American College of Cardiology

2008 Medicare Physician Fee Schedule Poses Regulatory Challenges for CV Specialists

The Final Rule for the 2008 Medicare Physician Fee Schedule outlines a challenging regulatory environment for cardiovascular specialists over the next several years. Regulatory policies announced in the rule will significantly affect payment and operations for cardiology practices in 2008 and years to come.

Specifically in 2008, Cardiology practices should expect to see a decrease in Medicare revenues of at least 12 percent, depending on the mix of services provided. Some practices, especially those that derive a large share of revenue from in-office imaging services and those that provide cardiac catheterization procedures outside the hospital setting, face larger cuts.

The overall trend in payment for many key cardiovascular services is expected to continue to decline through 2010, even if projected cuts in the Medicare conversion factor are prevented. (Click here, to view a table showing national average Medicare payments between 2006 and 2010 for a selection of services cardiovascular specialists frequently provide for Medicare beneficiaries.) To view or download the full set of RVUs for 2008, click here. You can also look up payment amounts for specific procedures by clicking here.

The Medicare payment cuts for cardiology stem primarily from four policies:

1. The second year of the transition to new practice expense relative value units (RVUs) reduces payments for many cardiovascular imaging services. The new formula, however, does benefit other procedures critical to the care of Medicare patients with heart disease, such as interventional procedures, electrophysiology services, and evaluation and management services.
2. Additional increases in work RVUs for some services, specifically anesthesia and a few others, mean that CMS must increase the across the board reduction in work RVUs to maintain budget neutrality. This policy falls most heavily on services with high work RVUs (ie. angioplasty/stent placement and ICD and pacemaker implantation).
3. The Deficit Reduction Act (DRA) cap on Medicare payments for in-office imaging services will again limit reimbursement for some imaging procedures performed by cardiovascular specialists, most notably vascular imaging studies, cardiac CT and cardiac MR. The overall impact of the DRA cap for cardiology is smaller than in 2007, because payment for SPECT myocardial perfusion imaging studies will no longer be affected.
4. The flawed SGR formula will impose a 10.1 percent cut on all Medicare payments made under the physician fee schedule unless Congress intervenes. Visit www.acc.org/can to find out what you can do to help stop the cuts.

The Final Rule also includes a new rule prohibition regarding marking-up of charges for the professional and technical components of certain diagnostic tests ordered by the billing physician if the test is either purchased outright or performed outside the office where the physician practice performs “substantially the full range of its services…” The cardiology community is deeply concerned about the far-reaching effects of this anti-markup rule. Learn more about ACC’s response to the anti-markup rule and access resources to assist cardiology practices in assessing the impact of the Final Rule at: http://www.acc.org/advocacy/advoc_issues/rc_medicare.htm.