Patricia A. Pellikka, MD, FASE

As part of its strategic plan, ASE has established a goal of positioning cardiovascular ultrasound as the cardiovascular imaging “test of choice” in the new healthcare environment. As a noninvasive, radiation free, cost effective modality with broad benefits in the diagnosis and management of disease, echocardiography should be ideally suited for inclusion in Accountable Care Organizations (ACOs) and other capitated healthcare models.

Strategies for accomplishing this goal include advocating for high quality ultrasound practice and appropriate regulation and reimbursement; educating payers, providers and the public about echocardiography as the first choice in cardiac imaging; and preparing for change.

I’ve just returned from a meeting in Washington, DC with representatives of the Centers for Medicare and Medicaid Services (CMS), during which we expressed our concerns with the proposed reductions in reimbursement for the technical component of multiple procedures performed on the same day (multiple procedure payment reduction, or MPPR). Irene Butler (ASE advocacy staff), Diane Millman, our attorney, and colleagues from American College of Cardiology (ACC) and American Society of Nuclear Cardiology (ASNC) also participated in the meeting, which was held on Capitol Hill in the Health and Human Services Building. During our meeting, I emphasized ASE’s mission of quality and our work developing and promoting the appropriate use criteria. I recommended that reimbursement should be tied to measures of quality, such as laboratory accreditation, rather than subjected to further across-the-board cuts. I also spoke about the training and licensure required for our cardiac sonographers and the importance of their work. Thereafter, we discussed the MPPR, emphasizing that there is little or no duplicate service actually provided for different imaging studies, as these require different rooms, training, staff, and equipment. The CMS representatives seemed to like the idea of adopting quality measures, and we will try to engage them in further discussions.

We have also made progress in the private sector. ASE, in collaboration with the ACC, was successful in convincing McKesson Health Solutions to reverse its decision to implement claims coding edits that deny separate payment for echocardiogram interpretations when performed on the same date of service as inpatient evaluation and management visits.

As strategic partnerships will be important to accomplishing our objectives, ASE has joined the Alliance of Specialty Medicine, which helps us to stay current with the buzz on Capitol Hill and to respond, in a coordinated way, to threats to specialty medicine. We are also participating in “Choosing Wisely,” a campaign launched by the American Board of Internal Medicine Foundation (ABIM) to coordinate the work of leading medical specialty societies to promote patient-centered care that avoids unnecessary and potentially harmful interventions, and to reduce the rapidly-expanding costs of the health care system. Consumer Reports has joined the campaign to provide resources for consumers and physicians to engage in these important conversations, and the campaign has garnered support by legislators, who seem to appreciate the efforts of the specialty societies to help improve outcomes while controlling costs.

We appreciate the willingness of many of you to join the American Medical Association (AMA) to help ASE reach the level of joint membership necessary to apply for a seat at the AMA House of Delegates, the body which considers changes to code proposals and reimbursement recommendations that are sent to the CMS each year. This seat is critical to enable ASE to directly participate in reimbursement code changes and valuation. Other sub-specialty organizations such as the Heart Rhythm Society and the Society for Cardiovascular Angiography and Interventions have gained seats, and ASE seeks to join them in having a more independently pro-active voice for echo-specific issues.

As part of making echo the most valuable choice in cardiovascular imaging, ASE is exploring the possibility of developing a registry that would enable us to extract data on utilization and practice patterns to help ASE to advocate for quality measures and to help our members benchmark themselves. As part of this project, ASE aims to find a way to utilize the EHR records to limit putting a greater burden on our member’s labs to participate in a registry.

A webinar to help members better understand the Physician Fee Schedule and Hospital Outpatient Prospective Payment Schedule and related reimbursement changes is being planned, and a full-day track was held at our 2012 Scientific Sessions to help attendees prepare for changes in the health care delivery system. At the sessions, topics included strategic planning, building the successful practice, communication skills, and the role of echocardiography in the successful practice. Medical practice management in the new healthcare norm was explored by speakers who covered both private practice and hospital-based practice issues, from business options for cardiovascular practices and academics, to building a successful echo lab in a hospital. Sessions covered how best to advocate for the future of the profession and discussed anticipated trends and how to deal with them. Presenters shared tips on how to deal with payers, how to navigate the system as practitioners, and how medical societies and associations can help.

To continue to provide practice management support to members, ASE is developing a “Practitioner’s Corner” to provide web resources to help our members negotiate the changing landscape. This area will help physicians plan for the future and build successful business models in both private and hospital-based systems. Excerpts from ASE’s scientific session practice management track will be featured, including information on healthcare reform, coding tips and pitfalls, and advice on running a profitable practice in today’s environment. Much of this grew out of an advocacy forum that was held with ASE leaders, including representatives from a variety of practice settings.

Additionally, the recently launched publication, Echo , will help complete members’ access to practical information on practice management in our field. The inaugural issue of the Echo offered an in-depth look at ACOs, and future issues will continue to provide an up-to-date and accurate picture of the changing healthcare landscape and suggestions for how cardiovascular ultrasound professionals might respond.

As practitioners, we have a “long and winding road” ^∗

∗ “The Long and Winding Road”, written by Paul McCartney and inspired by the B842 in Scotland, was the Beatles’ 20 ^th and last number one hit in the US.