Proposed Medicare Changes Will Increase Costs to Government

I read this in the Nashville Business Journal recently, and I suspect that mainstream media is hiding this on the last page of any article that they may write.

Changes proposed by the Centers for Medicare and Medicaid Services (CMS) - scheduled to become law January 1, 2010 - will dramatically impact the accessibility of life-saving cardiology testing and services currently available in cardiology practices. If enacted, cardiologists will be unable to continue offering necessary diagnostic tests in their offices, such as cardiac catheterization and peripheral vascular, forcing patients to seek outpatient care at hospital facilities.  

Invasive outpatient cardiology services offered in non-hospital settings were first introduced more than 30 years ago. Since that time, the cardiology community has facilitated measurable advances in cardiovascular technology and outcomes. As access to cutting-edge diagnostic and therapeutic services in non-hospital clinical settings (such as cardiology practices) has increased, patient mortality rates have consistently decreased. The availability of these services outside of the hospital environment saves Medicare tens of millions of dollars each year, and results in much lower out-of-pocket costs for patients as well.

In a sweeping measure that would reverse a four-decade trend of increasing access to cost-effective, non-hospital care, the CMS-proposed changes will reduce reimbursement for select cardiac services offered outside of a hospital-owned facility by as much as 60 percent. The draconian cuts will likely make it impossible for cardiology practices to continue providing these services to Medicare patients. 

In a measure that seems counter-productive to healthcare reform, the proposed changes will greatly increase hard costs to Medicare, as the reimbursement rate to hospitals for the same services provided in cardiology practices is much, much greater. If all outpatient catheterization cases currently provided in physician offices in the course of a year are driven into hospitals, costs to the Medicare program in 2010 will increase by at least $86 million. Medicare patients will personally experience the increase: the out-of-pocket cost for a catheterization performed in an outpatient hospital setting is $583.50 more than when the same procedure is performed in a cardiology practice. 

"Physicians across the country are extremely concerned that a lack of timely access to cardiologists and office-based services will reverse the historic improvements in cardiac patient outcomes that have been achieved in recent years," explained Steve Blades, president of Cardiovascular Outpatient Center Alliance (COCA), a non-profit organization representing more than 60 outpatient cardiac catheterization centers across the nation. "Decreased access and delay in treatment, compounded by an influx of patients to hospital-based cardiac centers, is expected to lead to an increase in cardiac admissions to hospitals for needs that should have been addressed in an outpatient environment." 

Concern in the medical community - among both physicians and patients - has led thousands to reach out to elected officials in an effort to stop the enactment of the CMS proposal. 

"These proposed changes represent a lose / lose proposition in healthcare at a time when our country desperately needs more win / win options on the table," said U.S. Congressman Parker Griffith (D-AL). "It is completely illogical to take a measure that will increase patient costs, increase government costs and decrease access to care - which is why so many are speaking up." 

COCA, along with the American College of Cardiology and the Cardiology Advocacy Alliance, encourages physicians, patients and concerned citizens to learn more about the proposal and contact their elected officials. Additional information can be found at www.guardingheartsalliance.org.