Mark the Date!
Saturday, October 11, 2003
Join us for the Ohio-ACC's 13th Annual Meeting at the Crowne Plaza Dayton. Bring your family because we will celebrate the Centennial of Flight at The United States Air Force Museum at Wright-Patterson AFB. There is something for everyone -- for office managers, for fellows-in-training & for industry vendors!  Register today.

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Join the ACC PAC
Now more than ever, we all need to become avid supporters of the ACC Political Action Committee (PAC).  If we do not advocate politically for our patients and ourselves, we will continue to find ourselves at the end of the line.  Whether you believe in political activism or not, it is a reality that we are outspent by our adversaries many times over.  Please sign up today. I have made a pledge that Ohio will attain at least an 80% donation rate.  Of course, 100% would be preferable, and I do not have to remind you that medicine need not take the course it is taking.  After all, the changes that we are seeing in medicine affect not only us as physicians but our patients as well! Please heed the call. Time is fast running out to salvage a health system that is the best in the world.

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Ohio House Bill 71
Ohio legislation dealing with ban on physician investment in specialty hospitals -- learn more.

ACC Welcomes Cardiac Care Associates
The ACC’s newest membership category, Cardiac Care Associates, is now accepting applications. Registered nurses, physician assistants, clinical nurse specialists, and nurse practitioners can download an ACC membership application.  Questions? Call 800.253.4636, ext. 697.

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Attention Fellows-in-Training!
Compete at the upcoming poster competition during the Ohio Chapter-ACC 13th Annual Meeting. Deadline for receipt of abstract submissions has been extended until September 25th!

PRESIDENT'S MESSAGE
Philip M. Dorfman, MD, FACC
As the summer winds down, it's time to turn our attention to serious issues in medicine.  We as cardiologists are facing at least a 4.2 percent cut in January from CMS. Already it is projected that the cut could reach closer to 5 percent. And because private insurers tie their reimbursement to Medicare, the cuts will be even more severe. Included in the House-passed Medicare reform bill is a provision that would provide a 1.5 percent increase to physicians in 2004 and 2005. The formula would then revert back to the original baseline in 2006, which would result in significant cuts. The ACC continues to work with the Medicare reform conference committee to ensure that physicians do not receive a payment cut next year and to make more permanent solutions to the payment formula problem. You can send a letter to you federal lawmakers on this issue through the ACC Web site. Simply go to www.acc.org and click on "Take Action Now."

NPWP Solution
Changes in the way Medicare calculates practice expense values are also a threat to cardiovascular relative values.  Procedures in the Non-Physician Work Pool (NPWP) have not been subjected to resource-based calculations because CMS's methodology does not appropriately account for the associated overhead costs of procedures with a large technical component.   Procedures in the NPWP include office-based nuclear cardiology, office-based echocardiography and office-administered oncologic therapy.  Now CMS is planning to eliminate the NPWP in 2005.  Estimates for decreases in the technical payment for office-based nuclear cardiology range of up to 25 percent!  Let me assure you that the ACC has been devoting a great deal of time and effort to this area of reimbursement.  A number of cardiology offices are being asked to complete surveys primarily to substantiate that the "true" practice expense cost for cardiologists has risen faster than other specialties.  Considering the necessity of our practices to hire more para-professionals to provide the level of care that our patients require, I do not doubt that this will indeed be the case.  Keep an eye on www.ohioacc.org for further updates on this issue.

Malpractice Issues Persist
Physicians in Ohio are retiring or leaving the state in record numbers.  Only three malpractice carriers remain, and one of those carrier's ratings has recently been downgraded to a B-.  Hospitals are racing to establish captive insurance companies---off-shore companies that do not have to fully comply with US insurance regulations.  Be wary of these schemes as they may not protect you as completely as you might think.  For the most part they are not ratable and so do not qualify for a specific rating required by hospital regulations (unless of course the hospital itself sets up the captive). They do not include tail coverage and, for the most part, do not include a right to settle clause (ie. the captive can force you to settle a claim even if you feel it is frivolous or non-meritorious -- putting you in the position of having another “notch” in the Physician Data Bank).  Tort reform and changes in the Supreme Court have not had the dramatic effect we thought they would have.  We are told these changes take time to work their way through the system.  I worry that there won’t be much left of medicine in Ohio by the time these changes wind their way through the system.

Dwindling Numbers of General Cardiologists
Lastly, as many of my colleagues are seeing, there is a significant lack of general cardiologists in the country.  Everyone seems to be specializing!  The ACC has seen this as a very serious threat to the specialty.  The longer people live, the more cardiologists we will need.  To address this issue, there are a number of suggestions being circulated.  One of these was especially troubling to me---an extra year of training for internists to become general cardiologists.  This solution causes even more loss of control of our specialty and can only lead to more infighting and angst among our colleagues.  We must not ignore the foundations of our specialty. Share your comments.

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