The Cost of Medicare Cuts

Centers for Medicare and Medicaid Services (CMS) Set to Cut Medicare Physician Fees for Cardiovascular Imaging
November 3, 2009 | Reed Miller

[snip]
While most of the CMS's [Centers for Medicare and Medicaid Services] cuts will be phased in over four years, it is planning to cut the fee for myocardial perfusion single-photon-emission computed tomography (SPECT) imaging by 36% in 2010, as it "bundles" add-on codes into the primary procedure over one year. [SPECT imaging is the nuclear portion of a typical stress test]

As proposed in the draft rule in July, the new physician fee schedule also eliminates payment for consultation codes, which will reduce payments for cardiology consultation services.

SCCT president Dr Jack Ziffer (Baptist Hospital of Miami, FL) told heartwire that "because [the cuts] are so broad-based, my first concern is for patients and access—will institutions be able to provide these services?" For example, under the new fee schedule, CT imaging of the pulmonary veins, often performed to augment an electrophysiology exam, are assigned a global payment of $179. "I'd be hard-pressed to imagine [anyone] can do that study for that [fee]."

ASE advocacy committee chair Dr Ben Byrd (Vanderbilt University, Nashville, TN) told heartwire that because the physician fee schedule determines payments to outpatient physician practices but not hospital-based doctors, its ultimate effect will be to drive many cardiologists to close their practices and go to work for hospitals.

Dr Jack Lewin, CEO of the American College of Cardiology (ACC), agrees that that impact of the cuts could be devastating for private practices. "This is truly a black day for cardiology. There has never been an assault of this magnitude on cardiology, ever." Lewin fears "private-practice cardiology will cease to exist as viable, and cardiologists will shift to hospitals or integrated systems."

Read the comments following the article:

For years, cardiologists have lost money talking with patients and making it up with profitable imaging tests. To take away the profits and make cardiologists lose the value of their investments without compensation is incredibly unfair. In addition, to not significantly increase reimbursement for cognitive services makes the practice of quality medicine impossible.

As we are discussing a federal option as the best hope for improvement in healthcare delivery, our current federal option is in the process of destroying the healthcare that we currently can provide.

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Healthcare professionals have been hit multiple times by congress in recent years,
increased regulation, decreased reimbursement and a failure to restrain the legal system.

Rob