7/8/2009 12:58:34 PM #

I believe the public should be educated on the difficulty of practising medicine as it stands now, even before the proposed Medicare cuts. In April 2008, we moved our practice from Building 1 to Building 4 within the same medical center complex. We filed the address change with Medicare immediately. However, it took Trail Blazer, the Texas carrier for Medicare, nearly 6 months, before we were reimbursed for services rendered for our patients. Reimbursement sent to our old address was not allowed to be forwarded. Trail Blazer never returned mail, e-mail, nor phone calls. We exhausted our line of credit from the bank. Appoximately 80% of our patients are Medicare. Our practice nearly collapsed. The more patients we saw, the deeper we were in debt. Not until having this experience did I realize why some of our colleagues would restrict the number of Medicare patients they see. I can fully empathize with them now. We need to collectively stop this type of physician abuse.

Gloria Hui, M.D.

7/11/2009 11:56:25 AM #

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Lock and Load: ACC takes aim at proposed CMS cuts to cardiologists « CardioBrief

cardiobrief.org

8/2/2009 9:37:54 AM #

I find it repugnant and sickeningly ironic that our President has the gall to dictate to physicians about how to do our jobs while actively smoking cigarettes and happily eating junk food from local D.C. establishments. I have yet to read a single provision in the Health Care Reform Legislation that acknowledges that non-compliant citizens elevate their chances at suffering from a major cardiovascular event. Should the healthy subsidize the poor health habits of the irresponsible or is this just the worst form of hypocrisy now made into Federal policy?

Charles H Koo MD FACC

8/3/2009 1:33:14 PM #

I was informed by the hospital quality assurance nurses that it takes 2 of them to check and recheck each record to ensure that we have documented anti-platelet, beta blocker, ACE/ARB therapy for coronary disease and heart failure patients. It also takes a special personnel to determine whether a patient is admitted, in observation, or in day surgery but bedded overnight.
As physicians, we are in agreement to reduce cost,broaden patient access, and improve efficiency. I have yet to hear any government proposals as to how we may collectively reduce health care administrative costs. As there is proliferation of government mandated rules, all in the name of improving patient care, I can only imagine ballooning administrative costs, without true benefit in patient care improvement.

Gloria Hui, M.D.

8/11/2009 8:13:04 AM #

We are all concerned with the proposed Physician Fee Schedule for Medicare reimbursement in 2010 and also with the healthcare reform debate now. The PFS would be devastating to our practice and to all cardiologists in private practice. The draconian cuts in the echo and nuclear imaging reimbursements will be particularly traumatic, since as we all know, that practices survive on the technical imaging component and not on revenue generated by seeing rechecks and new patients alone. Cardiology is accused of being over priced and imaging services over utilized, however, the rapid growth of mobile diagnostic services I do not feel has been examined for its impact. Cardiologists have no control what is being ordered through these mobile diagnostic services but I can personally attest that the primary care physicians to whom it is marketed have increased their utilization dramatically. Stark laws prohibit cardiologists from having a financial interest in these companies which can structure agreements which are quite lucrative to the primary care physicians. Unfortunately, the quality of the studies on a good day is suspect and the indications for the studies loose.

What has the ACC done to investigate the impact of mobile diagnostic services and present this data to CMS? Screening for appropriateness of the test and ensuring that all imaging services are accredited would be a nice start. We are on the precipice of private practice in this country being eliminated. This PFS is the first step in that endeavor.

I would encourage all members to voice their opinions to their Senators and Representatives and to also read the musings of Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel who has been appointed to two key positions: health care policy adviser at Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. What this man has written is frightening.

Brian P. Hearon, MD FACC, FCCP, FSCAI
Hickory Cardiology Associates/Western Piedmont Heart Centers

Brian Hearon, MD, FACC, FCCP, FSCAI

8/12/2009 10:32:52 AM #

From the advocacy standpoint, we should also consider the following:

1) It is very tempting for politicians to lump cardiologists in with other specialties who perform in-office imaging for the technical component only - but this is untrue. My practice has certified nuclear, vascular, and echo labs, and when we perform imaging services in-house it is part of the global care of the patient. The cardiologist who examines a patient and then interprets an echo to grade valvular disease and ejection fraction (or the OB-GYN who does in-office sonograms to measure biparietal diameter as part of antenatal care) is no different from the pulmonogist who is reading PFTs on his COPD patients. This is not the same thing as a urology group buying its' own CT scanner, as the Washington Post recently alleged.

2) The American College of Radiology is pushing this issue for pecuniary reasons. Full disclosure - my father is a retired radiologist and a Fellow of the ACR. When the ACR tells Congress that non-radiologists are self-referring for imaging, they ignore the fact that when a radiologist recommends an additional imaging procedure (the joke in my community is that the typical report reads "X-ray of the left ankle shows no fracture, cannot rule out brain mass, chest or pelvic tumor, suggest total body imaging") they are rewarded by both shifting liability to the clinician, and by the additional revenue they generate -so they actually have more incentive to generate further imaging studies than clinicians do.

3) We should also impress upon the lawmakers and policy advisors that while Primary Care needs improved reimbursement, certain specialties have the same care coordination and administrative burden as the primary care practitioners. Specifically, cardiologists function as care coordinators for patients with CAD, CHF, and prosthetic valves or implanted rhythm devices - because no one wants to touch these patients without our approval. The same applies to nephrologists caring for dialysis patients, pulmonologists caring for patients with severe COPD, and oncologists with patients on complex chemotherapy regimens. It is tempting for non-physicians to see all specialists as people who don't have the burden of care coordination - but practicing cardiology is not the same as performing Botox injections or practicing opthalmology - we are on call for our patients 24/7 and we do coordinate their care. The revenue generated by imaging and procedures is necessary to support the ancillary staff we need to allow that availability and provide service to our patients.

Kenneth A. Bernhard, MD, FACC, FACP

8/26/2009 11:45:35 AM #

Jack, It certainly makes one cynical about the process being used to reform healthcare when the issue of defensive medicine, and its primary driver, overzealous lawyers, is completely off-limits. Several estimates, including one from McClellan and Kessler, put the costs of defensive medicine at over $100 Billion per year. As one who has practised medicine in the US, Britain and South Africa, US physicians uniquely spend half their time looking over their shoulders and doing unnecessary tests and procedures "to cover their behinds", as was pointed out in the latest edition of Forbes. The contingency fee system that exists uniquely in this country helps to drive these frivolous yet costly lawsuits. Somehow every other country manages to practice medicine without the need for this curse. I have previously written to you about this. If the medical commmunity does not stand up and speak with one voice on this issue, who will raise it? Each one of your members has personal experience of this. The costs of malpractice insurance, although exorbitant and frankly iniquitous in states like Pennsylvania, are only a small part of the costs. The ACC and similar organizations need to speak out against the enormously powerful Trial Lawyers Association. If you don't, cardiologists and other physicians will be the ones paying the price.

Brian G. Firth MD, PhD, MBA

9/22/2009 6:00:48 AM #

Dr. Lewin,

Congratulations and thank you for your many extraordinary efforts.

Regarding the impending/projected shortage of cardiologists, I cannot over-emphasize how singularly critical this is as our only effective leverage over the legislator/administration/insurance industry/medicare and the public.

We must use this wisely to ensure the commitments and reform we demand before we produce any further cardiologists.

George Moutsatsos M.D.

10/14/2009 2:09:49 AM #

Dr. Lewin
Healthcare reform at the expense, blood, sweat and tears of the healthcare providers is simply wrong. We have talked, we have reasoned, we have negotiated we have prayed. Now is the time for action. Never in my career have I seen such a concerted effort against physicians and our efforts to provide a quality product to the american people. We talk of the financial strength of the Trial Lawyers Association in stopping tort reform in our national healthcare overhaul bills which also is wrong and lends to the saying that he that has the gold makes the rules. We are at a milestone where we need to collectively discuss limiting services provided. Until this discussion is proposed politicians will pick away at the financial structure of medicine until we are providing the services at our own expense. Performing dangerous invasive procedures which require years of training and expertise for $300 as the physician professional fee, performing echocardiograms for $286.00, placing pacemakers for $459 as the physician professional fee and not to mention the potential complications and liability. Dermatologist performing echocardiograms in their offices for financial gain. Physicians are great at talking and maneuvering to circumvent the deteriorating financial structure of medicine but are we willing to take the necessary steps to assure the viability and future of our profession. The costs of technology and the business of medicine are escalating while the reimbursements decreasing so at some point a line has to be drawn where our voices can be truly heard. We fund a war for a billion dollars per day and wish to invest nothing in the quality and lives of the american people to assure their health. Never in my career would I have imagined that I would be working 24/7 literally to make below minimum wage and wondering if I will be able to provide adequately for my own family. Each physician must look in the mirror and make his own personal decision. Stand for something, stand for what is right. Physicians must take a stand now for the future good of the profession as a whole. We once were respected.

James Smith, MD

10/14/2009 4:40:03 PM #

The ongoing systematic and calculated genocide against our profession ( the most noble, precious and priceless service to humanity ) obligates us to defend ourselves at any cost.

The response is swift and easy. Immediately halt the training of all new cardiologists. Let them not only come to value and appreciate us but beg at our feet with despair and mercy for our services, to save their lives at all and any cost.

To do any less, is cowardice and inaction of a species that deserves to perish.

George Moutsatsos

10/24/2009 4:34:46 AM #

Unless the proposed cuts are eliminated, many cardiology practices will be forced to close especially those in inner cities, rural areas, and attached to university programs. Of course vital care to our patients will be forever lost but the unintended consequences will include enormous increase in unemployment, unpaid debt and loss of health benefits as cardiology practices go bankrupt.

Jim Stevenson, MD