attebery searfoss caa updatefall2012.medaxiom.com/images/attebery_searfoss_caa... · 2012-10-03 ·...

Tim Attebery

CAA Update 10/3/2012

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Presentation Summary

¨  Who is CAA ¨  Washington Update ¨  CAA Membership

MedAxiom fall conference

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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)

equestrienne MedAxiom fall conference

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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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attebery searfoss caa updatefall2012.medaxiom.com/images/attebery_searfoss_caa... · 2012-10-03 ·...

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