WHAT DO YOU THINK? An article today discusses plans to cut fees for cardiovascular services. A link to an article, which activates referenced links within article, is HERE (Must register - FREE- at website for access)...
Reprinted Here
Source: http://www.theheart.org/article/1018537.do
CMS set to cut Medicare physician fees for cardiovascular imaging
November 3, 2009 | Reed Miller
Baltimore, MD - Against a chorus of opposition from cardiovascular imaging specialists, the Centers for Medicare and Medicaid Services (CMS) is planning to make significant cuts to physician payments for several cardiovascular imaging services [1].
In its 2010 Medicare Physician Fee Schedule final rule, released late on October 30, 2009, the CMS follows through on its July proposal to cut physician payments for cardiovascular and radiology services. The CMS will accept comments on the final rule until December 29, and it goes into effect January 1, 2010.
For example, according to the American Society of Echocardiography (ASE), the new rule cuts 10% from the fee for transthoracic echocardiography with spectral and color Doppler. "Taken together with the payment cuts that echocardiography services have already experienced, the CMS's final rule represents a grave threat to the provision of high-quality echocardiography services by physician practices," the ASE says [2].
The Society of Cardiovascular Computed Tomography (SCCT) calculates the new fee schedule reduces the fee for ECG by 5% and the combined echo codes by 14%. The SCCT acknowledges that the CMS has taken "an important step" by adding four new codes for cardiac computed tomography but says its preliminary review found errors in the practice expense calculations for the codes for CT of the heart with 3D images. The SCCT says it has already begun to address this issue with the CMS [3].
While most of the CMS's 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.
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."
Cuts linked to AMA survey
The cuts are the result of the CMS's decision to incorporate the AMA Physician Practice Information Survey (PPIS) into its formula for establishing practice expenses over the next four years. In a release, the CMS says the inclusion of the PPIS data is one of "several refinements to Medicare payments to physicians that will improve payment rates for primary-care services relative to other services" [4]. But the SCCT argues these data were "not appropriately reviewed or validated. Cuts of this magnitude—whether enacted this year or spread over four years—cannot be absorbed."
Requests for comment from the CMS had not been answered at the time this story was published.
Byrd told heartwire that the PPIS canvassed about 3500 doctors but got only about 55 responses, 11 of which were from hospital-based physicians, who are not affected by this physician fee schedule, and the remainder of the survey data is not a valid sample of real-world practice. The survey suggests that costs of cardiology imaging practice have gone down 42% in recent years, but there is ample evidence that costs have actually gone up about 5% annually, Byrd said.
The ACC, ASE, and SCCT say they have begun talking to legislators in the key Senate and House committees that oversee the CMS to try to work out a legislative solution that will prevent the planned cuts.
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Sources
1. Centers for Medicare and Medicaid Services. Medicare Program; Payment policies under the Physician Fee Schedule and other revisions to Part B for CY 2010. Accessed November 3, 2009. Available here.
2. American Society of Echocardiography. Final Medicare Physician Fee Schedule rule phases in cuts: echocardiography, nuclear cardiology hit hard [press release]. Accessed November 3, 2009. Available here.
3. Society of Cardiovascular Computed Tomography. CMS releases final 2010 physician payment rule. Accessed November 3, 2009. Available here.
4. Centers for Medicare and Medicaid Services. CMS announces payment, policy changes for physicians services to Medicare beneficiaries in 2010 [press release]. October 30, 2009. Available here.