June 2007 | Vol. 25, No. 6

News from the SVU Advocacy Committee

By David Parlato, Chair

Your SVU Advocacy Committee continues to monitor and address several important regulatory and legislative advocacy issues this month.

Physician Quality Reporting Initiative (PQRI)

Physician Quality Reporting Initiative (PQRI) is a new CMS program designed to reward physicians for voluntarily reporting on a series of 74 quality measures. CMS initiated this program under authority of the December passage of the Tax Relief and Health Care Act of 2006 (TRHCA). This parallels the Pay-for-Performance model toward which CMS and other payors are trending. Of interest to the Vascular Lab community is measure #11: Stroke and Stroke Rehabilitation: Carotid Imaging Reports. The description of the metric to be reported follows:

Percentage of final reports for carotid imaging studies (neck MR angiography [MRA], neck CT angiography [CTA], neck duplex ultrasound, carotid angiogram) performed for patients aged 18 years and older with the diagnosis of ischemic stroke or TIA that include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement

Services reportable under this initiative are those professional component claims paid under the Physician Fee Schedule. As written, there is no enrollment necessary to participate in this program. Reporting is accomplished by adding a zero dollar G-code as a counter for adult patients with a diagnosis of ischemic stroke or TIA. 80% or more of reportable cases must be captured to remain in program compliance. The first reporting period is July 1 – year end 2007. You are in compliance with the measurement requirement if your lab uses criteria that reference distal ICA (NASCET) diameter correlation.

The payoff for this reporting work ?From CMS:

“The bonus payment, subject to a cap, is the equivalent of 1.5% of total allowed charges for covered physician fee schedule services provided from July 1 through December 31, 2007.”

This is paid to the physician in a lump sum in mid-2008, and the program requirements for the coming year will also be published in advance. Search “PQRI” on the CMS web site for more information.

Access to Medical Imaging Act of 2007 (AMIA)

There are now two bills in Congress to create a moratorium for two years on the implementation of the imaging cap provisions of the Deficit Reduction Act (DRA). Rep. Carolyn McCarthy (D-NY) introduced H.R. 5238, and Sen. John Rockefeller (D-WV) introduced the Senate version (S. 1338) this month with 17 cosponsors. Both bills target the $2.8 Billion in Medicare imaging payment cuts which disproportionately affect non-invasive vascular imaging codes.

SVU is a proud member of AMIC, the Access to Medical Imaging Coalition, which is strongly advocating the passage of these bills in Congress.

CMS OPPS Miscalculation

An astute Advocacy Committee member and Florida imaging entrepreneur noticed a secondary reduction in TC payments from CMS. Our advocacy advisors at Sidley Austin discovered that CMS initially calculated incorrect OPPS payment rates (too high) for January 2007, and since these rates were used to cap payments under DRA provision, CMS “overpaid” providers by about 5%. This correction appears to apply nationally, and is being implemented retroactively. We are continuing to monitor the implementation and impact of this error correction. Please share your personal experience with this payment issue at govtrelations@svunet.org. Thank you.

Reminder SVU 2007 Current Issues Conference

This November 2-3 the SVU will host its biennial Current Issues Conference in Arlington, VA, across the Potomac River from Washington, DC. The one and one half day program will cover a variety of important topics for vascular laboratory management, including legislative, regulatory, quality, reimbursement and compliance issues. Speakers are noted leaders in the vascular profession as well as from the Federal government. Check the SVU website for more information soon, including a preliminary program! If you do billing/reimbursement for your vascular lab, just want to find out the latest on various regulatory and legislative advocacy issues affecting the vascular ultrasound profession, or need some CMEs by the end of the year, you will want to attend this year’s SVU Current Issues Conference, especially in light of the current drastic DRA reimbursement cuts for vascular studies.