ACC Testifies Before House Committee on the Future of Small and Solo Practices

For the second time in two weeks, the ACC headed to Capitol Hill on July 19 to testify before a Congressional committee. Jerry D. Kennett, MD, MACC, testified before the House Small Business Committee on the impacts of hospital and large practice integration on small and solo medical practices.

This was a vital opportunity for the College to share how a combination of factors has threatened private practice, resulting in as many as 70 percent of ACC’s physician members integrating with hospitals. Kennett shared how key drivers of this rapid evolution, including Medicare physician payment rates falling behind actual practice costs, direct cuts to Medicare physician reimbursement and increased administrative and regulatory burdens, have stifled options for physicians, steering them into the security of hospital integration. A 2010 American Medical Association (AMA) survey on the impact of short-term delays on Medicare physician payment provides insight into how dire the situation is. The AMA found that 60 percent of the Medicare physicians surveyed reported looking into opting out of Medicare and treating patients through the private contracting option, implications that would have a devastating impact on patient care and access.


"Private medical practices are vital in providing care to patients and at the same time are small businesses that need reliable payment systems to pay for office space, supplies, equipment and for salaries for the people they employ," said ACC President William Zoghbi, MD, FACC. "Small- and medium-sized practices are finding it increasingly difficult to survive in the current environment. Unpredictable and continued reduction in Medicare reimbursement, coupled with burdensome regulatory requirements have a direct negative impact on small physician practices."

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During the hearing, Kennett urged the Committee to avert the nearly 30 percent scheduled Medicare reimbursement cuts, repeal the sustainable growth rate (SGR) and provide stable payments for several years to allow the development of new delivery and payment models. On the topic of SGR, Kennett called the decade-long process and 15 Congressional interventions "a vicious cycle that creates uncertainty for physicians and their practices and threatens access to seniors."


Cardiology has been in the line of fire for payment reductions since 2007 when the Deficit Reduction Act of 2006 was implemented, reducing payment for advanced imaging services and Relative Value Unit cuts were made. Physician Practice Information Survey cuts, equipment utilization rate assumption increases and bundled payments followed. In July 2012, CMS proposed a 25 percent reduction of the technical component when one cardiovascular diagnostic service is provided by the same physician practice at the same session. Looking ahead, physicians will see penalties for failing to participate in the Physician Quality Reporting System and failing to e-prescribe and the Value-Based Payment Modifier program will begin in 2015.

"We believe a sustainable Medicare payment system should provide opportunities for physicians to care for patients in private practice as well as in an employed model," Zoghbi noted. "The ideal payment system should be sustainable and reward patient-centered care, quality and outcome, demonstrated through appropriate use."

The 2012 Legislative Conference will explore the key issues facing cardiology, including physician payment and the changing practice landscape. Attendees will also have an opportunity to meet directly with congressional leaders to share ways the cardiovascular community is navigating through rapidly changing environments and striving to provide quality, cost-effective, evidence-based care.

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