7/1/2009 1:54:01 PM #

Proposed 2010 slashes by CMS in echocardiography on top of previous 2009 cuts are not the way to increase quality (the reverse will happen). Pediatric Cardiologists practicing quality medicine cannot sustain a quality practice with quality equipment and quality staff if these additional 2010 cuts are implemented!
Proposed cuts in consultations will also impact tremendously on practice revenue.

Russell Schiff, MD

7/1/2009 6:11:57 PM #

The question submitted to President Obama by the ACC is obviously key. Additionally, I would have asked him how he plans to implement shifting reimbursement from single care episodes to continous care for chronic diseases, and how he envisions reimbursement incentives for care coordination efforts.

Lars Laslett

7/3/2009 2:55:58 AM #

You hit the nail on the head. It is all about quality which in turn will improve value (a desired outcome per dollar spent). I fear the discussion is a mute point unless the President first reforms (as if he had the inclination!) the Medicare Payment Advisory Commission; have no idea who this guys are but their focus is just on dollars spent (I therefore suspect insurance industry ties).

Jack, I feel insulted by the proposed 30% cut in payment. I am also afraid of what is going to happen to my patients and my practice and have already started the process of warning good people that they may not have a job with me soon.

Fernando Lopez, MD, FACC

7/8/2009 4:26:11 PM #

In current economic environment healthcare reform is absolutely crucial for our future viability as one of the economic powers in the world.Balancing access,quality,coverage,innovation,research and value(positive outcome per $ spent)and comparative standing with other developed nations is a monumental goal.I would like to ask President how he will prioritize these lofty goals? I have some practical suggestions for reducing cost and creating value:
1 Rather than "gatekeepers"make patients the stake holders for their own health by having them pay even a small fraction of the service up front.
2 Specialized care and services should be rendered by respective specialists only.Abuse in imaging alone amounts to Billions because anybody with MD or DO (sometimes mobile service with neither degree)can render subpar service and still get paid fully.Redundant unnecessary services is one of the major reasons for escalating healthcare costs in U.S.A "SmartCard" technology can help curtail duplicate services and also can serve as patient's portable personal health record.
3 The hospitals should be encouraged to provide more preventive services rather than trying to beat each other in so called "Hotel Services" and spending millions for advertisements.Truly specialized and ultra expensive services should be rendered only at designated "Centers Of Excellence"based on outcome data and credentials of respective Specialty staff.
4 Physicians'cognitive clinical services and preventive care should be reimbursed by all carriers without any deductibles,unlike the current payment system which rewards tech rendered care with often no proven outcome impact.
5 Lastly,no reform will succeed if we do not reform our legal system as it pertains to healthcare.Federally mandated tort reform is a must.Contingency legal fees should be banned and plaintief or their counsel should be charged meanigful case filing fees(which can be reversed if they win) by the courts to cut down number of frivelous law suites.

chandrakant pujara,MD,FACC

7/9/2009 3:43:42 PM #

I agree with everyone's comments. I agree that the focus on quality is what will lead to better value in medicine. I have been an advocate for physician's partnering with hospital administration on quality indicators within cardiology. However, my partners and I are rapidly becoming insulted by the current attitude of the federal government which doesn't only seem to be focused on slashing reimbursement, but targeting the field of cardiology. Cardiologists have been leaders in the field of evidence based medicine in the approach to patient care. We focus on every quality indicator in our office, and we track all of this information. We also try to provide access for patients given the critical nature of the problems that we treat. We are rapidly approaching a point where we cannot afford the overhead to focus on these issues. We have recently had to lay off 3 members of our staff and are considering 5 more (out of a staff of 55). All of the cost containing ideas that Dr. Pujara describes have been discussed by physicians openly and yet you never hear it discussed by policy makers.
Within our practice, we have the potential to face a drop in physician income of >25% this year. With a 30% cut next year, we would not be able to pay our rent! We are already speaking with our hospital about becoming hospital employees, but this is leading to the consideration by 3 of our 10 physicians leaving the practice and potentially leaving medicine. I would ask the president what he would tell a future cardiologist in training what his or her future holds. As people come out of medical school with >$100,000 in debt and put off their personal interests well into the fourth decade of their life, are they going to be able to make a living that justifies the sacrifices. While I love doing what I do, and I believe that I am good at it, I also believe that there is a lower limit to what I am willing to be paid and continue to work in this field. This is what my partners and I are currently discussing rather than the most recent review article in JACC. This is what is going to jeopardize the furture of Americans.

Patrick Anonick, MD, PhD, FACC