Tim Attebery
CAA Update 10/3/2012
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Presentation Summary
¨ Who is CAA ¨ Washington Update ¨ CAA Membership
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Law of Unintended Consequences
¨ Resourceful and creative Kindergarten teacher ¨ Lesson in self-discipline and the rewards of hard
work ¨ Local store donated some excess planters ¨ Local nursery donated some plant seeds ¨ Each kid got a planter and……………….
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Oops!
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CAA Background
¨ Started in 2005 – offshoot of MedAxiom ¨ Need for entrepreneurial cardiology to protect its interests and
advance positions beneficial to non-academic cardiology ¨ Nimble, action-oriented, focused, aggressive ¨ Not-for-profit entity ¨ Affiliated PAC ¨ Represents member groups à both integrated and private,
large and small ¨ Close collaboration with MedAxiom & ACC
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CAA is to ACC…..
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CAA is to the ACC…..
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TEA PARTY is to the GOP
CAA Team
¨ Jennifer Searfoss – Executive Director ¨ Marshall Brachman – Lobbyist & Special Advisor ¨ Board of Directors ¨ Past Presidents
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Jennifer Searfoss
¨ Attorney – JD from University of Maryland
¨ 15 years of government affairs experience specializing in healthcare
¨ MGMA & UnitedHealthcare ¨ Expertise in federal healthcare
policy and payor advocacy ¨ Amateur (going pro)
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Marshall Brachman
¨ Grew up in Ft. Worth, TX ¨ University of TX – MBA ¨ 15 years of executive
leadership (pre-DC) ¨ DC-based lobbyist since
1989 ¨ AIPAC supporter, pilot,
scuba diver & world traveler ¨ Married with 3 kids and one
amazing car! MedAxiom fall conference
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Board of Directors
¨ Tim Attebery – President-elect ¨ Cathie Biga*
¨ Richard Bodager
¨ Dan Caldwell – President
¨ Rock Erekson
¨ Tim Higgins ¨ Ann Honeycutt*
¨ Pat White (ex-officio/non-voting)
¨ Mike Foster, MD ¨ Matt Phillips, MD
¨ Jeff Steinhoff, MD
¨ Mark Victor, MD – Vice-President of Medical Affairs
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*Past President
CAA Coalitions, Friends & Allies
¨ Coalition for Patient-Centered Imaging ¨ Access to Medical Imaging Coalition ¨ Medical Imaging & Technology Alliance ¨ ACC, ASNC, ASE, SCCT, MGMA ¨ MedAxiom groups ¨ Members of Congress à Rep. Roe (TN), Rep. Pitts (PA),
Rep. McCarthy (NY), Rep Reichert (WA), Rep. Barrow (GA), Rep. Price (GA), Sen. Kerry (MA), Sen. Kohl (WI), Sen. Wyden, Sen. Corker (TN) & more
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CAA – Major Accomplishments
¨ Led the fight to defeat the Weiner amendment on the ACA ¨ Major role in passing accreditation language ¨ Successfully kept Stark proposal from a mini-SGR for imaging ¨ Played a major role in keeping imaging from being used as an offset in the
2011 Trade Assistance Act (to pay for the expansion of the Health Coverage Tax Credit)
¨ Legislated a mandated 75% EU (from 50%) to keep the CMS rule (and MedPAC recommendation) of 90% EU from adoption
¨ Played major, ongoing, role in stopping CMS and Congress from requiring the use of RBM’s
¨ Important role in supporting innovative relationships between hospitals and physicians (improve quality, lower cost, improve patient experience)
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Major Accomplishments (cont’d) ¨ Played major role in PDUFA legislation to mitigate attempt to make
ordering of radiopharmaceuticals impractical ¨ Continue effort to repeal IPAB ¨ Played major role in adoption in the Innovations section of the ACA to test
appropriateness criteria ¨ Continue to play a role in stopping the effort to penalize for MPPR ¨ Play a major role in AMIC and CPCI to help shape industry message for
the Hill ¨ SGR – make sure that CV is not the “pay for” for SGR fix ¨ Ongoing communication, information sharing, updates, etc.
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WASHINGTON UPDATE
“What Do You Do with Lemons?” MedAxiom Fall Conference
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Congress’ Efforts to Control Spending 16
Congress’ Efforts to Control Spending 17
150 trillion lemons needed to pay off the national debt
Washington Update
¨ In-Office Ancillary Exception ¨ Radiology Benefits Management Companies ¨ CAA’s AUC Policy ¨ SGR ¨ Medicare 2013 ¨ Meaningful Use ¨ Site-of-Service adjustments ¨ Sunshine Act ¨ IPAB Repeal MedAxiom fall conference
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In-Office Ancillary Exception
¨ Weiner Amendment to the ACA à 2010 attempt ¨ CAA along with other coalition partners
successfully blocked this Amendment
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National Spokesperson for the “Kill the IOAE” Movement
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Call me if you don’t like the
IOAE
2012 Efforts to Remove the IOAE
¨ Senator Baucus and others in Congress à CBO score ¨ Affects more than just imaging ¨ If the score is big à could be used for SGR $$ offsets ¨ Impossible to save Medicare any $$ ¨ “Silo” scoring approach not a “systems” scoring approach ¨ Silo à impact on payments to physicians ¨ Systems à impact on overall Medicare payments ¨ Allies à build a coalition, prepare for Lame Duck session ¨ ALL CARDIOLOGISTS SHOULD BE CONCERNED!!
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RBM’s & CAA’s AUC Policy
¨ President Obama à expand role of RBM’s to include Medicare FFS ¨ UnitedHealthcare’s Plan for Secure Horizons ¨ Affirmative position vs. “anti-RBM” ¨ CAA’s proposed AUC Policy ¨ FOCUS tool or equivalent “point-of-care” clinical decision-support
tool ¨ Initial approach à encourage ordering physician to report ¨ Penalties for non-reporting ¨ Penalties for “inappropriate” ordering above a certain level ¨ CAA’s position must be “scoreable”
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President of the National Association of Radiology Benefits Management Companies
SGR
¨ Annual drill, plus some special excitement for 2012 ¨ Lame Duck session ¨ Budget Control Act of 2011 ¨ Sequestration and the Super Committee ¨ Automatic à $1.2 trillion in spending cuts (10 years) ¨ 1 Year SGR fix à $15 Billion (150 Billion lemons) ¨ Offsets? IOAE? Imaging, CV services, other? ¨ AUC could be used as an offset (ACC analysis)
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Medicare 2013
¨ Final (4th) year of cuts based upon the flawed PPIS survey ¨ Interest rate assumptions ¨ Equipment utilization ¨ Misvalued CPT Codes ¨ MPPR à 25% reduction ¨ Transitional Care Management ¨ Non-random complex prepayment medical review ¨ Physician Compare Website ¨ Group Practice Reporting Option ¨ PQRS Reporting issues
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Medicare 2013 (continued)
¨ GPRO requirement for groups with 100 or more physicians ¨ E-prescribing ¨ Value-based payment modifiers and penalties à Physician
Feedback Program (expansion of the Quality & Resource Utilization Reporting program)
¨ Payment adjustments in 2015 based upon 2013 performance ¨ Quality and cost ¨ Claims-based outcomes vs. Registries ¨ Cost performance methodology à risk-adjusting approach
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NCDR
¨ 2013 Data ¨ Published in 2014 – Hospital Compare
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Meaningful Use
¨ Delays Stage 2 requirements until 2014 ¨ Physicians must attest by October, 2014 in order to
avoid imposition of penalty in 2015 ¨ Modified definition of “hospital-based provider” ¨ Very little change in core and menu objectives ¨ Very little change in the clinical quality measures ¨ More details at the CAA Table ¨ Free Webcast for CAA members
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Site-of-Service Adjustments
¨ MedPAC recommendation ¨ Equalize E&M payments between hospital-based
and physician office based for non-emergency E&M services
¨ Big CBO score ¨ Strong opposition from AHA and other hospital
organizations ¨ What’s next? E&M first, then imaging???
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Sunshine Act
¨ Part of ACA ¨ Requirements for disclosure and reporting of
certain transactions or arrangements between physicians and drug, device and medical supply companies
¨ Regulations still being drafted (overdue) ¨ Effective January 1, 2013 ¨ More details at the CAA Table
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Good News!!!
¨ CAA representatives recently met with the individuals drafting the Sunshine Act regulations
¨ Hours of negotiation
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Sunshine Act – Formal Exception
¨ “Popcorn” exception
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IPAB Repeal
¨ Independent Payment Advisory Board ¨ 15 member panel appointed by the President ¨ Starts in 2014 ¨ No oversight from Congress ¨ Congressman (and physician) Phil Roe (TN) and
Senator Cornyn (TX) leading the charge to repeal IPAB
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Bills Pending ¨ IOAE (Speier) à HR 1476, would close the IOAE ¨ CARE-MIRT (Whitfield/Barrow) à HR 2104, deals with standards for imaging
technologists ¨ USPSTF (Blackburn) à HR 5998, calls for more transparency and accountability by
USPSTF ¨ IPAB (Roe) à HR 452, deletes IPAB from ACA ¨ IPAB (Cornyn) à S. 668 & 2118, deletes IPAB from ACA ¨ MPPR (Olson) à HR 3269, requires CMS to reverse the cuts for multiple imaging ¨ Medicare Physician Payment Innovation Act (Schwartz-Heck bill); temporarily increases
physician reimbursement by 2.5% ¨ Preventive Health Savings Act (Burgess & Christensen à HR 6482, will provide out-
year savings projections for initiatives aimed at wellness and disease prevention
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WHY CAA MEMBERSHIP
MATTERS
The Voice of Entrepreneurial Cardiology MedAxiom Fall Conference
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CAA Membership – It Matters
¨ Expanding role/importance of the Federal Government and national payors ¨ Concerns about over-utilization (imaging, PCI, ICD) ¨ Recent IOM Report à “30% of healthcare spending is avoidable” ¨ ACR efforts and expanding role of RBM’s ¨ Concerns about provider-based billing increases (California Attorney
General) ¨ New payment models à cardiology needs to shape those models (VBP,
ACO’s, bundling, episode of care, etc.) ¨ Influence requires engagement ¨ Engagement is based upon information, knowledge, and personal
relationships ¨ The “anti-cardiology” forces are organized and well-connected
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Washington View & Philosophy
¨ Entrepreneurial physicians are bad ¨ Entrepreneurial physicians are the reason that
healthcare costs are out of control ¨ Sub-specialists make too much money ¨ Diminish the power and ability of entrepreneurial
physicians ¨ Create a financial and regulatory environment that
discourages risk-taking and entrepreneurialism ¨ The “W-2” Plan à “control” the docs
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Current State of CAA Membership
¨ About 1,600 paid members in 2012 ¨ Down from a high of 2,200 in 2008 ¨ Need about 2,500-3,000 members to maintain
“break-even” operations ¨ MedAxiom has 6,000+ physician members ¨ 50% of MedAxiom physicians = 3,000
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Integrated/Employed Physicians
¨ “My group solved its problems through integration, why do we need to support CAA?’
¨ “We depend upon the health system’s government affairs staff and lobbyist to handle this now.”
¨ “Can’t the ACC take care of all of this.”
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Young Docs
¨ “I’m happy being an employee. I don’t want to bother with all of this political and business stuff.”
¨ “What does the CAA do for me?” ¨ “Aren’t we all going to work for the government
anyway?” ¨ “Hey, the VA isn’t so bad!” ¨ “I’ll use my $135 to join the Book of the Month
Club.”
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Why the CAA Matters: IOAE Situation
¨ What happens if the IOAE goes away? ¨ To integrated groups? To independent groups? ¨ Economic reality à if you can’t survive outside
the integrated state, then your financial value declines
¨ “Best Alternative” rule ¨ When “hospital integration” becomes “full
dependency on the hospital” à cardiologists’ bargaining power and leverage is LOW!!
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And now, a message from Dr. Matt Phillips
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Call to Action
¨ Current CAA members à continue ¨ Past members à rejoin ¨ Never members à join ¨ Each group à appoint 1 physician to serve as the “CAA
Liaison” along with the CEO/administrator ¨ Participate in the Monthly CAA Conference Calls and
circulate the CAA newsletter ¨ Get to know the U.S. Representatives & Senators for your
Service Area (and their key staff members) ¨ Participate in the Fly-In events ¨ Provide a CAA Update at each Physician Meeting
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$150 – Is it worth it?
¨ $150 annual membership dues for 2013 ¨ 10% discount available through 12/31/12 ¨ $135 à 37¢ per day ¨ What’s at stake? ¨ If you don’t have a seat at the table, you’ll be
on the menu ¨ Fund this special voice for entrepreneurial
cardiology in DC! MedAxiom fall conference
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CAA
¨ “C” à cardiology, catalysts, communicators ¨ “A” à advocate, activate, advance, access, antagonize ¨ “A” à alliance, axis, attack, army
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Join Today – Say “Okay” to CAA
¨ Cardiology Advocacy Alliance ¨ Cardiology Army of America ¨ Catalysts, Advocates & Antagonists
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Thanks!!!
¨ Stop by the CAA Table ¨ Talk to one of the CAA Board members à wearing
a special CAA jersey ¨ Participate in our “Trail Map” game and register to
win a fabulous prize ¨ Special CAA T-shirt for pledging your membership
during this meeting
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