Proposed Medicare cuts could close a lot of cardiology practices

Proposed Medicare cuts for 2010 threaten access to lifesaving medical services for millions of heart and cancer patients. If enacted, changes recommended by the Centers for Medicare and Medicaid Services (CMS) will drastically cut current Medicare reimbursements to cardiologists and oncologists for critical and life-saving services, such as echocardiograms, stress tests, cardiac catheterization and numerous other services.

Deaths from heart disease have declined 29 percent over the past eight years due to advances in prevention, diagnosis and treatment of heart disease. However, heart disease remains the No. 1 killer in the United States, followed by cancer. Ironically, CMS punishes both sub-specialties with a 25 to 40 percent reduction in their payments, starting 2010.

In addition to the 25-40% reduction for cardiology services, CMS will also reduce the overall physician’s payment by 21.5%. All in all, CMS is proposing a total reduction of more than 50% for cardiology services. In other words, we may see higher death rates from heart disease and cancer in coming years.

CMS used the Physician Practice Information Survey to justify the proposed reduction. Based on PPSI, CMS claims that overhead and other cardiology practice expenses have decreased 33%. This conclusion is clearly incorrect based on information submitted by more than 2,000 cardiologists from 1996 to 2008. These practices’ expenses increased more than 30% from 1999 to 2008.

The CMS conclusions lack transparency, and I have serious concerns about the validity of the survey. Greater analysis is needed prior to implementation.

What is the impact of the proposed payment cuts on cardiac patients?

The cuts could force cardiologists to limit care to Medicare patients or even stop accepting Medicare patients, close cardiology and oncology practices in rural areas, forcing the patients to travel long distances for cardiac care, and wait days or weeks for tests and services. Cardiology practices will be forced to reduce staffing, affecting customer service to patients — not to mention the aging population and the emotional, physical and financial burden on people who are already suffering from heart disease.

Cardiologists will struggle to treat Medicare patients because in most cases the reimbursements are less than the costs of providing medical services. Over recent years the costs of running medical practices have increased dramatically. The average overhead cost for a cardiology practice is between 55-65%.

If the total cardiology practice revenue is cut by 25-40%, there is little or no margin for the practice to survive without sacrificing accessibility and quality. Unless these proposed changes are rescinded, patients will suffer the consequences, especially in rural areas where the proportion of Medicare patients is exceptionally high.

The American College of Cardiology has met with CMS staff, the Obama administration and members of Congress. More than 350 cardiologists, including myself, met with Congress last week and asked them to examine these cuts and their impact on patients’ care.

Political pressure from Congress is needed to stop Medicare’s proposed cuts. Congress and Medicare need to hear from the patients and the community that the proposed cuts will have a devastating effect. You must act now: The deadline is only 4 weeks away.

Contact Medicare, Congress and lawmakers and tell them the impact these cuts will have on your cardiac care and ask them to stop the proposed cuts.

For contact information for Medicare and legislative representatives, call Blue Ridge Cardiovascular Associates at 829-4374.

Dr. Roshandel, MD, FACC, is a cardiologist at Blue Ridge Cardiovascular Associates in Culpeper.