Feature | July 16, 2012

ACC, ACR Scorn Proposed Medicare Physician Fee Schedule

July 16, 2012 — The American College of Cardiology (ACC) and the American College of Radiology (ACR) are warning that the extreme cuts to funding for medical imaging scans in the 2013 Medicare Physician Fee Schedule Proposed Rule are unnecessary, unfounded and will undermine patient care.

The proposed rule calls for an expansion of the multiple procedure payment reductions for interpretation of scans performed on the same patient, in the same session on the same day, to all providers in the same practice or hospital. The Centers for Medicare and Medicaid (CMS) expanded both the number of physicians affected by this policy and the number of exams. ACR issued a statement explaining there is no publicly available evidence to support a 25 percent reduction to physician interpretation payments in general. A 2011 study proves that any efficiencies in the multiple procedure setting are highly variable and, at most, total one-fifth of what CMS contends. No efficiencies in care support a funding cut when different physicians in a group practice interpret separate imaging scans for the same patient, ACR stated.

“The proposed Medicare physician fee schedule rule undeniably has negative consequences for physicians and their patients," said ACC President William Zoghbi, M.D., FACC. "In addition to the mandated 27 percent sustainable growth rate (SGR) cut, CMS proposes an additional 3 percent reduction for cardiovascular services.

“Part of these cuts result from a misguided policy that will reduce payment if more than one diagnostic cardiovascular service is provided on the same day. This policy disadvantages physicians who aim for efficiency and reduces payments based on a misguided understanding of how different services, such as echocardiography and SPECT imaging, are from one another.  Furthermore, it would lead to a major inconvenience to patients. We aim to demonstrate to CMS why this proposal would not be beneficial.   

“Congress has until the end of 2013 to come up with a solution to the flawed SGR payment formula and to prevent next year’s SGR-based cut, currently estimated at 27 percent, from taking effect. The need to fix SGR continues to be a top priority in the United States.

“With the Accountable Care Act (ACA) ruling behind us, it's time to continue down the path to healthcare reform. The American College of Cardiology’s goal is a sustainable system that rewards quality and focuses on patient-centered care.  While this rule takes steps in that direction, it is undermined by old ways of cutting payments without improving quality.”

The ACR also issued a strongly worded statement about the cuts.

“These cuts affect primarily those suffering from multiple trauma or heart attacks, stroke patients and those with widespread cancer — all of whom often require multiple imaging scans to survive," said Paul Ellenbogen, M.D., FACR, chair of the American College of Radiology Board of Chancellors. "Interpretation of these scans often requires expertise of different physicians. These are not screening exams for otherwise healthy people. They are for people with immediately life-threatening illnesses or injuries. These cuts discourage doctors from working as a team and pull the rug out from under the very physicians working to save these people’s lives."

For more information: www.cardiosource.org/ACC

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Image courtesy of Boston Scientific

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