Everybody has a budget. Your family does, my practice does, your state has a budget, the ACC has a budget... and so does the country (at least some of the time). This week the president released his 2014 budget and I thought you might like to see some of the proposed provisions that impact cardiology and the practice of medicine as a whole.

Interestingly, there is an assumption that Medicare payments to physicians will not be reduced by the mandated Sustainable Growth Rate (SGR) formula.  This formula is scheduled to cut payments to physicians by 25 percent in 2014, but previous scheduled cuts have been overridden by short-term Congressional action. Perhaps it’s time to just fix it already!

There is also a proposal to reduce payments for the so-called “indirect” costs of graduate medical education (GME) by 10 percent starting in 2014, at a savings of more than $10 billion over 10 years. This is an increasingly important topic that the ACC’s legislative team is following closely.

While it’s important to note that this budget proposal is likely to be dead on arrival given the divided Congress and president, imaging is another area that “we” (the collective ACC) will also be keeping close tabs on this year. The budget proposal includes a provision to mandate prior authorization of advanced imaging (CT, MR, nuclear), as well as a proposal to limit the availability of the in-office ancillary services exception so that advanced imaging services (CT, MR, nuclear) could not be provided if ordered by a physician in that office. (The budget proposal does indicate that the exception could still be available if certain undefined accountability standards are met. But….)

On the brighter side, the budget proposal does contain provisions to increase funding for the FDA, partially by taking advantage of user fee programs authorized last year, previously existing programs for prescription drugs and medical devices, along with the new programs for biosimilars and generic drugs. Also $534 million in user fees are aimed at decreasing use of tobacco products. The National Institutes of Health also gets a small 1.5 percent bump from 2012 levels, for a total of $31 billion. The administration also includes funding for continued investment in health IT implementation and electronic information exchanges, given that current funds from the American Recovery and Reinvestment Act are beginning to expire.

Other proposals include a provision to lower the target growth rate for the Independent Payment Advisory Board so that the board could take binding action even with lower cost growth in health care.  Target growth rate would reduce to GDP plus 0.5 percent.  The IPAB, a major feature of the ACA, has yet to be formed. The budget would also extend funding for a consensus-based entity (likely the National Quality Forum) to focus on performance measures and quality improvement.  Current government funding for NQF expires at the end of 2014.

As I mentioned before, many of the items contained in the budget are unlikely to come to fruition due to the divided Congress and president. However the proposal provides a glimpse at administration priorities for next year. Perhaps we should all make sure to save the date for ACC’s Legislative Conference this September!

< Back to Listings