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Cardiologists File Suit Over Medicare Payment Rates

Janice Simmons, for HealthLeaders Media, January 5, 2010

The American College of Cardiology (ACC) has filed a complaint against Health and Human Services (HHS) Secretary Kathleen Sebelius in the U.S. District Court for the Southern District of Florida over "unlawfully adoption" of Medicare payment rates for cardiology services in 2010.

The complaint says that Sebelius—in her capacity as the HHS secretary—has based payment rates for cardiology services on the 2010 Medicare Physician Fee Schedule (MPFS) that uses an "invalid" physician practice information survey in "a manner that challenges access to care for patients," ACC said.

In the complaint, "defects exist" with the methodology and data used to develop the survey, which was used to base the cuts in Medicare reimbursement rates for cardiology, said ACC, which filed the complaint on Dec. 29.

This includes using a small number of cardiologists (55) to set reimbursement rates under Medicare for all cardiologists nationwide—when results from this group differed from other information that was available, said ACC. Also, it added that survey results were not in compliance with the federal regulations that "govern precision standards, transparency, and review."

"The process by which Medicare determined the reimbursement rates was deeply flawed. 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," said ACC CEO Jack Lewin, MD.

ACC said that according to its data, reimbursement cuts will result in three fourths of the nation's private cardiovascular practices cutting services and eliminating thousands of current staff. An upswing has been noted in cardiologists moving from private community practices to direct employment by hospitals.

"Already practices are closing their doors and their patients have nowhere to turn. Hospitals do not have the capacity or the specialized ability to absorb the influx of patients," said ACC President Albert Bove, MD.

In November, after the cuts were announced, the ACC launched a nationwide grassroots campaign to raise awareness of the issue. In late December, Rep. Charlie Gonzalez (D TX) introduced a bill with 55 bipartisan co sponsors to freeze cuts at the 2009 reimbursement levels. Sen. Bill Nelson (D FL) also is leading a sign on letter regarding the cuts in the Senate.


Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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