Medicare rate cuts giving cardiologists a heart attack

In a move that threatens the continued existence of out-patient, cardiological care, the Center for Medicare and Medicaid Services (CMS) has announced rate cuts approaching 40% in the amounts paid for key diagnostic tests utilized in the treatment and monitoring of heart related disease.

And you’ll never guess why.

The cuts are the direct result of a decision made by the CMS to adopt a survey conducted by the American Medical Association (AMA) – and a pretty poor survey at that.

While the AMA’s survey was sent out to 3500 doctors, only 55 chose to participate – 11 of which were from hospital-based physicians who are not affected by the rate cut. Further, while the questionable survey suggested that costs of cardiology imaging practice have gone down 42% in recent years, there is significant evidence to reveal that those costs have actually increased by about 5% annually.

It is difficult to believe that Medicare is prepared to change the way cardiology is practiced in this country based on what 55 physicians had to say. However, that is precisely what is happening.

So, why would the American Medical Association want to cause so much trouble for the nation’s cardiologists?

The answer lies in the press release issued by the CMS in announcing their decision.

In the final rule with comment period, CMS is also adopting several refinements to Medicare payments to physicians which will improve payment rates for primary care services relative to other services.

Via CMS press release

What this means is that Medicare has decided to cut back on important cardiology services so that they can pay primary care doctors a higher rate.

I’m all for paying primary care physicians better. We have a shortage in the ranks of the primary care docs and need to produce more of them. But is this really the best way to go about improving their situation? If you – or anyone in your family- have ever suffered from heart problems, you probably don’t think so. And if you haven’t experienced heart issues, statistics indicate you may have to deal with some trouble involving this medical discipline down the road. Trust me – when it happens you are going to want every test that might save your life.

While most believe that the AMA speaks for America’s physicians, they don’t. In fact, only about 17% to 25% of doctors in the United States continue to hold membership in the AMA and those that do tend to be primary care physicians – not specialists like the cardiologists.

So, in a political effort to gain higher payment rates for their membership base, the primary care physicians, the AMA has thrown cardiologists under the bus – and very possibly your own heart health with them.

According to Dr Jack Lewin, CEO of the American College of Cardiology,

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.
Via TheHeart.org

Because the rate cuts do not affect physicians practicing inside hospitals, expect many cardiologist to give up private practice and join hospital staffs.
This is hardly the way to convince our seniors that health care reform is a good thing for them. While the Medicare decision probably does not tie into a cost savings required to make the numbers work for reform, (it appears that the money is being robbed from cardiologist Peter to pay primary care physician Paul,) all our seniors will see is that they are no longer able to visit their cardiologist in his or her office for the tests necessary to monitor their cardiac health. If they need the tests, they will have to check into the hospital where the tests will still be covered by their Medicare.

Hardly a prescription for saving money.

The CMS has made a mistake and a serious one at that. It is now up to their masters in the Congress to make this right – and fast.

Otherwise, a year or two from now, cardiology care may look very different in America, and we aren’t going to like it.