Heart Rhythm Professionals Face Major Cuts Under Medicare Final Rule for 2010
Dear Heart Rhythm Society Members:
On October 30, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2010 Medicare Physician Fee Schedule, which includes policy decisions that will significantly reduce payments for heart rhythm services. Hopefully, you have been following the Society’s work with CMS and Congress to advocate against the payment policy changes finalized in the rule.
Practice Expense Changes
Under the final rule CMS will implement data from the American Medical Association’s Physician Practice Information Survey (PPIS) over a four-year period to update the practice expense per hour (PE/HR) rate used to calculate inputs for cardiology services. Despite our extensive advocacy efforts to prevent use of the data, CMS decided to use these data, but agreed to transition implementation of the data over a four-year period, which will lessen the severity of payment cuts for 2010.
This action must not understate the impact of the cuts for 2010 and beyond. If the data is fully transitioned to 2013, and Congress does not act to abate the 21.2 percent negative update under the sustainable growth rate (SGR) formula scheduled to take effect on January 1, 2010, the outcome could result in a staggering 20 to 40 percent reduction in practice expense for some electrophysiology services. Payment cuts this steep could also result in transfer of certain services currently performed in a physician’s office to the more expensive facility setting. Or worse, some private practices may be forced to shift to hospital ownership.
Consultation Service Changes
Also of great concern under the final rule is CMS’ decision to discontinue payment for in office and initial hospital inpatient consultation services. This action will force heart rhythm professionals to use office and hospital Evaluation and Management codes to report the intensity and medical decision making required to diagnosis complex cardiac rhythm and electrical abnormalities. Specialty providers, such as heart rhythm professionals, who provide a disproportionate share of specialized consultative services will experience a significant decrease in their reimbursement due to the elimination of consultation codes.
The Society Continues Advocacy Work
We have been tracking these issues closely and advocating on your behalf. Earlier this year, at the request of the Society and other cardiovascular groups, U.S. House Representatives Mike Rogers (R-MI) and Charles Gonzalez (D-TX) circulated a “Dear Colleague” letter (PDF,128K), asking members of Congress to support their concerns expressed to the Secretary of Health and Human Services, Kathleen Sebelius regarding the severity of payment cuts to cardiology services. The Society followed up our concerns with use of the PPIS data in a face-to-face meeting with CMS.
How Can You Help?
In light of the recent decisions by CMS to implement the PPIS data and other policy changes that negatively impact patient access to care, I would like to reaffirm the position of the Heart Rhythm Society regarding our fight to save electrophysiology practices and allow timely access to quality care. While we will continue to work with the American College of Cardiology and other cardiovascular groups to take our message of opposition to Capitol Hill, the Obama Administration and CMS, the Heart Rhythm Society is the only medical society that advocates exclusively on behalf of you, the heart rhythm professionals. We will keep you informed of these activities and will continue to analyze the impact of the final rule. Many of you have participated in HRS-led efforts to bring sound and fair reason back to these issues, and have participated in our grass-roots efforts. If you have already participated, thank you. If you have not yet added your voice to our efforts, please consider engaging with our Society by:
Sincerely,
Richard L. Page, MD, FHRS,
President
Heart Rhythm Society
