ASE working for you through advocacy

SONOGRAPHERS’ COMMUNICATION ASE Working for You Through Advocacy ASE has an active advocacy program to monitor and develop plans involving current regulatory trends and issues affecting the field of echocardiography. For example, sonographers on the ASE Advocacy Committee recently helped to establish an ASE policy regarding local Medicare review policies. This policy establishes reimbursement based on quality requirements on the performance of an echocardiography study. In September, ASE Sonographer members Alex Neumann and Rick Rigling joined Drs Alan Pearlman and Julius Gardin in representing ASE during the American College of Cardiology (ACC) Legislative Conference in Washington, DC. This 3-day legislative conference was structured around preparatory and educational meetings as well as presentations from national experts on health care issues which have effects on the cardiology world as a whole. The second and third days of the conference were devoted to participants slated to meet with members of Congress and their staffs. The educational meetings consisted of media training sessions, how the Medicare system works, how a bill is developed and passed, stimulating grassroots advocacy, physician manpower shortage, imaging advocacy issues, and how to have an effective lobbying meeting. Due to the contentious election year, there were a number of speakers who presented the Republican and Democratic positions directly from the presidential camps. The meeting on manpower was highly debated and brought about strong discussion. It was very interesting to hear the specifics of the decrease in training slots, decrease in funding, and decrease in people entering general cardiology. Some discussion took place regarding changing the amount of internal medicine training and foreign physicians coming to the United States as well as foreign medical students. It is clear that the physician manpower shortage in cardiology is having an impact on access to care. There was much discussion of the fear of malpractice issues being the largest reason behind the shortage. A meeting, which was designed and presented by ACC staff as a Nuclear Cardiology advocacy meeting, turned into a discussion of how the ACR is trying to get Congress to modify the Stark Laws to directly affect cardiologists doing imaging in their offices. The ASE played a big part as the discussion turned to how to effectively change imaging usage to only cardiologists and to link the methods of quality control through a process such as lab accreditation like the ASE has developed through the December 2003 LMRP (LCD) document. Another discussion came up about how to work toward evidence-based medicine, which would be a solution for some usage and reimbursement problems. The staff said the ACC needs a document on imaging to show how effective use of the technologies would be aligned in prac-

Rick Rigling, RDCS, FASE, Danbury Hospital, Danbury, Conn

tice and how they could tie that into a policy of quality control, like the ASE LCD. The problem, as they admit it, is the normal practice would be to do a full ACC/AHA Guideline and Standard based on research which takes time. They suggested a quicker process of developing a position paper, since it is needed “now.” They were going to continue that discussion and move it up on the list of priorities. The 3 main talking points which we were asked to have discussed at the Congressional office meetings were: 1. Reform of the formulas directly effecting Medicare Physician Payment Update 2. Medical Liability Reform on a national level 3. Possibility of changing the Stark Laws to disallow imaging in physicians offices Following the Capitol Hill visits, there was a debriefing session to talk about successes. The general outcome was fairly positive. The Congressional representatives all knew they had to get malpractice reform done but the Democratic Senate does not agree on the cap or the method. They appear fairly positive that it will be a passable bill next congress, after January. They were also very well equipped to talk about the importance of fixing the physician payment plan soon before it bankrupts the system. Unfortunately again, with no solutions, but with a strong hope they would see it as a big issue in the next Congressional session. On the issue of the possibility of changing the Stark Law, about 50% of them knew about it and said ACR was already at their office. Most, however, did not see a good reason to change the law at this time. Rick Rigling, BS, RDCS, FASE

22A Journal of the American Society of Echocardiography

Volume 17 Number 12