Advocacy 2012-2013 Achievements and Challenges

By David Wiener posted 07-03-2012 22:22


Dear ASE members,


I am writing this at the close of the ASE Scientific Sessions in National Harbor, MD, where ASE's Advocacy Committee had its annual face-to-face meeting the other day. As I start my second year as your advocacy chair, I am amazed by the energy and devotion of the 30 or so members who were present, as I am each month by the dedication and creativity they evince on our monthly telephone calls and when we call upon their expertise - often on short notice - for various projects I am also grateful for the skill and hard work of Irene Butler, Health Policy Manager for ASE. While the committee members and I have "day jobs," Irene lives advocacy for us 24/7. Similarly, we are in the debt of our wonderful Washington counsel, Diane Millman, JD, whose sage advice transcends legal matters and benefits us in everything we do.

Advocacy for 2012-13 has marked achievements and faces challenges. As Jim Thomas outlined in his State of the ASE address, our achievements include maintaining level reimbursement by CMS for several ultrasound codes, no mean feat in the present environment. The AMA RUC accepted the concept of an echo room, meaning a uniform list of up-to-date equipment upon which to base technical fees for echo studies; the last list off of which CMS was working includes a VCR! We will see whether CMS agrees with the RUC recommendations. We struggled mightily this year over a software edit by McKesson Health Care Solutions which denied payment to groups for an inpatient echo interpretation when an E and M service was billed on the same day. Just last week we achieved resolution about that decision, but even more significant is that we found common ground with McKesson, and learned that they are interested in hearing ASE's voice and partnering with us in the future.


Among other items of note: ASE is looking for a seat in the AMA House of Delegates so we that we can represent cardiac ultrasound in this time of momentous changes in medicine. We are just a few ASE members shy of the number we need, so if you are a US-based physician, please consider joining the AMA in July. Our committee has constituted a subgroup to probe (pun intended) the benefits and drawbacks of various options to code for the more extensive TEE's done during interventions such as TAVR. A separate group is considering the echo community's approach to the proliferation of devices such as handheld echo and the role of non-traditional users such as emergency physicians and intensivists. In particular, how do we reconcile differing recommendations for training and competence, always keeping in mind that ASE’s focus is on excellence and patient safety?

We are exploring the place of cardiac ultrasound as payment models evolve in the United States. Appropriately used, high quality echo remains a vital tool irrespective of the way the US health system is organized. We, its practitioners, are not mere imagers but are patient-centered clinicians who apply ultrasound in cardiology and cardiac anesthesia. In the coming months, you will be hearing from our experts via courses, communications and journal articles as we seek to inform and represent you.


This is an interesting time to be involved in advocacy (sometimes it feels like that apocryphal curse about living in interesting times)! The Advocacy Committee is honored to represent you. We love to hear from you - you are our warning system when things go wrong, and we depend on everyone's input to make things go right. So please be in touch with Irene ( or with me (