Outpatient cath lab cuts could mean closures, higher patient payments

With cuts, reimbursement would be hundreds of dollars below procedure costs.

Under proposed changes from The Centers for Medicare and Medicaid Services, reimbursement for cardiac catheterization procedures performed in nonhospital outpatient labs would be reduced by 47% by 2010.

In response, members of the Cardiovascular Outpatient Center Alliance (COCA) have met with members of Congress to ask them to intervene and request CMS set fair and reasonable reimbursement consistent with the cost of the procedure.

“We just want a level playing field. If everything’s being cut, we want to be at the level where we’re cut with it, not where we’re put out of business,” Steve Blades, president of the COCA, told Cardiology Today.

According to Blades, the federal government would incur $40 to $50 million in increased costs, “defeating the very purpose of these reductions.”

Cuts would hurt

Based on published 2008 Medicare reimbursement numbers, patient copayments also would increase by $500 – or 157% - while access to catheterization services would be diminished, according to a COCA press release. Medicare beneficiaries currently pay $326 for a catheterization procedure performed in a nonhospital lab, while out-of-pocket costs for the same procedure in a hospital outpatient lab total $839.

Once fully implemented, nonhospital cath labs would receive reimbursements several hundred dollars below the cost of performing the procedure, Blades said. Because private insurers typically follow CMS’s lead, the cuts could create a dangerous domino effect that would reduce reimbursements from all payor sources, driving many nonhospital labs out of business, according to the COCA.

Patients may encounter longer waits if they get cath lab procedures done in a hospital vs. a freestanding lab, because hospitals focus on urgent patient care.

The effect on clinicians, Blades said, is “there’s a tremendous drop in efficiency, and also an economic impact not only on them but on the staff.” Staff used to working with a specific clinician will be absorbed into hospital staff and have to adjust to working in a different environment.

“Bottom line is … the real issues are access and cost,” Blades said. – by Judith Rusk

This is terribly concerning. Such a policy will definitely impact the way outpatient cath labs function and serve the public, because what we are able to do is expedite catheterizations and turn patients around so they don’t have to come into the hospital. That has always been the kind of thing that’s been good for patient care and patient satisfaction. We certainly hope that in the long run CMS would reevaluate whether this is in the best interest – not necessarily of hospitals or physician reimbursement – but patient satisfaction and patient care.

–Peter C. Block, MD

Cardiology Today Section Editor