The Cost of Living : Cardiologists' Lament

The Cost of Living : CJR:

The Herald’s story, by John Dorschner, said the doctors were complaining that Medicare had reduced “reimbursement for cardiac services on average by 40 percent,” and that another 21-percent cut was coming March 1. The doctors’ letter warned that they “will be either forced out of business or forced to drastically increase the number of patients seen, most likely with physician assistants or nurse practitioners.” Oh, oh. The specter of rationing and inferior care—and from nurse practitioners no less!

Dorschner’s story described a new Medicare rule, which took effect January 1, that cut projected total revenues for cardiologists by 13 percent on average over four years while increasing the revenue of internists, family doctors, and general practitioners.

Think of it as income redistribution designed to make primary care more attractive to med students and increase the supply of those kind of docs. (At a minimum, the health-reform debate has illuminated payment disparities between the primary-care doctors and the high-priced specialists who have always commanded big bucks.)

Heart doctors across the country—not only in Miami—cried foul, and Jack Lewin, who heads their trade group, the American College of Cardiology, vowed “to do everything we can in the legislative, legal and regulatory arenas to stop these cuts.” Lewin could have added the media to that list of arenas, because the ACC pulled out all stops to sound the alarm with the nation’s press and public through its Campaign for Patient Access.

The Herald’s story was the best of a bunch of news articles that for the most part passed along the cardiologists’ complaints, threats, and warnings without any hint that there was another side to the story. Between the slanted newspaper articles and audio news releases from the ACC, millions of Americans learned that the incomes of heart doctors, which can be upwards of $400,000, could take a hit. As an example of the kinds of cuts Medicare envisioned under the new rule, the administrator of one Florida heart practice explained that the reimbursement for a nuclear stress test could drop from $850 to $600. Presumably he said it with a straight face.

We will need to have this very important discussion at some point, so I'm glad to see someone looking critically at the need for substantive analysis of complaints about reimbursement.

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