New ASE Guideline Focuses on Cardiac POCUS in Children

Cardiac point-of-care ultrasound has the potential to improve patient care, but its application to children requires consideration of anatomic and physiologic differences from adult populations, and corresponding technical aspects of performance. This new guideline, Recommendations for Cardiac Point-of-Care Ultrasound in Children, is the product of an American Society of Echocardiography task force composed of representatives from pediatric cardiology, pediatric critical care medicine, pediatric emergency medicine, pediatric anesthesiology, and others, assembled to provide expert guidance.

This diverse group aimed to identify common considerations across disciplines to guide evolution of indications, and to identify common requirements and infrastructure necessary for optimal performance, training, and quality assurance in the practice of cardiac point-of-care ultrasound in children. The recommendations presented are intended to facilitate collaboration among subspecialties and with pediatric echocardiography laboratories by identifying key considerations regarding (1) indications, (2) imaging recommendations, (3) training and competency assessment, and (4) quality assurance. Read more here.

Urgent Call to Action – Support ASE Representation on Vital Issues by Joining the AMA!

ASE is working hard to ensure your voice is heard on issues related to legislative matters, regulatory issues, coding and reimbursement. To do so, ASE must maintain the Society’s seat in the American Medical Association (AMA) House of Delegates. To qualify, 25% of ASE’s U.S. physician members must also be members of the AMA.

As a member of the House of Delegates, ASE:

  • Helps sets the legislative and regulatory priorities for the AMA.
  • Has full delegate status which provides ASE with full representation before CPT/RUC.
    • This has contributed to some of ASE’s more recent, substantial advocacy successes.

For more detailed information please read: The ABC’s of Payment for Cardiovascular Ultrasound Services and Why the AMA Matters .

To help ASE reach this critical goal, click here.

We urge you to join the AMA today to help us ensure that echo has a voice!

January 2023 JASE now available

The role of echocardiography in detection and evaluation of valvular heart disease is a focus topic of the January 2023 JASE, now online. This issue also includes ASE’s newest guideline, “Recommendations for the Use of Echocardiography in the Evaluation of Rheumatic Heart Disease,” from Pandian et al.

January 2023 JASE

Patricia A. Pellikka, MD, FASE, who begins her tenure as JASE Editor-in-Chief with this first issue of 2023, said that she chose the focus topic to coincide with the publication of the guideline, putting out a call for papers last summer. Read Dr. Pellikka’s first Editor’s page, which offers insights on several of the clinical investigations. Editorials, brief research communications, and correspondence in this issue also provide further insights on echocardiography in valvular heart disease. The guideline is the January CME article.

The President’s Message from Stephen H. Little, MD, FASE, shares the history of ASE’s Leadership Academy, which was developed by the Governance Committee “to provide a way to engage our early and mid-career members to develop their leadership skills.” If you missed the prior announcement of those who were recently accepted into the third cohort of the LA, meet them in his message! The continuing education and meeting calendar outlines a multitude of learning options near and far.

ASE Partners with Preventative Cardiovascular Nurses Association (PCNA)

ASE is partnering with Preventive Cardiovascular Nurses Association (PCNA) to present education on topics that touch echocardiographers and the cardiovascular nursing team. The goal of this partnership is to share learning, perspectives, and communicate the challenges and opportunities around patient identification and management that impact both communities.

Sharing expertise across team members can provide each member with a deeper understanding of issues in various cardiovascular diseases. ASE is committed to working across the field of cardiovascular health to impact better patient care. We hope that by identifying synergies with groups like PCNA that have similar challenges and a different perspective, we can bridge gaps and build understandings for all practitioners.

LEARN MORE

Congress Passes the CAROL Act

ASE would like to thank Congress for passage of the Cardiovascular Advances in Research and Opportunities Legacy (CAROL) Act (H.R. 1193/S. 1133). ASE was pleased to support this bipartisan legislation. Senators McConnell and Sinema introduced the Senate companion legislation to Congressman Barr’s House legislation, which will help heart patients through expanded research, education, and investments into valvular heart disease.ASE Advocacy

According to the CDC, valvular heart disease affects 2.5% of the U.S. population. As many as 11 million Americans are living with heart valve disease and, each year, five million additional Americans are diagnosed with it. The CAROL Act pledges the necessary investments in research and prevention to aid the millions of American lives affected by this disease. We thank leaders in the House and Senate for their partnership in getting this bill done.

We surpassed our GivingTuesday goal of $30,000—thank you so much!

The ASE Foundation is ecstatic to share that we have already surpassed our $30,000 fundraising goal! Thank you to the 109 donors who have contributed a total of $32,457.94 as of this afternoon.

Thank you for your support on GivingTuesday

We may have reached our goal, but we are not done! The Foundation is still accepting donations towards its GivingTuesday fundraiser until December 3, so if you have not already done so—it is not too late to donate! Every donation brings us closer to our 2022 Annual Appeal goal of $225,000.

An investment in the ASE Foundation is a testament of support in the future of cardiovascular ultrasound. Wherever your heart lies in our field, ASEF is making a difference. Show us #YourPriority with a donation to the initiative that most aligns with your passion. If you would like to make a donation to support a 2023 Global Outreach Travel Grant in memory of Greg Tatum, MD, FASE, please indicate that your donation is in his memory on the donation form.

100% of your donation will go toward charitable projects in 2023. Thank you for showing us that supporting the future of cardiovascular ultrasound is #YourPriority. Together we will continue to make a world of difference!

Today is GivingTuesday—Help Us Raise $30,000!

GivingTuesday

Hello, and Happy GivingTuesday! The ASE Foundation is thrilled to participate in this global giving movement for the 10th year in a row. To mark the occasion, we set an ambitious fundraising goal of $30,000. Will you join the movement and help us reach our goal?

Follow this link to make your donation today. Your contribution to the ASE Foundation is an investment in the future of cardiovascular ultrasound and directly impacts the scope and success of our 2023 initiatives. No matter where your heart lies, the Foundation can support your passion and you can take pride in knowing that 100% of your donation goes back out into the field.

On this special day, we ask that you remember the ASE Foundation. Donations towards our $30,000 fundraising goal will be accepted through December 3. When you donate, let us know what inspired your contribution on social media. Remember to include #GivingTuesday and tag @ASE360.

November JASE-Enhancing Stress Echo

The November JASE includes, “Passive Leg Raise Stress Echocardiography in Severe Paradoxical Low-Flow, Low Gradient Aortic Stenosis,” from Drs. Buffle, Papadis, Boscolo Berto, Grani, Seiler, and de Marchi. Dr. de Marchi noted, “Stress echocardiography has been relying on dobutamine, also for patients with aortic stenosis. This study evaluates an increase in LV filling using passive leg raise in both, classical and paradoxical low-flow low-gradient aortic stenosis. It shows that adding leg raise to dobutamine increases the parameters we wish to stimulate in stress echocardiography.”

Two other clinical investigations also look at novel applications of stress echo. Additional clinical investigations explore optimum indexing of cardiac measurements, fetal echo prediction of postnatal obstruction in total anomalous pulmonary venous connection, cardiac function and pulmonary hemodynamics in infants with Down Syndrome, and echocardiographic imaging of myocardial scar, with an accompanying editorial, “Detecting Scar in Echocardiography: Has the Power Shifted?” from Drs. Appadurai and Thomas. A review article, which offers CME, explores tricuspid regurgitation related to cardiac implantable electronic devices. A group of robust brief research communication on validation of alternative left atrial indexation methods in obesity, development of a new technique for ultrasound imaging of the innominate vein and the venous angle, local arterial stiffness assessment, and assessment of diastolic energy loss in hypertensives versus controls and thought-provoking correspondence round out the issue.

The President’s Message from Stephen H. Little, MD, FASE, illustrates how ASE is making sure that it is preparing, planning, and prioritizing to be a leader in how Societies grapple with all of the digital data that is part of general society and of course, echocardiography. The continuing education and meeting calendar outlines a multitude of learning options near and far.

ASE Releases New EchoGuide App

FOR IMMEDIATE RELEASE

Contact: Angie Porter
919-297-7152
aporter@ASEcho.org

American Society of Echocardiography Releases New EchoGuide™ App
The mobile and web app provides quick access to common and challenging echocardiography measurements and values

(DURHAM, NC, Nov. 9, 2022)—The American Society of Echocardiography (ASE) announced today that it is launching a new interactive mobile and web application for healthcare professionals providing cardiac care. EchoGuide™ is a calculator and algorithm app based on key guidelines published by ASE.

The free app offers physicians and sonographers quick access to common and challenging echocardiography measurements and values. Tools and functionalities are organized by cardiac structure and include over 50 complex calculators, charts and algorithms that provide quantitative assessment.

“The ASE EchoGuide app is a fantastic tool for echocardiographers, sonographers, and fellows in training that brings the comprehensive ASE guidelines to their fingertips. This practical app includes key reference tables, calculators, and easy-to-use multi-parametric integrative algorithms to increase your confidence level when interpreting or performing echocardiographic studies,” says Enrique Garcia-Sayan, MD, FASE, University of Texas Health Center in Houston.

One unique feature available to users is the ability to select their favorite and most-used interactive tools for easy access. Popular topics include the left and right ventricle, left and right atrium, valves including aortic, mitral, tricuspid, pulmonic and prosthetic, and z-scores for aortic root, among many others.

EchoGuide™, sponsored by Abbott, was developed by technology consultancy and custom software development firm Digital Mettle Custom Software based in Raleigh, N.C. The app is intended for educational/informational use only, and is not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease by aiding clinical decision-making. Learn more at ASEcho.org/EchoGuide.

About American Society of Echocardiography
The American Society of Echocardiography (ASE) is the Society for Cardiovascular Ultrasound Professionals™. ASE is the largest global organization for cardiovascular ultrasound imaging serving physicians, sonographers, nurses, veterinarians, and scientists and as such is the leader and advocate, setting practice standards and guidelines for the field. The Society is committed to advancing cardiovascular ultrasound to improve lives. For more information, visit the ASE website ASEcho.org or social media pages on Facebook, Twitter, LinkedIn, or Instagram.

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CMS PFS and HOPPS Final Rules

 

 

On November 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-1770] Final Rule, which includes final policies related to Medicare physician payment and the Quality Payment Program (QPP).  In addition, CMS released the calendar year (CY) 2023 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Final Rule [CMS-1772-FC], finalizing payment rates and policy changes affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings for CY 2023.

PFS Overview

Conversion Factor

The final 2023 Medicare conversion factor (CF) is $33.06, reduced from the 2022 final conversion factor of $34.61. The final rule establishes a 4.47% cut to physician payments under the 2023 fee schedule unless Congress can pass legislation that would offset or mitigate this reduction in payment.

Stakeholders, including ASE, have advocated for an improvement over the proposed rule’s 4.47% reduction to the CF, but the final rule’s methodology resulted in a slight decrease. The update is based on several factors: a statutory 0% update scheduled for the PFS in CY 20231 and a funding patch passed by Congress at the end of CY 2021 through the Protecting Medicare and American Farmers from Sequester Cuts Act. This bipartisan legislation partially mitigated a 3.75% cut to the CY 2022 CF and staved off other Medicare cuts, including a phased-in delay of the Medicare sequestration and pay-as-you-go cuts. The 3% payment patch was only in effect for 2023 and the Medicare sequestration relief was phased out starting April 1, 2022. The overall negative adjustment to the CF for 2023 is driven by the expiration of the 3% payment patch and a statutorily required budget neutrality adjustment due to other spending increases. Additionally, unless Congress acts to further delay additional anticipated cuts arising from pay-as-you-go federal budget requirements, Medicare payments could be cut by an additional 4%.

Physicians are concerned that full relief may not be possible given the significant cost of trying to offset an almost 4.5% cut and numerous competing interests facing Congress in an end-of-year legislative package. ASE will continue to work with a coalition of national and state medical societies in urging Congress to prevent these cuts before January 1, 2023. 

Practice Expense

Last year, CMS finalized a proposal to update prices for clinical labor through a four-year transition period that will be completed in 2025. Physician specialties with substantially higher average shares of direct costs attributable to clinical labor are anticipated to see increases in payment from the clinical labor pricing update, while those with lower average shares of direct costs attributable to labor are anticipated to see decreases in payment. During the four-year transition period, clinical labor rates will remain open for public comment.  Unfortunately, echocardiography related services did see an increase in the clinical labor RVUs based on the revised calculations.

Although CMS did not propose a methodology for updating future PEs, CMS believes “it is necessary to establish a roadmap toward more routine PE updates.” CMS also opined that indirect PEs would benefit from a data refresh, and signals “[its] intent to move to a standardized and routine approach” to valuing indirect PEs. Unfortunately, CMS notes that it received few direct responses to many of the specific prompts included in its recent request for information and feedback. Most commenters, including ASE, recommended CMS delay any changes to update the indirect PE survey inputs and urged CMS to wait for the American Medical Association (AMA) data collection effort prior to implementing any changes. The AMA indicated it has continued to work on updates and would likely be ready by early CY 2024 with refreshed data. CMS, however, acknowledges comments that refreshed survey data alone would not address all the competing concerns that CMS must account for when allocating indirect expenses, and that the agency may look to supplement or augment survey data with other verifiable, objective data sets in the future, including data sets that are already in the public domain.

Split / Shared Visits

CMS will delay until CY 2024 the split (or shared) E/M visits policy originally scheduled for implementation in CY 2023. For CY 2023 (as in CY 2022) the substantive portion of a visit may be met by any of the following elements:

  • history
  • performing a physical exam
  • making a medical decision
  • spending time (more than half of the total time spent by the practitioner who bills the visit).

Under this change, echocardiographers furnishing split/shared E/M visits will continue to have a choice of history, physical exam, medical decision making, or more than half of the total practitioner time spent to define the substantive portion, instead of using total time to determine the substantive portion, until CY 2024. The ASE and many other specialties pushed CMS not to implement its new definition of “substantive portion” as more than half of the total visit time and we will continue to advocate against implementation of this policy change.

Merit-based Incentive Payment System (MIPS)

CMS will maintain the CY 2023 MIPS performance threshold at 75 points (same as CY 2022). This impacts the CY 2025 payment year. Please note, CY 2022 is the final year for the “exceptional bonus” for high MIPS scores. While most cardiologists continue to meet the minimum MIPS reporting thresholds, failing to satisfactorily participate in MIPS for the CY 2023 performance year will result in a 9% payment cut in CY 2025.

MIPS Value Pathways (MVPs) are intended to connect activities and measures from the four MIPS performance categories that are relevant to a specialty, medical condition, or a particular population. For the CY 2023 performance period, CMS will add 5 new MVPs to the previously announced 7 MVPs in the program. CMS will also add measures to the existing 7 MVPs.

HOPPS Overview

For CY 2023, CMS applied a productivity-adjusted market basket increase of 3.8% under the Hospital Outpatient Prospective Payment System (HOPPS) and the Ambulatory Surgical Centers (ASC) Payment System. However, CMS applied several budget neutrality and other adjustments, including a significant 3.09 percentage point reduction to account for changes to its 340B drug purchasing policy. After accounting for these adjustments, the CY 2023 HOPPS conversion factor increases by 1.67% over the 2022 value. The ASC conversion factor will increase by 3.88%, a different and more favorable adjustment largely because it is not directly impacted by the 340B-specific budget neutrality adjustment. In continuation of its existing policy, hospitals and ASCs that fail to meet their respective quality reporting program requirements will be subject to a 2% reduction.

Based on the finalized policies, CMS estimates that total payments to HOPPS and ASC providers (including beneficiary cost-sharing and estimated changes in enrollment, utilization, and case-mix) for CY 2023 will be approximately $86.5 billion and $5.3 billion, respectively, for an increase of approximately $6.5 billion and $230 million, respectively, from CY 2022 program payments.

Supervision by Non-Physician Practitioners

CMS further extends supervision authority to non-physician practitioners for select diagnostic services.  In 2020, in response to the COVID-19 pandemic, CMS liberalized its regulations to allow certain non-physician practitioners (nurse practitioners, physician assistants, clinical nurse specialists and certified nurse midwives) to supervise the performance of diagnostic x-ray tests, diagnostic laboratory tests and other diagnostic tests paid under the PFS for the duration of the PHE to the extent they were authorized to do so under their scope of practice and applicable state law. In the CY 2021 PFS final rule, CMS further revised its regulations to make the previous revisions permanent and to add certified registered nurse anesthetists to the list of non-physician practitioners permitted to provide supervision of diagnostic tests to the extent authorized to do so under their scope of practice and applicable state law.

CMS has finalized its policy to further revise existing supervision requirements to make clear that nurse practitioners, clinical nurse specialists, physician assistants, certified registered nurse anesthetists and certified nurse midwives may provide general, direct, and personal supervision of outpatient diagnostic services to the extent that they are authorized to do so under their scope of practice and applicable state law.

To view the Final CY 2022 Payment Rates – MPFS and HOPD, please log in to the ASE Member Portal and visit the Advocacy Portal page.

For further information please see:

CMS Final Rules and Fact Sheets  

CY 2023 Physician Fee Schedule Final Rule
CY 2023 Physician Fee Schedule Final Rule Fact Sheet

CMS HOPPS/ASC Final Rules and Fact Sheets    

CY 2023 HOPPS/ASC Payment System Final Rule
CY 2023 HOPPS/ASC Payment System Final Rule Fact Sheet