By Steve Sternberg, USA TODAY

Heart specialists on Monday filed suit against Secretary of Health and Human Services Kathleen Sebelius in an effort to stave off steep Medicare fee cuts for routine office-based procedures such as nuclear stress tests and echocardiograms.

The lawsuit, filed in U.S. District Court for the Southern District of Florida, charges that the government's planned cutbacks will deal a major blow to medical care in the USA, forcing thousands of cardiologists to shutter their offices, sell diagnostic equipment and work for hospitals, which charge more for the same procedures.

"What they've done is basically killed the private practice of cardiology," says Jack Lewin, CEO of the American College of Cardiology (ACC), which represents 90% of the roughly 40,000 heart specialists in the USA.

The issues raised in the lawsuit are not related to the health reform legislation being hammered out on Capitol Hill. But the dispute offers a revealing case study of the impact of payment reform on one specialty — cardiologists — and, ultimately, their patients.

It also illustrates the vulnerability of the heart doctors, who over the past few decades have invested heavily in nuclear scanners and other costly tools of their trade only to discover that they may be too expensive to operate in an era of increasing restraint on medical costs.

Victor Fuchs, a professor of health economics at Stanford University, says the outcry among cardiologists should come as no surprise in a system that has long rewarded doctors for investing in technology.

"What you really need is a reimbursement system that brings about a more rational use of these devices and a more rational investment in them," he says. "That's never going to happen without a lot more pain and suffering on the part of the people who are affected by the shift."

Medicare's new fee schedule would cut reimbursements for nuclear scans by about 40% as of Jan. 1, according to the ACC. Fees for echocardiograms and other tests will shrink by about a third, with those cuts phased in over four years. In March, doctors also face an additional 21% cut due to an adjustment in the formula that limits the growth of Medicare spending for doctors' fees.

Jonathan Blum, director of the government's Center for Medicare Management, says the agency is bound by law not to increase spending when making reimbursement decisions each year. That means the agency must rob Peter to pay Paul — or the cardiologists to pay the internists and family physicians — to boost payment rates for long "undervalued" primary care services, Blum says.

He says the agency relied on a survey showing that the cardiologists can absorb the payment cuts. The lawsuit claims the survey was flawed and unrepresentative of their real costs.

George Moutsatsos, a managing partner in Cardiology Consultants of Delaware, a group of 32 heart specialists that serves half of the heart patients in the state, says heart attack patients in rural areas are likely to suffer.

Moutsatsos says the money doctors make for providing imaging services helps compensate them for their round-the-clock availability to treat heart attacks with balloon angioplasty.

"In rural areas, we get very little money to do this work," he says. "Those are the areas where we're going to consider cutting."

Scott Smith, (my doctor) a cardiologist who works in rural Silver City, N.M., not far from the Mexican border, says, "The closest cardiologist to me is 150 miles away. With all these cuts coming, it will make it impossible for me to break even seeing 40 patients a day.

"It's so absurd, it's kind of funny," he says. "I know ACC doesn't think it's funny. It's an efficient way of getting rid of cardiology."

Lewin and other heart specialists met with Sebelius on Dec. 8 and explained their concerns. "I thought she was very empathic," he says, but Sebelius has yet to take action.

 

 

This raises the question of how do we deal with the excessive unnecessary tests and procedures that are marketed my the medical community. It would be much better to pay a reasonable fee for one that are really needed and stop the rest. Of course there would be hell to pay if we tried that.

At the time I received my pacer 5 yrs ago the cardiologist had me scheduled for an echo-cardiogram, chemical stress test, and they would likely have led to the cath lab all because he diagnosed me with several unjustified conditions. When I found out I pinned him down for evidence that I needed the tests, and when he couldn't come up with anything I canceled them. 5 years later there is no evidence that I would be any better off if I had gone ahead with several thousand dollars billed to medicare.

There is a very well established industry that makes billions on fear based marketing. We all pay for it.

frank

 

I am certain that although there is some tremendous medical work being done in the USA, there is also a great many procedures being performed that are completely unjustified by any medical condition. It seems that as soon as a fully insured American enters a hospital the doctors see a bucketful of dollars first and the patient second. Not only are unnecessary tests being carried out but actual unnecessary surgical procedures being carried out that are often to the detriment of the patient. The doctor buys a new machine, well he is bound to want to get his money back as soon as he can , so the temptation to put as many people through the "new test" is tremendous. The drug companies are up to a similar fraud, pushing drugs out and on to patients who dont need them and wont benefit by them. Obahma is only trying to find a happy balance that will benefit all Americans. Cheers Peter

 

The opposite is true in most countries. In my country the UK the problem is getting the tests and the treatment in the first place and the reason why that is the case is because we dont pay any bills direct to doctors or hospitals . This means every patient is seen as a "cost" to the system rather than a profit. So you get fobbed off. Although you still need to be careful as for instance a drug company might be trying to promote or test/increase the use of a drug by paying doctors directly or more usually indirectly to prescribe the new drug. This happened to my daughter and to me. My doctor thought? I was nuts and needed a mind altering drug. I was taken aback, no one is going to get me to take any "nut" drugs. I think my head is better screwed on than my doctors.Let him take them. My daughter took hers and she became immediately addicted and they made her extremely ill with no benefit. I understand there is a huge class action in the USA over this drug. We all need to be on our guard. Cheers Peter

 

that they can cut any more. I had SOB few yrs ago & had an echo & the "chemical" stress test. Charges were in the neighborhood of $6500. Medicare & my medigap plan paid about $800. I told my cardio how bad I felt about it & he said it is their ethical duty to see everybody. Now I do realize that charges are high & that private insurance (including mine before Medicare) pay more but I sure hope that the "Powers to be." don't cut any more out of Medicare. Even tho there is some attitude that we older folks are a drain on the system I
(& most of us) paid into the system & supported the previous generation. Now its our turn!

 

people who are here illegally and get all kinds of government help, people who can work but wont because a shyster lawyer can get them SSD or some other government aid, people who keep having kids so they can get more government aid, and I will stop now before my defib goes off!!!!!!!!! People who pay into the system who work thier whole lives are the ones that get take the cuts monetaraly and medically always has been that way and always will be, I just dont understand it at all. They have finally found a legal genicide that they can practice......This is a sore subject for me.

dave

 

I agree with Frank in his reply, I was admitted to our local hospitl for chest pains, prior to my ICD, after a day I was ready to be discharged, I THOUGHT, the local doctor came in told me he had scheduled me for a slew of test, none of which dealt with the chest pain issue, after the first test for something to do with stomch, I had enough and asked to be discharged, the doctor told me NO, you will go when I say so, I decided to sign myself out of that place, that brough a raft of anger, the nurse literly riped the iv out of my arm, and I finially left. A few weeks later I received a letter from Medicare stateing they would not pay for the test because it had nothing to do with issue I was admitted for, and advised me not to pay it....Shortly after that I received a letter from the Medicial Group that they would no longer treat me and I had to find a new doctor.... And of course the bill was turned in for collection, now they are warning me the collection people going sue me, I cant await that process, I have saved my letter from Medicare....Needless to say I by pass the local hospital , I would rather trust the local amblunce crew and parmedic to administer aid on the way to a hospital in Erie. Again the waste starts with doctors that are more intrested in making a buck that praticeing medicine as was done years ago.

 

Each of you make valid points, but aren't some of your conclusions based on after thought. Sure we have all had unnecessary tests, or duplicate tests that provided no additional information. Yet if I were given a list of the tests my doctor proposed for me, even if I knew some were duplicates, and being told to mark off the ones I didn't want I doubt that I would have the courage to mark off any. Especially if cost was no object because my pockets were stuffed with money or I am paying for insurance that I know will cover the cost.

Now let's put the shoe on the other foot. Since many different illnesses can present similar symptoms, in order for the Dr. to prescribe the right treatment they are faced with dilemma of guessing or having some unnecessary diagnostic procedures performed. Personally I don't want to know it if a doctor is guessing about how to treat me.

So we are back to the same old bugaboo. Sure we have a lot of unscrupulous doctors out there but we also have a lot of Dr. that do devote their lives to trying to keep many of us alive. Try as I may, and believe me I have seen a lot of different doctors in my life, I would be hard pressed to pick out one that I thought fell into the unscrupulous category. For some of them I can look back now and say that is a one dumb ---, but if I had known that before I saw them I would be as dumb as they for letting them treat me.

It is my opinion the medical profession is like any other profession. It is not perfect, but I think trying to legislate perfection (especially with the bunch of crooks we currently have for legislators) will only make things worse.

Smitty

 

My husband and I spent all of our younger years growing up and flowing with the "tides" and working very hard. We raised an "All American Apple Pie" family of 3 children, we were all involved in good, clean Christian activities in Church, Scouts, Schools, etc. We did not put much thought into getting older, except one day we would be alone to travel and enjoy each other after the "kids flew the nest" ~ We were the All American Family of USA.

Well, the kids were "gone" and the looking forward to "growing older" became high BP, cholesterol, bone strengths, "Arthur" and all the other wonderful elderly aches and pains. "Snap, Crackle & Pop" days now.

After the loss of my "Better Half" of 42+ years in 2001, paying for my own insurance of about $1,300.00 + quarterly and a deduction from Medicare each month for their insurance, I can not wait for the "new political" insurance to take over for us "young at heart", better known as the "elderly" ~ ~

By then, IF I still have a Cardiologist, a GP and a Pharmacist, I hope to be able to get an appointment with them when needed. God Bless Us over 65 ~ ~

Carolyn G. in TEXAS ~ ~ VIVA The UT Longhorns!