Cardiologists Sue HHS to Prevent Medicare Cuts

If the public was wondering just exactly how health care reform is going to impact their doctors and physicians, a recent article in USA Today explains how one group of specialist’s has had enough.

On Monday, “heart specialists filed suit against Secretary of Health and Human Services Kathleen Sebelius in an effort to stave off steep Medicare fee cuts for routine office-based procedures such as nuclear stress tests and echocardiograms. The lawsuit, filed in U.S. District Court for the Southern District of Florida, charges that the government's planned cutbacks will deal a major blow to medical care in the USA, forcing thousands of cardiologists to shutter their offices, sell diagnostic equipment and work for hospitals, which charge more for the same procedures.”

Although “the issues raised in the lawsuit are not related to the health reform legislation being hammered out on Capitol Hill,  the dispute offers a revealing case study of the impact of payment reform on one specialty — cardiologists — and, ultimately, their patients.”

Considering the fact that heart disease is America’s biggest killer, this lawsuit should open the eyes of many Americans who think health care reform is going to bring better care and more access to citizens. Dealing with health related issues such as heart disease and other heart problems such as high cholesterol are extremely complex and complicated areas of medicine that require extensive and ongoing training. With all of the constant breakthroughs in pharmaceutical and medical devices to help patients with heart problems, cardiologists need more money, not less to stay up to date on new ways to save lives—literally hundreds of thousands.  A previous article in USA Today in fact showed that when it comes to cardiac care, More is better for Medicare patients.

According to Jack Lewin, CEO of the of Cardiology (ACC), which represents 90% of the roughly 40,000 heart specialists in the , Congress and HHS have “basically killed the private practice of cardiology." The slow decline of the private practice of cardiology “illustrates the vulnerability of the heart doctors, who over the past few decades have invested heavily in nuclear scanners and other costly tools of their trade only to discover that they may be too expensive to operate in an era of increasing restraint on medical costs.”

Lewin and other heart specialists met with Sebelius on December 8, 2009, and explained their concerns.

The problem now is that doctors are being punished for taking part in a system that “has long rewarded doctors for investing in technology,” according to Victor Fuchs, a professor of health economics at Stanford University. Mr. Fuchs believes that instead of reducing reimbursement rates for cardiologists, Congress needs to create “a reimbursement system that brings about a more rational use of these devices and a more rational investment in them."

As of January 1, 2010, medicare's new fee schedule cuts reimbursements for nuclear scans by about 40% according to the ACC. They also noted that fees for echocardiograms and other tests will shrink by about a third, with those cuts phased in over four years. On top of those cuts, in March, doctors also face an additional 21% cut due to an adjustment in the formula that limits the growth of Medicare spending for doctors' fees.

In an attempt to justify such cuts, Jonathan Blum, director of the government's Center for Medicare Management, said that “the agency is bound by law not to increase spending when making reimbursement decisions each year.”

Consequently, in order to not increase spending, the agency has to reduce payments to cardiologists in order to pay “the internists and family physicians — to boost payment rates for long "undervalued" primary care services.” Trying to bolster such a claim, Mr. Blum cited a “survey” that showed “cardiologists could absorb the payment cuts.” The heart specialists asserted in their lawsuit that this “was flawed and unrepresentative of their real costs.”

These cuts will especially impact heart attack patients in rural areas according to George Moutsatsos, a managing partner in Cardiology Consultants of Delaware, a group of 32 heart specialists that serves half of the heart patients in the state. He acknowledged that “the money doctors make for providing imaging services helps compensate them for their round-the-clock availability to treat heart attacks with balloon angioplasty.” Such compensation is critical in rural areas where cardiologists get “very little money to do the work,” areas where his group was going to “consider cutting.”

Scott Smith, a cardiologist who works in rural , added that because "The closest cardiologist to him was 150 miles away,” all of these cuts will “make it impossible for him to break even seeing 40 patients a day.”

With hundreds of thousands of baby boomers on the verge of retirement and being added into the Medicare system, along with millions more who are likely to enter our system through health care reform, can we really afford to be losing the private practice of cardiology? How can we pay cardiologists less when the advances we have seen over the past few decades have led to longer survival rates for heart attacks, more heart procedures, earlier detection of heart disease, and better recovery for heart patients?

Politicians and bureaucrats need to take a different approach at paying for medical care from physicians, especially specialists. The highly technical field of cardiology is rapidly changing and advances everyday are making this practice area critical for making patients healthier and live longer. In light of this lawsuit, hopefully discussions will begin on ways to continue giving cardiologist the payments they deserve.