This is actually not a maybe but a reality from what I have heard from cardiologists in the southern California area. They are already thinking and putting mental and maybe other plans in place if this comes about. As you see from below, the Medicare payment structure pays more for their services in the hospital versus being an outpatient.
From a recent post Nov. 2009:
“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. If CMS is using the survey from the AMA and there was such a small return and this is the basis for the cut, I guess it would appear be sure and answer their surveys? They may have had better luck on Sermo for a matter like this.
This is hard to believe and all it will do is create a shortage in cardiology. If you have ever had heart problems and need help, you don’t want these folks to go away and only be available only at the hospital as the care will not be the same. As the article states, those on Medicare will have to check into the hospital to be seen, where they have coverage. Perhaps things will change around here as they did this week for radiation oncologists, which were also facing a big cut, and that has now been reversed to a small cut of 1% a year for a total of 5%. Also, the respondents of the survey had a large number of are already hospital based.”
This is indeed interesting to see how many ways they want to cut the pie and also we need to keep in mind that technology will be adding cost here too, so it goes with the territory of needing reform and getting it funded. Nobody is going to hit the nail on the head. Cardiologists need to keep up with technology too and that is another cost factor. BD
Since the Centers for Medicare & Medicaid Services (CMS) issued its 2010 physician fee final rule last week with cuts to cardiology practices averaging 27 percent, the American College of Cardiology (ACC) has expressed adamant opposition, and its CEO, Jack Lewin, MD, said that this will cause the shuttering of practices. However, former CMS Administrator Thomas A. Scully explained how the agency is limited by finite funding and growing pressures to fund other areas of healthcare.
The first area of contention is how CMS arrived at this final rule. The ACC strongly disagrees with the data that CMS used to calculate practice expenses and justify its cuts.
CMS is under “tremendous pressure” both from Congress and the public to re-allocate funds to primary care physicians and basic preventive services, Scully said. “As a result, all the specialties are going to get trimmed back. The general problem is the increasing volume, so the payment per service is going to continue to decrease, especially under the current system where the government sets prices," he said.
“When spending goes up, the RB/RVS system makes cuts, because the budget is finite. The sandbox is not getting any bigger,” Scully said.
Lewin concurred that CMS is “stuck with the current formulas” and noted that this is another reason that healthcare reform is needed.
This lack of practice sustainability will lead cardiologists, according to Lewin, to become “employees of hospitals, causing the closure of individual and group cardiology practices.” Acknowledging that cardiologists have already begun to move in that direction due to previous cuts, he explained that cardiologists receive better reimbursements, and Medicare pays two to four times more for the same tests in a hospital setting.
He cautioned, however, that hospitals will not be able to accommodate this shift, especially as costs increase two to four times.