CMS reimbursement cuts ensure that American cardiology is a "dead man walking"

At midnight on December 31, 2009, the practice of American cardiology as we know it will cease to exist. It is sentenced to execution by lethal reimbursement cuts that will dismantle every single cardiology practice in this country. In keeping with traditional execution, this lethal injection will consist of three separate entities. Instead of sodium thiopental, pancuronium bromide and potassium chloride, the abolition of hospital consult codes, a reduction in pay for nuclear studies, and shrinking pay for echocardiography should effectively take us to asystole. Most noncardiologists "get it," but this one is for you, CMS, which obviously doesn't.

Offenders are allowed a final statement, so I'm taking full advantage of it. Here is mine: Cutting reimbursement by 50% for hospital consults by abolishing the 53, 54, and 55 series will effectively cause me to terminate employment of some of my office staff. If anyone who regularly complains about their lack of reimbursement and our salaries being too high is thinking this will put us in our places, consider how much longer it will take to get a patient seen when we have no nurse practitioner in the office. Reducing nuclear reimbursement by 34% will cause bonuses counted on by growing families to be abolished. Cutting echo reimbursement by 14% will cause me to choose a less effective health insurance plan with a much higher deductible for my employees. Only catastrophic illness will be covered. Fewer opportunities for building expansion, equipment upkeep, and maintenance will be available.

Because of less revenue, patients who already wait days to weeks to be seen will be forced to wait longer for an appointment due to fewer ancillary staff. My staff of 13 full-time and 2 part-time employees will work harder for less pay and fewer benefits. My senior partner of 20 years, who has only spoken of retirement a few times, is now disillusioned beyond belief, because he is devalued more at this point in his career than at any other and remains at the same risk of malpractice. In other words, 40 000-plus patients are in danger of being covered by two instead of three cardiologists. My other partner, an excellent technical gadget guru who isn't the most efficient human being I've ever met when it comes to record keeping and billing, will sink further into the quagmire with even less reimbursement for what he does keep up with.

The same criticisms about the death penalty for criminals holds true for the death penalty for American cardiology:
1. It will discriminate against the poor, who in many practices will be turned away. I've made the statement that I'd rather be dead than turn away someone with inability to pay. I might as well make the funeral arrangements now.
2. It condemns the innocent to die; not only can patients die, which is the worst scenario, practices will as well. Cardiologists who work hard, pay their bills, pay their taxes, adhere to rigid guidelines for billing, and do an honest day's work will be at the same risk of reducing their practice size and seeing fewer patients right along with the criminals who have regularly cheated on billing.
3. The death penalty is not a deterrent to crime; changing reimbursement is not going to keeping cheaters from cheating. It will just encourage them to cheat more so they can make up the difference. It also won't drive any personal responsibility into the mix, a glaring omission in every single attempt at healthcare reform of any type.
4. The death penalty is biased. Well, I need another paragraph for that one.

Cardiologists are the grease that drive hospital machinery on an hourly basis. Why select our subspecialty for penalty? What other subspecialty competes in comparison for the length of time and investment it took to train us or the after-hours work that is required to complete a day? Imagine a day without us. No more "Discharge Mr Jones if OK with cardiology" orders. No more "Please see Mrs Smith ASAP to 'clear' her for surgery for gallstones she's had for eight years. No more "We're waiting on cardiology" for anything other than STs up. No more "waiting on cardiology," period. We'll be in the office. We can't afford to come to the hospital anymore. Think about it.

I'll bet that smile is fading, just a little bit right about now. Maybe I'll lash out like a common criminal as the drips start to run. The light is glaring down as I lie on the table. I sense a bad taste in my mouth and a sensation of "cold" in the back of my throat. As my pulse starts to slow, I raise my head and glare at you behind the glass: "CMS . . . I hope you are happy."

See also:

CMS set to cut Medicare physician fees for cardiovascular imaging

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