February 2007 Message from the President Age-adjusted death rates from cardiovascular disease have been steadily declining since 1950 due to therapies that prevent or reduce the progression of atherosclerotic disease, heart failure, and thrombotic or embolic events. Major progress has also been made in noninvasive cardiac imaging. We are standing on the threshold of a practice-changing revolution involving multi-slice CT and cardiac MRI that may reduce the need for invasive testing. Three factors led to the "perfect storm" creating a financial sinkhole for payers: the growth of these expensive technologies, the increased longevity of the population as a whole, and the aging of the demographically significant baby boomer. Real health spending per capita has grown at an annual rate of 4.3 percent. This has been viewed as a detriment rather than a positive outgrowth of medical advances. Cardiac imaging of all types has grown 26% per year for the past 10 years. Nuclear cardiology and echocardiography, for example, grew at an average annual rate of 16.1% and 10.5% per Medicare beneficiary from 1999 to 2004. Despite the fact that heart disease remains the leading cause of death in the U.S., and despite lack of evidence demonstrating that volume changes are inappropriate, reimbursement for many imaging services was reduced as a result of a provision in the 2005 Deficit Reduction Act (DRA) capping Medicare Part B reimbursement to the Hospital Outpatient Prospective Payment System (HOPPS) rate regardless of site of service. These cuts are threatening those physicians who offer high quality, convenient imaging services in their offices, a step which expedites care and places clinical decision making at the point of service. Additionally, the fairly recent Radiology Benefit Management companies (RBMs) are instituting barriers to ordering tests using precertification strategies. Although the Illinois Chapter was instrumental in passing an AMA resolution condemning preauthorization to ration imaging, RBMs are unlikely to disappear from the landscape without effective alternatives to address this explosive growth. One proposal which has interested certain payers and even members of congress is the use of appropriateness criteria promoted by Illinois Chapter member Dr. Robert Hendel to reflect "cost-effective" care. At the end of September, Energy and Commerce Health Subcommittee Chair Nathan Deal (R-GA) drafted legislation creating a pilot project exempting physicians from the DRA imaging cuts if they met the following requirements: 1) lab accreditation; 2) lab technician certification; 3) physician training and proficiency standards; and 4) a determination of appropriateness of imaging services. While this proposal was not widely supported by other key lawmakers, it did underscore how much attention is being devoted to imaging as a way to reign in health care costs. Demonstrating that total health care costs can be curtailed if the right test is performed for the right reason at the right time is critically important in this current environment. The American College of Cardiology has been developing "appropriateness criteria" by using the Rand methodology for nuclear cardiac imaging, cardiac CT angiography, and cardiac MRI, with echocardiography to follow later this year. Showing that an evidence-based, clinical decision-making process designed to maintain high quality, cost effective testing will be far superior to indiscriminate "across the board" cuts and developing artificial barriers to reduce imaging costs. If this strategy can be successful in cardiology, look for more efforts to create and apply appropriateness criteria to other imaging modalities in years to come. 2007 Nominating Committee — Board of Councilors Vacancies The Nominating Committee consisting of Dr. David Hale, immediate past-president, Dr. James Calvin, Dr. Jerome Hines, Dr. Thomas Stamos, Dr. Donald McElroy, Dr. Mohamed Haseeb, Dr. Frank Aguirre and chaired by Dr. David Fishman met recently and reviewed candidates for two vacancies in the Chicago District and three vacancies in the North Suburban District. After due deliberation, the following slate of candidates was approved: Chicago District (two vacancies) Clifford Kavinsky, MD Bradley P. Knight, MD Isam A. Mikati, MD North Suburban District (three vacancies) John T. Barron, MD Robert C. Hendel, MD Thomas J. McKiernan, MD Irwin M. Silverman, MD Jeffrey Snell, MD Email ballots for Chapter members with brief biosketches of candidates are in process. Door to Balloon Time (D2BT): ACC and Chapter Program March 1, 2007 is the deadline for hospitals to join. This deadline is not a final cut off as the ACC will accept hospitals that join after this date; however, hospitals that do not join by March 1 will not be included in the public release of the list of participating hospitals and subsequent media attention. The ACC has received a lot of requests for the release of this list and desires to highlight the program, and hopefully draw individual attention to the participating hospitals and the good work they are doing. Eleven Illinois hospitals have signed up so far. It is critical to get their support in promoting this message to the hospitals that have not yet joined. YOU CAN HELP! Please help us compile a comprehensive list of primary PCI hospitals in Illinois so it can be used for recruitment purposes. Please send us the names of your primary PCI hospitals along with the names and addresses of the director of the cardiac catheterization laboratory and the hospital administrator to ilacc@ilacc.org. Draft Certificate of Need (CON) Rules on Cardiology Services Under Chapter Review An Illinois Chapter review group led by Dr. David Hale, Immediate Past President of the Chapter, along with Dr. Lloyd Klein and Dr. Daniel Rowan attended a December 15, 2006, meeting in Chicago to collect comments on a "DRAFT OF CERTIFICATE NEED OF RULES: CARDIAC SERVICES" promulgated by the Illinois Health Facilities Planning Board (IHFPB). This review continues a series of Chapter reviews begun in 2002. Highlights of the current draft included comments regarding the use of arbitrary operator volumes in the physician credentialing process. The Chapter strongly maintained that physician credentialing should remain a local responsibility of participating institutions. The Chapter also supported participation in national registries enabling institutions to measure their outcomes against national benchmarks such as the ACC NCDR or STS database. The bulk of the discussion concerned the performance of coronary angioplasty with offsite surgical backup. Current ACC guidelines support primary angioplasty for management of ST segment acute myocardial infarction at a Class II b level. Elective angioplasty with offsite surgical backup was not widely endorsed, carrying a Class III prohibition in current ACC guidelines. Elective angioplasty programs should only function if they are participating in national research. Rules pertaining to cardiovascular surgery were reviewed and found to be generally acceptable. Rules pertaining to electrophysiology services were not fully developed and were tabled pending future input from the electrophysiology community. The IHFPB thanked the Chapter for its continued involvement and the final version of the CON rules regarding cardiac services is expected by Spring 2007. For a copy of the letter from the Chapter to the IHFPB reiterating these and other points, members should contact the Chapter office. April 27, 2007 Practice Management Symposium and Annual Meeting Dr. Jerome Hines, Chair of the 2007 Practice Management Symposium (PMS) program, has named the Program Planning Committee for this event which is scheduled April 27 at the Union League Club in Chicago. Committee members include Dr. David Hale, Dr. Diane Wallis, Cathy Biga, Greg Timmers, Jeffrey Shelton, and Dr. Timothy Sanborn. Set your calendars for what will be an exciting program and a lively discussion of the issues facing all of those delivering care to cardiovascular patients. Member Featured in Get With the Guidelines Webinars on D2BT In late 2006, Dr. Peter Kerwin, Illinois Chapter Member and Medical Director of Advocate Good Samaritan Hospital's Cardiac Catheterization Lab, and Colleen Kordish, RN BSN, Cardiovascular Outcomes Coordinator and Nurse Champion for Get With The Guidelines (GWTG), discussed how to implement a process-driven approach and decrease the door to balloon time for a program in Illinois and another one in Pennsylvania. The conference was recorded and made available for later viewing online in the GWTG Web conference archive (https://gwtg.webex.com/). Dr. Kerwin will also be presenting the D2BT initiative at the Women's Cardiovascular Health Summit. Sharing what works with individual hospitals to reduce infarct angioplasty time is a major quality initiative of ACC and the Illinois Chapter for 2007 and we will continue to recognize the efforts of those who are trying to make a difference. ADVOCACY ANNOUNCEMENT: Save the Date Friday, February 9: All Member Call to Discuss DRA Impacts Although the Medicare physician payment fix was a significant victory for cardiology and the broader physician community, the DRA provision capping payment for the technical component of in-office imaging procedures at the payment level under the hospital outpatient prospective payment system (OPPS) is drastically reducing payment for key nuclear cardiology, cardiac MR, CT, and vascular imaging procedures. The ACC has scheduled an all-member conference call for Friday, February 9 from 4:00–5:00 p.m. EST to discuss the impacts of the DRA cuts and next steps. To RSVP for the call, go to: https://e-meetings.mci.com/emeet/rsvp/index.jsp?Conference_ID=3350980&passcode=3064190. Meanwhile, the ACC has prepared a spreadsheet comparing 2006 and 2007 national average Medicare payments for cardiovascular imaging procedures affected by the DRA. It is posted online at: http://www.acc.org/advocacy/pdfs/DRA_Impact_for_Cardiology.xls. For more information on this issue, contact Rebecca Kelly at rkelly@acc.org. March 6, 2007: CV Summit III A conference call was held with representatives from Pfizer with Diane Wallis, MD, and Jack Carow, ACC Executive Director, to discuss the meeting agenda and select candidates for workshop facilitators for CV Summit III. This event will build on the work done in CV Summit I and II to continue to build bridges between the Chicagoland payers and Illinois cardiologists represented by the Board of Councilors to overcome barriers to the delivery of cardiovascular care in Illinois. Participants will break into three groups: "Improving drug therapy outcomes through enhanced patient adherence"; "Managing CV risk in Clinical Practice"; and "The Value of Medicine: What Is Missing from the Public Debate." Also on the agenda are items to facilitate establishing a mission statement and developing an action plan for the consortium. Midwest Fellows Forum A Midwest Fellows Forum is under development. It will be co-sponsored by the Chicago Cardiology Group (CCG); American Heart Association Greater Midwest Affiliate (AHA); and Illinois Chapter of the American College of Cardiology (ILACC). The purpose of the Forum is to provide an opportunity for networking and addressing educational and clinical issues that specifically meet the needs of the fellows at Illinois training institutions, as identified by the fellows themselves. The Forum will also serve to educate young cardiologists about AHA, ACC and CCG programs that will benefit their careers, as well as opportunities for involvement in local and regional AHA, ILACC and CCG activities. To begin, all cardiology fellows enrolled in accredited training programs in the metropolitan Chicago area (with potential to expand into neighboring states) will be invited to participate in Midwest Fellows Forum events, which will be planned and executed by the fellows themselves. Administrative and staff support for the Forum will be provided by the CCG, AHA and ILACC, and the overall effort will be led assisted by key leaders from all three organizations. Members of each organization will be invited to attend the program aimed at fostering communication, networking and interaction with the fellows in training. Illinois Committee Appointments Two Illinois chapter members, Dr. Lloyd Klein and Dr. James Calvin, have been named to national ACC committees. Dr. Klein, Director, Clinical Cardiology Associates, Gottlieb Memorial Hospital, Melrose Park, is a nationally-recognized expert for his work in interventional cardiology and has found time to make valuable contributions to the Illinois Chapter as a member of our Board of Councilors and as a member of several leading committees of the Chapter, and was named to the Cardiac Catheterization and Intervention Committee. Dr. Calvin is presently Director, Section of Cardiology at Rush University Medical Center. He has been named to the cardiology training and workforce committee and will also represent the Chapter on the ISMS Manpower Task Force. He also has served as a member of the Board of Councilors Congratulations to both who will represent the chapter well. ACC '07 Chapter Reception to Honor Rolf Gunnar, FACC, MACC Plans are underway for the Illinois Chapter Reception during the 2007 ACC Scientific Session in New Orleans that will be held at the Rooftop Restaurant, 41st floor, New Orleans Marriott. The customary collegiality between Chapter members and among alumni of Chicago area training programs is set to begin at 5:00 p.m. and end at 6.30 p.m. A highlight of the reception will be a special recognition ceremony honoring Rolf Gunnar, MD, FACC, who is scheduled to receive an ACC Master Fellowship award during the Scientific Session. Invitations will be mailed to all Chapter members shortly. Please mark your calendars for this outstanding event. Imaging Updates: 2007 ACR Imaging Agenda Ariel Gonzalez, assistant director of State Legislative Relations for the American College of Radiology (ACR), outlined its state legislative agenda for 2007 at a luncheon meeting on January 12 at the AMA's State Legislative Strategy Conference in La Quinta, Calif. According to Gonzalez, ACR's first priority is self-referral laws with a particular emphasis on imaging, followed by Certificate of Need (CON) laws with an imaging focus. Third priority is rebuffing licensing attempts by technologists not approved by radiology. The Illinois chapter will oppose any revisions of physician self-referral laws that would restrict in-office imaging and to oppose any expansion of CON laws in Illinois which would limit imaging opportunities for cardiologists. UnitedHealth Group Announces Imaging Accreditation Program UnitedHealth Group (UHC) has announced a new, nationwide quality improvement initiative. The "UnitedHealthcare Imaging Accreditation Program" is based on the accreditation standards jointly developed by the American College of Radiology (ACR) and the more than 22 sponsoring organizations of the Intersocietal Accreditation Commission (IAC). Under the program, United Health Group will enlist the expertise of the ACR and IAC in facilitating accreditation for its network of contracted imaging physicians. To date, the ACC has successfully postponed further implementation of UHC's prior notification program and has proposed developing an appropriateness criteria tool in place of having cardiovascular physicians have to call in for prior notification. The proposal has been sent to UHC and discussions are underway. For more information, contact Kathy Flood at kflood@acc.org. Women's Initiative Committee Cochairman Marla Mendelson, MD, and Santosh Gill met with committee member Holly Novak, MD, along with representatives from Pfizer to begin planning of the first meeting of the Women's Initiative Committee for 2007. The format will continue to be a dinner speaker program with the focus on networking and mentoring of female fellows in training, and residents and medical students interested in a career in cardiology. The meeting to be announced will be a luncheon program in Chicago on a Saturday. Stay posted for further updates. Register Now for NPI, List Cardiology First The National Provider Identifier (NPI) compliance date of May 23, 2007 is quickly approaching so APPLY NOW! The processing time for new NPIs is currently taking up to 30 days through the NPI Enumerator and it is expected to increase as May draws closer. In addition, it can take up to 120 days to implement the NPI in current business practices., once an NPI has been obtained. When completing your application, be sure to list CARDIOLOGY as your primary specialty. Since your NPI records will be used to assemble practice expense data and could be used to calculate physician reimbursement in the coming years, it is important to list Cardiology ahead of Internal Medicine to properly classify providers performing cardiovascular procedures. To start the NPI application process, please contact the NPI Enumerator by visiting: http://nppes.cms.hhs.gov/ or calling: 1-800-465-3203. For more information about the NPI, go to http://www.cms.hhs.gov/NationalProvIdentStand/. Cardiology Care Associates (CCAs) and Fellows in Training (FITs) Admitted to Chapter Board of Councilors ACC has approved a bylaws amendment submitted by the Illinois Chapter Board of Councilors which provides a seat on the Board for CCAs and Fellows in Training (FITs). Plans are currently underway to find sponsorship support for a CCA program. There are approximately 150 CCAs in Illinois. The Midwest Fellowship Forum is responding to the needs of Fellows in Training. New Member, Illinois State Task Force on Stroke Holly Novak, MD, of Springfield, Illinois has been appointed to represent the Illinois Chapter on the Illinois State Task Force on Stroke. This task force, appointed by Governor Blagojevich, is charged with improving the care of the stroke patient in Illinois. AMA, ACC to Conduct Physician Practice Information Survey The American Medical Association (AMA) with the support of the ACC and more than 60 other medical specialty societies is conducting a multi-specialty survey of America's physician practices. The purpose of the survey is to collect up-to-date information on physician practice characteristics in order to develop and redefine AMA and ACC policy. Data related to professional practice expenses will also be collected. The AMA and ACC will survey thousands of physicians over the year from virtually all physician specialties to ensure accurate and fair representation for all physicians and their patients. Throughout the year, you may be contacted by the Gallup Organization to participate in this study. We encourage your participation in this survey, as the data obtained will be a critical source of information for the AMA and ILACC. Should you be called upon to contribute, your participation ensures that the information collected will represent you and your patients' concerns to national policy makers. Please watch for this survey and do your part in completing it in a thorough and accurate manners. Racial and Ethnic Differences in Cardiac Care Diane Wallis, MD, President of the Illinois Chapter, met with Aaron Hamb, MD, Chief Medical Officer of Provident Hospital and Medical Director of 100 Black Men of Chicago; Bertha Mitchell Smith, Director, Health & Family Services, the Chicago Urban League; and with other community leaders at a January 26 workshop, It was sponsored through the generous support of Astra Zeneca. Its theme focused on ‘"Racial and Ethnic Differences in Cardiac Care: The Weight of the Evidence." ACC, SCAI Convince CMS to Price Cardiac Cath Injection Codes Nationally As a result of efforts by the ACC and the Society for Cardiovascular Angiography and Interventions (SCAI), CMS has issued an emergency update to the 2007 Medicare Physician Fee Schedule reversing its decision to carrier price the cardiac cath injection codes (CPT 93539 - 93540). Instead the agency has assigned the codes work, practice expense and/or malpractice relative value units (RVUs), allowing them to be priced nationally instead of at the local Medicare Carrier and Administrative Contractor level. The update does not change the 2007 CMS Final Rule requirement that local Medicare carriers and MACs price the technical component (TC) of the cardiac catheterization codes (CPT 93501– 93533; 93555–93556) performed in the non-facility setting. ACC staff, Cardiology Carrier Advisory Committee members, and ILACC are continuing to monitor and work with the local Medicare contractors to determine these 2007 cardiac catheterization prices. For further information, contact Henry McCants at hmccants@acc.org. NCDR ACTION Registry Open for Enrollment Enrollment is now open for the ACC's new NCDR-ACTION Registry™, which replaced Genentech's NRMI Registry and the CRUSADE Registry on January 1. The new registry aims to bring together myocardial infarction data from hundreds of hospitals across the country into one unified platform with standardized clinical data elements to facilitate benchmark outcomes, analyze treatment regimens, and support the mutually shared mission to improve the quality of patient care. Participation in the ACTION Registry™ is free due to sponsorships provided by Genentech, Schering Plough and Bristol Meyers Squibb/SANOFI Partnership. For enrollment information, complete the Information Request Form found at www.accncdr.org. Are You Getting Your ILACC eNews? To ensure that your ILACC eNews does not get filtered to your Spam or Bulk mail folder, please add ilacc@ilacc.org to your Address Book or Safe List in your email software. Also, if your email address has changed in the last two years, please send us an email at ilacc@ilacc.org informing us of your most recent email address so we may update your records. Meetings of Interest and Save the Dates February 13, 2007 AHA Go Red for Women Luncheon in Chicago This annual luncheon, sponsored by the American Heart Association Midwest Affiliate, will be held at the Navy Pier Grand Ballroom, 600 East Grand Avenue. The Go Red for Women Luncheon is an empowering event that helps women discover unique lifesaving power by learning about heart disease and stroke. Women can take positive action to reduce their risk factors. Luncheon activities include heath educational sessions, health screenings, exhibits and conclude with a keynote speaker during the lunch program. We encourage you to consider sponsoring members of your cardiovascular team (CCAs and RNs) to attend. For more information call (312) 476-6623. February 27, 2007 ILACC Board of Councilors Meeting Chicago Marriott Downtown at Medical District, 625 S. Ashland Ave., 1:30 – 4:00 p.m. Call the Chapter office for details. March 24-27, 2007 ACC '07/i2 Summit 2007 in New Orleans. Registration is open through February 21. Go to www.acc.org for more information. Chapter night for Illinois will be announced. April 24, 2007 Advanced Cardiology Reimbursement and Coding Workshop Wyndham O'Hare Airport Hotel, 6810 N. Mannheim, Rosemont, 9:00 a.m. – 4:00 p.m. This workshop is sponsored by the Illinois Chapter. Keep current on your Coding opportunities. Call the Chapter office for details. April 27, 2007 ILACC Annual Meeting on Practice Management Scheduled in conjunction with the annual Herrick lecture at the Union League Club in Chicago. This year's keynote address will be by Dr. Elliott Antman. Save the date now and plan to bring your CCA's with you to another exciting event! May 4–5, 2007 "Managing the Metabolic Syndrome and Reducing the Risk of Coronary Disease: A Practical Approach" Directed by Ronald Krone, MD, and Neil Stone, MD, in Chicago, Ill. Please visit the course site for more information at http://www.blackwellfuturacourses.com/courseDetails.asp?courseId=20 May 11, 2007 The American Association of Clinical Chemistry (AACC) Meeting: "The Cardiac Spectrum: Risk Assessment, Diagnosis and Management" Chicago O'Hare Renaissance Hotel. Call the Chapter office for details.