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Proposed cutbacks to Medicare may threaten rural cardiac centers
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New regulatory changes could close some rural diagnostic centers and force millions of patients to use hospitals for certain tests.
The Medicare reimbursement cardiologists receive for ordering certain diagnostic tests is scheduled to be cut beginning in January. The proposed cuts, which could reduce reimbursement for certain imaging and diagnostic tests by up to 40%, may force some centers to stop using certain diagnostic tools and instead refer patients to hospitals for the required tests. Patients using those services could then face long travel distances, higher out-of-pocket expenses up to five times as expensive as in-office co-pays and longer wait times for both access to testing and the return of test results.
“We currently provide cardiac services to nine remote clinics two to four times each month,” Joe Stevenson, MD, president of Sierra Nevada Cardiology Associates in Reno, Nev., said in a press release. “If these Medicare cuts go through, we will not be able to provide diagnostic ECG services on-site at those locations. That will mean our rural patients will have to drive up to 400 miles round trip to obtain these critical imaging tests. Some of them just won’t be able or willing to do that.”
Stevenson added that the hindered access to such tests could be detrimental to the condition and care of many patients.
“Since 50% of patients experience their first cardiac disease symptoms as [MI], the lack of access to diagnostic tests will put their lives at tremendous risk,” he said.
The Guarding Hearts Alliance, a partnership representing more than 23,000 cardiologists in the United States, met with lawmakers in Washington, D.C. on Oct. 13-14. Specifically, they expressed opposition to the restricted access to cardiac care that would be created by the implementation of new changes to Medicare reimbursement regulations. According to the press release, the Alliance also questioned the validity of the cited evidence underpinning the proposed changes, opposing what the group considered to be “questionable data gathered in 2006 via a statistically invalid survey that used data from only 55 cardiologists.” – by Eric Raible
The proposed cutbacks in Medicare reimbursement for outpatient echocardiograms, nuclear cardiology and other imaging were based on a very small and incomplete survey which did not convey true changes in practice expense. Many of the 55 respondents had no overhead at all and provided no services to outpatients, which is hardly an accurate way to measure practice expense. These proposed cuts will force many outpatient facilities to close and result in reduced access to care. This will hit especially hard in rural areas, where there are simply no alternative resources within reasonable distance. There will also be an increased wait for outpatient CV imaging services in hospital-based facilities whose first priority must be emergencies and inpatients. It is also unfortunate that these cuts pit physician against physician in a zero-sum game. Primary care physicians’ reimbursement will benefit from reduced payment for imaging. Cardiologists very much support improved pay for primary care physicians, but not at the expense of reduced echo and nuclear services. The American College of Cardiology, together with specialty imaging societies including ASE, ASNC and SCCT, have long supported aggressive approaches to ensuring that imaging is used appropriately and overutilization is reduced selectively, but not by reducing access to appropriate care using a blunt instrument of reducing payment for services to an untenable level.
– Samuel L. Wann, MD
Cardiology Today Section Editor