Society Meets with CMS on Medicare Consultation Services

The Heart Rhythm Society has been working on regulatory and legislative strategies to address the elimination of the Medicare Consultation Services (as described in the 2010 Medicare Physician Fee Schedule Final Rule).

Regulatory Track
On Wednesday December 16, the Society’s leadership met with officials from the Centers for Medicare and Medicaid services (CMS) to discuss our concerns with the elimination of the consultation codes scheduled to go into effect on January 1, 2010. During the meeting, Richard Page MD (President, Heart Rhythm Society), Richard Fogel, MD (Chair, Health Policy Committee), Kevin Wheelan, MD (Chair, Reimbursement and Regulatory Affairs Subcommittee), and George Carayannopoulos, MD (Member, Reimbursement and Regulatory Affairs Subcommittee) explained that electrophysiologists are in a unique position because a large percentage of our services are consultative. The Society’s leadership presented the results of an independent claims data analysis.

According to this analysis:

• Consultation codes comprise a higher percentage of overall billings for electrophysiologists than for cardiologists and all other specialties
• Patterns of Evaluation and Management (E/M) billings by both electrophysiologists and cardiologists differ significantly from those published in cross-walks by CMS
• Elimination of consultation codes will result in a 34 percent decrease in reimbursement for electrophysiologists

The Society believes that elimination of consultation services will no longer recognize the cognitive work of specialists and undervalues the nature of the professional input and advice that is being sought by the referring physician. The Society’s leadership also explained that because this 34 percent decrease in reimbursement is also compounded with other Medicare cuts to cardiology (e.g., practice expense cuts, equipment utilization rate change, etc), our members will likely need to consider business adjustments to their practices. As a result, the policy change will impair access to specialty level care for patients in need of critical cardiac rhythm management services.

At the conclusion of the meeting, the Society requested that CMS refrain from implementing the provision to eliminate consultation codes as set forth in the 2010 Physician Fee Schedule Final Rule. We asked CMS to evaluate the potential disruption in patient care, the administrative burden on Medicare carriers and other third-party payers, as well as the economic impact of eliminating consultation services. The Society will follow-up with CMS staff on this request.

The Society also sent a letter (PDF, 123K) to the Secretary of Health and Human Services Department, which oversees CMS, asking her to refrain from implementing elimination of the consultation codes.

Legislative Track
Senator Arlen Specter (D-PA) filed Amendment No. 3163 to the health care reform legislation to delay implementation of consultation services changes for one year. In addition, the amendment would require the creation of a coding structure which adequately accounts for consultation services.

Regrettably, this amendment was not included in the final health care reform package voted on by the Senate this week. Staff of Senate Finance Committee chair Max Baucus (D-MT) has indicated a willingness to negotiate adding this amendment when the Senate conferences with the House to agree on the final version of health care reform legislation early in January 2010.