CMS Proposes Major Payment Cuts
for Cardiology
The Centers for Medicare and Medicaid Services (CMS) today released its
proposed 2010 Medicare Physician Fee Schedule, which includes policy proposals
that would significantly reduce payments for cardiovascular-related services.
CMS projects that the proposed changes would reduce total Medicare payments
to cardiology by 11 percent. The projected payment cut would result from
the following policy proposals:
Practice Expense: CMS has proposed incorporating the
results of the American Medical Association’s Physician Practice
Information Survey into its formula for calculating practice expense relative
value units (RVUs). If implemented, this proposal alone would decrease
total Medicare payments to cardiology by 10 percent. However, with the
exception of evaluation and management services, nearly all services that
cardiologists perform would see cuts ranging from 10 percent to more than
40 percent for individual services. A few key examples:
- Transthoracic echo with spectral and color flow Doppler (93306): 42
percent cut
- Left heart catheterization (93510-26): 24 percent cut
- EKG: 21 percent cut
- Level 4 established patient office visit (99214): 11 percent increase
Equipment utilization: CMS proposes adopting the Medicare
Payment Advisory Commission’s (MedPAC) recommendation to change
the agency’s formula for calculating the per-procedure cost of medical
equipment worth more than $1 million. The proposal would assume that all
equipment with an acquisition cost greater than $1 million is used 90
percent of the time an office is open, thus driving down the practice
expense RVUs for services using that equipment. Within cardiology, cardiac
MR, cardiac CT, and non-hospital cardiac catheterization services would
see payment cuts as a result of this change.
Malpractice: CMS proposes to update the malpractice RVUs
with data from a new survey of specialty-level malpractice premiums. In
addition, CMS has proposed a new method for determining malpractice RVUs
for technical component services. The proposed new malpractice RVUs would
reduce cardiology payments by 1 percent.
Consultations: CMS has also proposed eliminating payments
for consultations provided in office and hospital settings. The RVUs assigned
to these codes would be redistributed to office and hospital visits and,
if implemented as proposed, services now billed as consultations would
be billed as hospital or office visits. This would reduce payments to
varying degrees for consultation services.
SGR: As required by current law, the proposed rule includes
a 21.5 percent reduction in Medicare Physician Payment as of Jan. 1, 2010.
This cut would be in addition to the payment reductions
that result from the proposed policy changes described above. In short,
there could be as high as a 30 percent cut in Medicare payments
for cardiology.
Taken together with the payment cuts cardiology has already experienced,
CMS’ proposed rule represents a grave threat to cardiology practices
and the patients they serve. The ACC and our partners across the cardiology
community are prepared to wage an aggressive campaign to prevent implementation
of these damaging policies. We will need your help to mobilize opposition
to the proposed cuts, and will be in touch shortly. More information over
the coming weeks will be provided in Cardiology magazine, ACC
News and The ACC Advocate.
In addition, as health care reform legislation continues to wind its
way through Congress, the ACC urges its members to contact their lawmakers
and ask them to prevent these payment policies that will result in devastating
cuts. You can reach your members using the ACC’s toll-free grassroots
hotline (800-210-7193) or by going to www.acc.org/can.
As this proposed rule so clearly shows, fundamental payment reform as
part of any overarching system change is absolutely necessary.
For questions, please contact advocacydiv@acc.org.
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