Neil J. Weissman, MD, FASE

My gratitude to Dr. David Wiener, Chair of the ASE Advocacy Committee, for his assistance in my column with the ins and outs of the Society’s legislative and regulatory plans!

I live in Washington, DC so this should not be too difficult. I was looking for a simple definition of advocacy to relate it to ASE’s work. I started with a neighbor who has had a number of political appointments. After she was done explaining, I realized she lived in a different world and spoke a different language so I needed to take an entirely different approach. So, like any smart father, I went to my 12-year-old son. “Well Dad, I guess it is when you believe in something and want others to believe it in too.” Now, that was something I could understand. From there, I allowed Webster to expand somewhat to “public support for or recommendation of a particular cause or policy.”

Echocardiography is something we believe in—we all know it is highly valuable because it provides so much information for so many aspects of cardiac anatomy and physiology and is instrumental in diagnosis, guidance of therapy, and prognostication. We believe in its value and want others to also believe (and recognize) its value, particularly those that set policy that affects reimbursement. And this is where a simple concept gets……. well, messy.

Figuring out how best to effectively affect legislation that directs reimbursement can be difficult—hence the omnipresent jokes about “Those who love sausage or legislation should NEVER watch either being made” (statement circa 1869; some things don’t change!). However, ASE has been making steady gains in this area and credits recent successes to an enhanced push from our Advocacy volunteers, staff, and our new lobbyist. We have actively worked on building new relationships with key members of the U.S. legislature. This summer, we worked with our members from Oregon to invite the Chair of the Senate Finance Committee, Senator Wyden, to attend our June Scientific Sessions meeting in Portland; he spoke in the main auditorium to over 1,000 people and had time to talk one-on-one about ASE’s issues. Getting this kind of visibility with Senator Wyden, one of the most influential legislators in Washington (the Senate Finance Committee has jurisdiction over a myriad of issues including healthcare), is a major step for our members and the organization.

Having a chance to educate key legislative members is important because we are fighting a lot of negative and damaging perceptions about medical imaging. Our studies of Medicare growth show that cardiovascular imaging use has actually decreased under the Physician Fee schedule in the U.S. over the past few years, but reports continue to persist about its rapid growth. Perceptions often lag behind the facts so we have to work hard to provide the education needed to change the dialogue. While this sounds simple, this ‘simple’ work is usually expensive; ASE has increased our advocacy budget substantially over the last few years to meet the needs of our members and advocate for their interests.

To do this type of “perception changing” we have some specific targets this year, and there is an opportunity for you to also get involved this month!

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  ASE members will be going to the Hill during American College of Cardiology’s Hill Day, September 14–16, to speak personally with members of Congress and the Senate. Last year we had over 55 ASE members participate by meeting with their legislators, and this year we hope to have even more. One of ASE’s important messages is to stop the “site neutrality” movement as we believe that this aims to lowering payments in both in-patient and out-patient settings. If you are planning to attend the Hill Day, or just want to talk with members of our advocacy team, join up with us at the Caucus Room of the Westin hotel on Monday, September 15 following American College of Cardiology’s meetings.

  
  
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  This month will also debut ASE’s Value-Based Healthcare: Summit 2014; The Role of Cardiovascular Ultrasound in the New Paradigm o n September 12 in Washington, DC. This summit will focus on educating key stakeholders on the value of echocardiography. Congressman Jim Cooper will be a keynote speaker, along with invited speakers from the Centers for Medicare and Medicaid Services (CMS), National Institutes of Health, and the Geisinger Health System. Patients will also be adding their perspectives to this powerful dialogue. ASE aims to focus on the ways echocardiography can deliver superior value in the changing healthcare environment.

  
  
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  Lastly, the association is actively monitoring the changes in reimbursement on behalf of our members. The Physician Fee Schedule was released on July 3 by the CMS. One key provision is that CMS tried to identify potentially “misvalued codes.” Under this process two of the most used echocardiography codes were selected, 93306 (transthoracic echocardiography with spectral and color Doppler) and comprehensive stress echo code 93351 (stress echo, including the stress test). These codes will now be revalued by the Specialty Society Relative Value Scale Update Committee. The concern is that there is considerable pressure to reduce payment for potentially “misvalued” codes and Congress mandated savings in this area. So this is where you can make a difference: To perform the reevaluation, they perform a survey to get information such as the time involved to do an echo, the amounts, types and prices of practice expense, etc. Since survey participants are randomly selected, and the information they provide is critical to fairly evaluate these codes, we need your help to take the survey if you are selected and be as thorough as possible. A similar survey done several years ago had a very poor and inaccurate response rate which led to a large cut in reimbursement for echocardiography so please respond if you are asked.

Last year ASE was successful in opposing the “package” proposal, which would have eliminated the separate payment to the hospital for the technical component of transthoracic echocardiography with spectral and color Doppler when the echo is performed on the same date of service as clinic visits, emergency room visits, and certain other services and procedures under Medicare. Each year, as pressure to reduce healthcare cost continues, there are always new issues that arise where we need to be sure to have a voice, to continue to educate and to share with policymakers that echocardiography has high value.

ASE is dedicated to ensure that echo’s value is widely known and appreciated and that your patients continue to have access to the necessary care they need.