The past several weeks have been frustrating for any physician in the United States, and perhaps even worse for cardiologists trying to run small businesses. Congressional gridlock is at its best as the debate over the sustainable growth rate (SGR) continues. The so-called “patch” keeps getting smaller and smaller and, as of right now, it looks like it will be Groundhog Day all over again come November.

As things currently stand, the Senate last Friday passed a six-month patch that would give doctors a 2.2 percent payment update through November. The agreement is now before the House, which could vote as early as tomorrow.

The ACC’s Legislative Conference in September will definitely be interesting if nothing is done before November to find a longer-term solution. The continued state of limbo is making it difficult for practices already struggling with reduced payments. You can’t plan for the future when the “future” changes every 30 days. To make matters worse, the 2011 Proposed Medicare Physician Fee Schedule is expected out later this month and, while we don’t know all that’s included, we do know the second year of the phased-in practice expense cuts will hit cardiovascular practices. There will also be additional SGR cuts.

I think it will be critical to use our face-to-face time with members of Congress to educate them about the current state of cardiology and what needs to be done in terms of payment reform and health reform implementation. We must also use this time to have a frank discussion about the value of cardiology as a specialty. We come to Congress as an association of cardiovascular professionals. We can proudly point to innovations that have led to meaningful reductions in cardiovascular death and disability. We also remain committed to the appropriate and safe use of imaging, the reduction of readmission rates and the prevention of cardiovascular disease.

In the meantime, it’s important to note that CMS as of June 18 is processing June claims at rates that reflect the 21.3 percent SGR cut. If the House and Senate act to avert the cut, claims will be processed as follows: (1) where the submitted charge is higher than the new rate, the contractor will automatically reprocess the claim; and (2) if the submitted charge is lower than the new rate, the physician should call the contractor. According to the AMA, no one is going to be reviewing the limiting charge for the period that the cut was in place because CMS assumes Congress will ultimately make the fix retroactive.

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