The American College of Cardiology has filed a lawsuit against Health and Human Services Secretary Kathleen Sebelius over pending Medicare physician payment cuts.
The suit, filed last week, is aimed at blocking the 2010 Medicare Physician Schedule, which is slated to go into effect on Jan. 15, 2010.
ACC officials say the Center for Medicaid and Medicare Services' schedule change, which cuts Medicare reimbursements to cardiologists by almost 40 percent, is based on faulty data and will limit patient access to critical diagnostic tests.
The Florida ACC Chapter, American Society of Nuclear Cardiology, Association of Black Cardiologists and Cardiology Advocacy Alliance have been named as co-plaintiffs.
The revised payment schedule will cut echocardiogram reimbursements by 42 percent and nuclear medicine test payments by 36 percent for cardiologists in private practice, according to the ACC. The group believes the lost income will cause cardiologists to lay off staff, close clinics or move to hospitals, which are largely unaffected by the pay cuts.
According to the ACC, member polls suggest more than one-fifth of cardiologists are considering abandoning their practice and moving to a hospital or another practice.
"What they're in effect doing is running private practice out of business, and basically the patients and the system pay more money to get the same tests in the hospital, while limiting access to patient care in rural areas and taking doctors away from the communities," said Amy Murphy, a spokeswoman for the ACC, in a report issiued by DOTmed News.
ACC officials said the CMS is basing its belief that the costs of running a private practice are declining on a faulty survey.
Known as the Physician Practice Information Survey (PPIS), it suggests that the costs of private cardiology have dropped 40 percent in the past five years. But ACC officials argues the survey relies on a small, unrepresentative sample of cardiologists who did not face financial pressures typical of practicing cardiologists.
"There were only 55 responses from cardiologists that they based the entire rule on," Murphy said. "Our own data, the MGMA (Medical Group Management Association) data and MedAxiom data show that practice expenses are rising.”
According to the complaint, the cardiologists in the CMS survey had lower expenses than most, as they didn't incur costs from purchasing radiopharmaceuticals, intravenous drugs for pharmacological stress tests, echocardiography contrast agents or extensive clinical staff.
"CMS has historically used precision testing to test the reliability of survey results for cardiology and other physician practice expenses," ACC officials said. "When CMS switched to the new PPIS, it abandoned precision testing of the practice expense survey data."
In addition to the lawsuit, the ACC has launched a public relations campaign to generate opposition to the new payment rates and is backing legislation being filed by Rep. Charlie Gonzalez (D-Texas) to keep cardiologist reimbursements at the 2009 level while allowing other specialties to operate at the new rates.