The American College of Cardiology (ACC) sues Medicare over physician rate cuts

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

The American College of Cardiology (ACC) has filed suit against U.S. Department of Health and Human Services Secretary Kathleen Sebelius charging that the 2010 Medicare Physician Fee Schedule was adopted unlawfully.

The American College of Cardiology (ACC) sues Medicare over physician rate cutsThe complaint seeks an injunction that will prevent the cuts — which the association claims used a flawed survey for determining reimbursement rate cuts — and will force HHS to conduct a new, more accurate survey.

“The process by which Medicare determined the reimbursement rates was deeply flawed,” Jack Lewin, MD, CEO of the ACC, said in a prepared statement. “As a result, the 2010 rule will levy cuts to cardiologist services by up to 40% and will deny critical cardiovascular care for millions of heart patients.”

Using data from the Physician Practice Information Survey (PPIS), CMS mandated 40% cuts in reimbursement for echocardiograms and 36% cuts in nuclear imaging.

Alfred Bove, MD, of Temple University, and president of the ACC, told MedPage Today that the organization pushed hard to get the 40% reduction in reimbursement for echocardiograms spread out over four years, for a 10% reduction per year.

But he said CMS wouldn’t budge on a 36% reduction for nuclear stress testing.

The cuts “would stop most physicians from doing the imaging in-office,” he said. “It would drive us well below cost.”

Bove added that the cuts would also result in staff layoffs at smaller practices and would further encourage cardiologists to close private practices and seek hospital employment — a trend Bove said has already been taking shape.

In a press release, the ACC said the Physician Practice Information Survey (PPIS) on which the 2010 payment rates were based gathered data from only 55 cardiologists — too small a number to be representative of cardiology practices across the nation.

The organization also charged that a consultant group hired by HHS to review comments on the proposed rule said the data were “counter to all other recognized cost measures.”

Supplemental survey data provided by specialty physician groups was “more representative of the true cardiology practice than the PPIS data,” the ACC charged.

Bove said the PPIS survey found that cardiologists’ costs have declined over the last five years, while other surveys show a 4% to 5% increase.

He said the majority of the 55 practices included in the survey may have been hospital-based practices where overhead was paid by the hospital.

A spokesperson for CMS told MedPage Today that the agency “can’t comment on the suit, but strongly believes that the 2010 physician payment rule ensures that Medicare beneficiaries continue to have access to the services provided by all physicians and that those physicians are paid appropriately.”

The spokesperson added that the rule “was adopted after opportunity was provided for public comment, including from affected medical specialties.”

Whether the ACC is granted its request for an injunction immediately or not, the new rates won’t go into effect as they’re supposed to on Jan. 1 because payment cuts have been put on hold in anticipation of a fix once the House and the Senate meld their versions of healthcare reform legislation.

The complaint was filed in the U.S. District Court for the Southern District of Florida. Co-plaintiffs include the Florida Chapter of the ACC, the Association of Black Cardiologists, and the Cardiology Advocacy Alliance.

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