More extensive efforts couldn't hurt but ... given the contribution of
vascular laboratory revenue to a typical physicians practice represents a
relatively small fraction of total income, the dollar impact of the decrease
in the conversion factor far outweighs the larger percentage decrease from
the vascular laboratory ... as an example: correction of the conversion
factor would cost $1.25 billion while correction of the ZWP decrease would
cost an estimated $1.3 million ... obviously, physicians associations are
going to be more interested in correcting the conversion factor (simply
follow the money) ...
On the other hand, the decrease in the ZWP impacts 100% of the procedures
provided by non-physician clinical staff in vascular laboratories (as well
as ultrasound in general, etc.) ... Consequently, we're much more impacted
by the decrease ... this also means that we own the problem to a larger
extent ... I hasten to add that AAVS has been very active on this issue
(notably Bob Zwolak), so we are not without physician support ... just that
non-physician clinical staff are disproportionably impacted and, as such, we
"own" more of the problem ...
Re PET & cardiac: To cardiology's credit, they have done a very good job of
establishing medical necessity for cardiac PET - this being a fundamental
issue related to coverage decisions (& in the absence of which no amount of
lobbying would have helped - a simple statutory issue) ... now we'll see
what restrictions are placed on utilization, either from CMS or carrier LMRP
In general, do disagree that "bite" is more effective than "bark" at CMS.
That is, rarely in my experience over the past 15 years of meetings with
HCFA/CMS have any meetings been adversarial (I can count them on the fingers
of one hand, and have fingers left over). Rather, the folks at CMS have
attempted to do the right thing on virtually every issue. When problems
have come up, it has almost always been secondary to their having very
limited resources and internal expertise to deal with very large problems -
and what has been required is that we provide education on the particular
issue and work with them for a solution. Using the supervision issue as an
example, HCFA received comments to a NPRM (which had suggested general
supervision was sufficient) that ultrasound required direct or personal
supervision (with one comment suggesting that ultrasound represented the
"cesspool" of medical practice in the US). Consequently, in the final rule,
they suggested direct or personal supervision was required. While it took
time and work on our part to correct this misrepresentation, HCFA did do the
right thing - which was their intent all along.
What we really need is to foster an active relationship with CMS - this in
an attempt to be proactive, as opposed to reactive. In order for this to
occur, more vascular technologists & sonographers must learn about and
become involved with the process (it is not like CMS employees a single
vascular technologist or sonographer) - this bringing to mind the quote from
Plato which, if memory serves, goes something like: "The penalty for wise
men that refuse to become involved in the affairs of government is to be
ruled by unwise men."
Musings at the end of a warm & sunny day in Seattle ... hmmm, I think I
recall another like this last August, but then I'm old and it may have been
a dream ...
Franklin W. West
(425) 398-7774 (direct)
(425) 486-8976 (fax)
[log in to unmask]
From: [log in to unmask] [mailto:[log in to unmask]]On
Behalf Of Hodge, Megan D.
Sent: Friday, March 01, 2002 9:52 AM
To: [log in to unmask]
Subject: Bark is not louder than bite.
Just received this blurb in one of our daily e-mail journals.
Reimbursement: Cardiac community wins expanded PET coverage
After extensive lobbying efforts from physician advocacy groups, CMS has
agreed to reimburse for primary, diagnostic positron emission tomography
(PET) scans of cardiac patients.
I believe that the physicians behind our vascular labs are not speaking
loud enough for their own reimbursement and although SVT and others are
trying to " bark" for the salvation of our specialty, it ultimately will be
those that " bite": and sink their teeth into CMS for anything to be done.
Just a thought on this rainy dreary day down in Houston!!!
Megan Hodge, RN RVT
Vascular Diagnostic Laboratory
The Methodist Hospital, Houston,TX
E-mail: [log in to unmask]