HELP STOP DRACONIAN CUTS IN MEDICARE
PAYMENT FOR CARDIOLOGY SERVICES
Effective January 1, 2010, CMS will begin implementation of Medicare payment cuts that will
threaten access to services that are critical to the detection and management of heart disease.
In the final 2010 Medicare Physician Fee Schedule Rule, CMS finalized extraordinary Medicare
payment reductions for cardiology services. Under the final rule, Medicare payment for virtually
all cardiology services would be reduced, with the most significant reductions slated for cardiac
ultrasound (35% reduction by 2013) and nuclear cardiology (36% reduction in 2010 alone). The
overall reduction for typical office-based cardiology practices is estimated at about 25% by 2013.
This reduction comes on top of a reduction of almost 30% in Medicare payment for office-based
cardiac ultrasound services that went into effect this year.
These reductions are largely the result of CMS’s proposal to use data from the new AMA
Physician Practice Information Survey (PPIS) to determine the Medicare payment for practice
expenses, such as equipment, supplies, salaries of non-physician clinical staff, and overhead.
WHY STOP THE CUTS?
• CMS finalized its proposal to use the PPIS survey over the objections of 124
legislators, without full analysis or adequate explanation.
• The impact of the cuts on the provision of cardiology services throughout the country will
be enormous, yet CMS did not subject the PPIS data to the rigorous statistical
standards that were applied to the cardiology survey and numerous other surveys
currently in effect.
• In fact, CMS did not even request from the AMA a description of how the
practice expense/hr data was computed, how the sample was selected, or what
weighting method was used until ten days after the expiration of the public
• Only a handful of specialties met the survey’s stated goal of 100 respondents per
specialty. The cardiology practice expense per hour data are based on responses
from only 55 respondents!
• CMS’ own contractor fundamentally concluded that the ‘type of cardiology
practice” included in the PPIS is not representative of the full range of cardiology
practices as a whole, noting that the PPIS data is not consistent with a number of
external benchmarks of cardiology practice costs.
• While CMS states that the cuts are to be transitioned over four years to alleviate the
impact on negatively impacted specialties, cardiology is by far the specialty that will
incur the greatest losses, and fully half of the cardiology cuts will go into effect on
January 1, 2010, unless Congress acts.
• Most of the funds cut from cardiology, medical oncology, clinical social workers, clinical
psychologists and others as a result of using the PPIS data are not redistributed to primary
• These cuts do not take into account additional Medicare payment reductions that are
included in the House and Senate health care reform bills. Specifically, both the House
and the Senate health care reform bills would modify the assumption regarding utilization
of nuclear cardiology equipment, which would result in additional Medicare payment
reductions for nuclear cardiology—among the services hit hardest under the 2010
Physician Fee Schedule Rule.
• The reductions slated in the final rule have already caused many cardiologists to sell or
consider selling their practices to area hospitals, where Medicare payment for cardiology
services is considerably higher, and Medicare beneficiaries will be required to pay
substantially higher copayments.
• The reductions especially threaten access in rural areas, which are currently served by
satellite offices that would be financially unsustainable if the 2010 Physician Fee
Schedule Rule is implemented.
Cuts of this magnitude will impact the quality of services provided to Medicare patients with
heart disease. Such cuts will influence the ability of physicians to hire and retain qualified cardiac
sonographers, maintain and upgrade equipment, and generally continue to provide high quality
services to their patients, especially in office settings.
The cardiovascular community requests that all members of the House of Representatives contact
Congressman Gonzalez (D-Texas) to sign on as a co-sponsor of H.R. 4371 intended to preclude
these drastic reductions from going into effect and urges all members of the Senate to consider
signing on to a letter to Senate Majority Leader Reid requesting that the health care reform
legislation or other appropriate legislation include a provision that averts or substantially
mitigates these disastrous reductions.