April 2005 | Vol. 23, No. 4

Happenings in Government Relations

By Bill Schroedter, BS RVT FSVU
Chair, SVU Government Relations Committee
Email: bschroedter@qualityvascular.com

February and March have been very busy months for SVU’s government relations effort with a multitude of issues and opportunities to be dealt with by SVU. SVU, in conjunction with the Coalition for Quality in Ultrasound (CQU), has made significant strides towards our goal of ensuring Medicare Beneficiaries receive only high quality services by requiring all persons performing technical component services are credentialed or the testing is performed in an accredited laboratory.

LCD "Liberalization"

First, we were notified by an SVU member in early February that Cahaba GBA, the Medicare carrier in Iowa and South Dakota released a “liberalization” of their vascular Local Coverage Determination (“LCD”) that removed the credential and or accreditation requirement but would require direct supervision by a radiologist. As they maintained this was a reduction in the requirements, there was no comment period required and this was effective nearly immediately. SVU and CQU at once commented to Cahaba and while we were successful in getting them to remove the direct supervision requirement, the rest of the policy was not reinstated, so convincing the carrier to revisit this policy change is at the top of SVU’s and the CQU’s agenda.

In early March, we had a conference call with Dr. James Corcoran, the Carrier Medical Director of First Coast Service Options, the Florida and Connecticut Medicare Carrier and others from his staff. On the call was Bill Sarraille, as well as CQU representatives from SVU, SVS, ARDMS, ICAVL, and ACR, in addition to a number of Florida providers all speaking in support of this policy. We all felt the call was well received and successful, but we ask SVU members in FL and CT to write to Dr. Corcoran offering your support of this policy. The CQU letter to Dr. Corcoran at First Coast Service Options is on the SVU website Advocacy section, under the Comments to Government page.

In California, the Medicare Carrier, National Heritage Insurance Company (NHIC) considered instituting the policy for credentialing and/or accreditation. The SVU in conjunction with the CQU, as well as separately, wrote to Dr. Bruce Quinn, the CMD, in support of this policy. Those of you from California probably received the SVU Member Alert asking you to write in support of this policy and if you have not done so, I would urge you take the time to do so as soon as possible. The CQU and SVU letters to NHIC are posted on the SVU website Advocacy section, on the Comments to Government website page. We are similarly hopeful of a positive outcome from our efforts in California. Thanks to those SVU members who have sent their own letters to Dr. Quinn at NHIC.

Congressional Hearing

In Congress, a House of Representatives Ways and Means Health Subcommittee hearing on medical imaging was held on March 17. This was specifically looking at the dramatic increase in utilization and its subsequent costs. While ultrasound is a very small piece of this, the CQU submitted comments stating our belief that a credentialing and/or laboratory accreditation requirement would be a means to limit overutilization of medical imaging to only those providers who are competent to do so. The CQU letter to the House Ways & Means Health Subcommittee also is posted on the SVU website Advocacy section under the Comments to Government page.

Pay for Performance

Another program that is gaining momentum is a “pay for performance” initiative launched by the Centers for Medicare and Medicaid Services (“CMS”). This program would reward physicians and other providers for performance of quality services. If you take a few minutes to think of the logistics of this, proper implementation could be quite difficult. They have launched several pilot programs to test the idea, one of which is the “Fistula First” initiative. Sponsored by CMS, Fistula First is a national vascular access improvement initiative designed to include all of the “stakeholders” in an effort to improve dialysis quality by improving vascular access patency. This initiative led to a new CPT procedure code effective January 1, 2005 -- G0365 Pre-operative mapping of the extremity arteries and vein prior to AV fistula creation, which will allow CMS to track the number of these mapping procedures. SVU has been working with SVS to provide input to CMS on this front. SVU Government Relations Committee members Bill Zang and Anne Jones attended a Fistula First meeting in Baltimore with CMS officials, in addition to the rest of the Fistula First Coalition. This was the first face to face meeting of an extremely broad-based group of stakeholders with an interest in this issue and it was a great opportunity to collaborate with SVS and create an awareness of the value of vascular ultrasound, the importance of quality vascular labs, and the need for better communication between the specialists caring for the chronic kidney disease and end stage renal disease patients. SVU members will be affected by this as a high quality pre-operative duplex evaluation is critical to a successful fistula creation. (See separate article on the Fistula First initiative in this issue under Government Relations News.)

The SAAAVE Act

SVU continues to support the efforts of the National Aneurysm Alliance (NAA) which is attempting to pass legislation that would create a policy for one time ultrasound screening for abdominal aortic aneurysms (AAA) for Medicare beneficiaries. Last month, Anne Jones attended a full meeting of the NAA, which is currently is working to solidify legislative support for the SAAAVE (Screening Abdominal Aortic Aneurysms Very Effectively) Act currently before both the US House and Senate. The House Bill is #H.R. 827 and the Senate Bill is #S. 390. Members of NAA sponsoring organizations are inviting their members to send “grassroots support” letters to Congress regarding the SAAAVE Act. We also are trying to assure screening events in the districts of key members of the House Energy & Commerce and Ways & Means Committees. We believe that it would be helpful for members of SVU to contact their representatives and express strong support for the SAAAVE Act. These letters should be sent soon, so they are awaiting the members when they return from the spring recess, in two weeks. We urge SVU members to send a letter of support of the SAAAVE Act to your Members of Congress, both Senators and Representatives, by either fax or email. A template letter of support which you can use is posted on the SVU website Advocacy section under the Comments to Government website page. You can find the fax number or email address of your Members of Congress by going to the following links for the House of Representatives (www.house.gov) and the Senate (www.senate.gov) where you can click and search for their Member of Congress by state and get their fax number or their email address from your Members’ websites.

Your help is still needed

We especially need help in North Dakota and urge our SVU members, and their medical directors, to EACH write letters to your Senators and Representatives in North Dakota. Senator Kent Conrad of ND and Senator Ron Wyden of OR need to receive as many letters as we can generate. If the SAAAVE Act passes, it will be a positive step for our members and our patients.

These efforts are the result of a great deal of work by a large number of individuals and I thank them sincerely. Additionally, SVU greatly appreciates our members for their time and efforts in writing letters and otherwise offering support for these government relations initiatives. We would appreciate it if you could send a copy of your GR letters to the SVU national office by mail, by fax at 301-459-5651, or by email to steveh@svunet.org. Thanks for your support of SVU’s Government Relations effort!