clean Air Act to issue climate change regulations. The legislation also invalidates a recent EPA issued endangerment finding that lists the likely human and environmental health effects results from greenhouse gas emissions.

The legislation now moves on to the full Energy and Commerce Committee for consideration. The legislation is expected to pass in the full committee along a largely partisan vote.

The ATS joined several other physicians and scientific organization in expressing our opposition to the legislation.

ATS Speaks at Press Conference About Air Pollution and Public Health

ATS member Kent E. Pinkerton, PhD, chair of the ATS Environmental health Policy Committee, represented the ATS this week in a press event to discuss how legislative riders in the House passed appropriations bill will harm American public health by increasing air pollution. Legislation enacted by the House of Representatives, H.R. 1, contained a number of legislative riders that reduce the EPA's ability to set and enforce air pollution standards under the Clean Air Act. Specifically, H.R. 1 strips the agency of its authority to regulate greenhouse gases and stops the EPA from issuing rules limiting pollution from cement kilns and regulation on coarse particulate matter. In his comments, Dr. Pinkerton noted the known adverse health effects air pollution has on patients with asthma and COPD.


Senate Defeats FY2011 Spending Measures; No FY2011 Spending Compromise in Sight

This week, the Senate defeated two FY2011 spending measures, setting up the need to pass another short-term spending measure to fund government programs past March 18. The good news is that the Senate voted down the House-passed continuing resolution that would impose a 5.2 percent cut for the NIH, a 17 percent cut for CDC and a 16 percent cut for the EPA. The Senate defeated the bill by a vote of 44 - 56, with three Republicans joining Democrats against the bill. The following day, Senate leaders brought the Senate Appropriations Committee's FY2011 proposal, which would cut $4.7 billion from current spending, to the, floor. This bill was also voted down, by a vote of 42 - 58.

As the deadline for expiration of the current continuing resolution, March 18, draws closer, House and Senate leaders have begun drafting an additional short-term FY2011 measure. The House is expected to bring a bill to the House floor next week to provide another three weeks of temporary funding for government programs that would expire on April 8. House leaders say this bill would cut $6 billion from current spending levels. The $6 billion in cuts over the three-week period aims to maintain the overall House Republican goal of rolling back current federal spending levels to FY2008 levels. The bill is expected to pass the House, although some House Republicans have indicated that they are uncomfortable with using short-term measures to fund government programs. Meanwhile, there is no news of a possible compromise between the House and Senate on final FY2011 spending.


ATS Testifies before FDA on New COPD Treatment

This week, the ATS testified before the FDA's Pulmonary-Allergy Drugs Advisory Committee on indacaterol, an inhaled COPD treatment. The FDA committee later voted in favor of FDA approval of low-dose indacaterol by a vote of 13 - 4.

ATS Washington Office staff testified in support of the development of new drugs to treat COPD. The ATS stated, "We strongly encourage the continued pursuit of novel compounds to treat COPD and are particularly interested to see the FDA support drugs that can improve symptom control and reduce the need for rescue medications."

Indacterol's manufacturer, Novartis, submitted an approval application for a low dose ( 75 micrograms), and a higher dose (150 micrograms). The higher dose was intended to be part of a combination therapy with a long-acting muscarinic antagonist. The FDA panel did not approve the higher dose due to concerns of increased adverse events.


The Washington Letter is written by the American Thoracic Society government relations office and emailed to all ATS members living in the United States. The letter keeps clinicians, scientists, and patients abreast of legislative, judicial, and regulatory issues in pulmonary, critical care, and sleep medicine. Each week's edition is archived on the ATS Web site, www.thoracic.org. If you have any questions or one more information about becoming involved in advocacy, please contact the ATS Washington office at 202-296-9770.