Imaging Prior Notification Required
UnitedHealthcare has begun a program to require prior notification for imaging procedures. When the insurer, which covers 70 million people, announced a similar program last fall, it was derailed by a protest from the American College of Cardiology and other groups. United relaunched the program in March, announcing it via letters to providers. According to United, it is only a prior notification requirement, “not a precertification, preauthorization, or medical necessity determination,” and will be required only for outpatient advanced diagnostic imaging services. If a provider fails to get a notification number, United will deny the claim, although a number does not guarantee payment. Physicians who have United's premium quality and efficiency of care designation are exempt. United rolled out the program last month in 15 states; it goes national next month.
ACC Sanctions Leon
The American College of Cardiology has sanctioned Dr. Martin B. Leon for making “statements that resulted in the breach and consequent premature lifting of the embargo on the COURAGE trial data presented at ACC's 56th annual scientific session in March,” according to a statement issued May 22. Dr. Leon, chairman of the Cardiovascular Research Foundation and a leading drug-eluting stent investigator, allegedly said that COURAGE had been “rigged to fail, and it did” at an industry-sponsored symposium before the ACC meeting. He was quoted in the Wall Street Journal, leading the ACC and the New England Journal of Medicine to lift the embargo on the study early. The ACC has said it will bar Dr. Leon's participation as a presenter, reviewer, or panelist at its March 2008 scientific meeting. In a statement, Dr. Leon said, “I still believe that my informal remarks were exaggerated, and I regret that they were interpreted as a breach of the embargo.” He said he presented evidence to the ACC supporting his beliefs, but that, “I have great respect for the professionalism and sensitivity of the current ACC leadership. I accept their decisions and look forward to a well deserved and long awaited vacation during ACC 2008.”
ACC on Imaging Accreditation
The ACC has formulated an official response to an imaging accreditation program announced earlier this year by UnitedHealthcare. Starting in March 2008, United providers of CT, angiography, MRI, MR angiography, nuclear medicine/cardiology, positron emission tomography, and echocardiography must become accredited by the Intersocietal Accreditation Commission or the American College of Radiology. In its position statement, the ACC said that it believes that accreditation programs developed by physicians are important quality improvement tools, but that it does not support certification and accreditation programs “strictly as cost containment mechanisms.” The ACC noted that it's important that United will rely on IAC and the ACR; the College is an IAC cofounder. Even so, exceptions to United's timetable may be needed “to ensure that patients have access to care in underserved areas,” said the ACC.
Imaging Access Bills Reintroduced
Bills seeking to institute a 2-year moratorium on reductions in imaging payments that went into effect this year have been reintroduced in the House and Senate. The cuts in payments under the Medicare program are mandated under the Deficit Reduction Act of 2005. Attempts over the last 2 years to repeal or delay the cuts have not succeeded. In March, Rep. Carolyn McCarthy (D-N.Y.), Rep. Gene Green (D-Tex.), and Rep. Joseph Pitts (R-Penn.) introduced their bill, the Access to Medicare Imaging Act (H.R. 1293). In May, a companion bill was introduced in the Senate by Sen. Jay Rockefeller (D-W.Va.) and Sen. Gordon Smith (R-Ore.).
BMS Pleads Guilty on Plavix
Bristol-Myers Squibb has agreed to pay $1 million and to plead guilty to charges that it colluded with Canadian drug maker Apotex to delay introduction of Apotex's generic clopidogrel. Under the agreement, BMS has admitted that one of its executives, senior vice president for strategy Andrew Bodnar, negotiated with Apotex to delay marketing of its generic clopidogrel. However, in a statement, BMS said that there is no guarantee that the court will accept its plea deal.
New Medicare Leadership
President Bush recently nominated Kerry N. Weems, a 24-year veteran of the Department of Health and Human Services, to lead the Centers for Medicare and Medicaid Services. Mr. Weems currently serves as deputy chief of staff to HHS Secretary Mike Leavitt. If confirmed by the Senate, Mr. Weems will fill the vacancy left by Dr. Mark B. McClellan who resigned from the CMS last year.