Huge cutbacks in Medicare payment rates will likely cause many community-based cardiologists to close their private practices and become employees of hospitals instead, Dr. Jack Lewin, CEO of the American College of Cardiology, said in an interview.
Although a federal judge refused to hear a suit challenging the 2010 Medicare payment rates for cardiologists, the ACC said it will continue to fight what it considers to be an excessive and arbitrary reduction in fees.
The ACC filed a complaint in late December in the United States District Court for the Southern District of Florida, alleging that Health and Human Services Secretary Kathleen Sebelius illegally adopted the rates, using invalid survey data. Only a federal court would have jurisdiction over Medicare rates; the suit was filed in Florida because several of the plaintiffs reside in the state.
Among other issues, the ACC said that the Physician Practice Information Survey, which was used to collect practice expense data to set the 2010 rates, was inaccurate because it collected data from only 55 cardiologists, too few to be representative of the nation's cardiologists, alleged the suit.
The Department of Justice filed a motion to dismiss the suit, arguing that the Centers for Medicare and Medicaid Services' administrative expertise outweighed the court's judgment, and that the Florida district did not have jurisdiction.
Judge William Dimitrouleas agreed, and refused to hear the suit on Jan. 12.
The ACC was “deeply disappointed” by the refusal, Dr. Lewin said in a statement. He added, “What is deeply troubling about today's ruling is that it sets the precedent that CMS has complete and unchecked control over physician reimbursement for patient care even where its determinations are based on faulty data.”
Dr. Lewin said cardiologists aren't the only ones who will be affected. “Today's ruling should be a warning to all physicians that anyone is susceptible to falling into CMS's crosshairs unfairly and without recourse,” he said.
The ACC has not given up its fight, although it may now move from the courts back into Congress.
Medicare payments for all physicians are slated to be cut by 21% in 2010, as required by the sustainable growth rate (SGR) formula. Reductions could be as high as 30%-40% for cardiologists.
Fees are to be cut by 11% on average (in addition to the 21%), plus there will be reductions in imaging payments that will disproportionately affect cardiologists.
Currently, the mandated 21% SGR reduction is on hold until March 1. Congress approved a 2-month delay, tucking it into an appropriations bill for the U.S. Defense Department, which was signed into law by President Obama in late December.
However, cardiologists were hit with other reductions starting Jan. 1. Medicare payments for echocardiography are being cut by 11% and for stress testing by 8%. The cuts are slated to be even deeper going forward.
The agency also is slashing single-photon emission CT payments by 37%. The ACC collaborated on creating a new single code for SPECT and expected a phasing in of a reduced payment. Instead, it's coming in just 1 year.
Finally, starting Jan. 1, cardiologists and other specialists were no longer allowed to bill Medicare using inpatient or outpatient consultation codes. The CMS eliminated the codes as part of the 2010 fee schedule.
The American Association of Clinical Endocrinologists, the American Gastroenterological Association, and other providers have petitioned Congress to adopt an amendment introduced by Sen. Arlen Specter (D-Penn.) to delay that elimination for a year. The amendment was attached to the Senate health reform bill. At press time, House and Senate Democrats were still in negotiations over what would be included in the final health reform package.
In turn, that will reduce access to cardiologists and increase Medicare costs because hospital-based procedures are more expensive, he said. These are unintended consequences of “bad public policy,” Dr. Lewin said.
Indeed, practicing in the community is getting a lot tougher, said Dr. Tom Hill, a cardiologist in an eight-physician Muskegon, Mich.–based practice.
The cuts will “have a significant impact on our practice,” Dr. Hill said in an interview. He noted that Medicare revenue has already been flat to declining for the last decade, while expenses have been rising.
He and his partners are looking at options for reducing overhead, including eliminating staff positions. They've already instituted cuts in pay and benefits, and they may also have to reduce services.
For instance, the practice conducts 20-30 echocardiographic and nuclear stress tests at its office daily. The nuclear imaging reductions could amount to a 35% cut in income, and further cuts will come from the echo reductions.