Proposed Medicare Paycuts Threaten Cardiology And Other Vascular Specialties

As Healthcare Reform legislation awaits approval, CMS cuts loom large over cardiology and other vascular specialties. No tort reform in the legislation and impending cuts suggests more of the same for physicians.

CMS Proposes Major Payment Cuts for Cardiology

The Centers for Medicare and Medicaid Services (CMS) today released its proposed 2010 Medicare Physician Fee Schedule, which includes policy proposals that would significantly reduce payments for cardiovascular-related services. CMS projects that the proposed changes would reduce total Medicare payments to cardiology by 11 percent. The projected payment cut would result from the following policy proposals:

Practice Expense: CMS has proposed incorporating the results of the American Medical Association’s Physician Practice Information Survey into its formula for calculating practice expense relative value units (RVUs). If implemented, this proposal alone would decrease total Medicare payments to cardiology by 10 percent. However, with the exception of evaluation and management services, nearly all services that cardiologists perform would see cuts ranging from 10 percent to more than 40 percent for individual services. A few key examples:

  • Transthoracic echo with spectral and color flow Doppler (93306): 42 percent cut
  • Left heart catheterization (93510-26): 24 percent cut
  • EKG: 21 percent cut
  • Level 4 established patient office visit (99214): 11 percent increase

Equipment utilization: CMS proposes adopting the Medicare Payment Advisory Commission’s (MedPAC) recommendation to change the agency’s formula for calculating the per-procedure cost of medical equipment worth more than $1 million. The proposal would assume that all equipment with an acquisition cost greater than $1 million is used 90 percent of the time an office is open, thus driving down the practice expense RVUs for services using that equipment. Within cardiology, cardiac MR, cardiac CT, and non-hospital cardiac catheterization services would see payment cuts as a result of this change.

Malpractice: CMS proposes to update the malpractice RVUs with data from a new survey of specialty-level malpractice premiums. In addition, CMS has proposed a new method for determining malpractice RVUs for technical component services. The proposed new malpractice RVUs would reduce cardiology payments by 1 percent.