NASHVILLE, TN – More than 90 outpatient cardiac catheterization labs around the country won’t survive the carnage if the Centers for Medicare and Medicaid Services passes its proposed fee schedule, according to the Cardiovascular Outpatient Center Alliance (COCA), an advocacy group representing more than 60 cath labs around the country.
Under the proposed Physician Fee Schedule, non-hospital cardiac catheterization labs would see 47 percent cuts by 2010 – bringing reimbursement several hundred dollars below the cost of a typical cath procedure. The closures would create long waits and dramatically increase out-of-pocket costs for thousands of Medicare beneficiaries.
COCA expects that private insurers would also follow CMS’ lead, aiding in the cath labs’ demise.
“In addition to closing outpatient cath labs around the country, the proposed cuts would have a devastating effect on the entire healthcare system,” said Steve Blades, president of COCA. “Patients would be forced back into crowded hospital settings where the cost of the same procedure is significantly higher, resulting in long waits and greater out-of-pocket expense.”
As a result, he said, the government would ultimately incur $45 million to $50 million in increased costs, defeating the very purpose of the cuts.
“Congress knows it’s a faulty rate, but it’s so expensive to fix that it just keeps getting put off,” Blades said.
Based on published 2008 Medicare reimbursement numbers provided by COCA, patient co-payments also would increase by $500 – or 157 percent – while access to catheterization services would be diminished.
Medicare beneficiaries currently pay $326 for a catheterization procedure performed in a non-hospital lab, while out-of-pocket costs for the same procedure in a hospital outpatient lab total $839.
“I’m concerned the severe reimbursement cuts initiated by CMS for non-hospital outpatient cardiac catheterization lab procedures will threaten access and quality for the Medicare beneficiaries in my state and throughout the nation,” said Senator Mary Landrieu (D-La.). “I believe CMS should establish reasonable reimbursement that will allow these important patient care facilities to stay in business.”
Despite cuts to the non-hospital cath labs, hospitals have received a 25 percent reimbursement increase since 2006 for outpatient cath procedures, even though research has shown that the cost structures are the same.
COCA says hospitals typically charge more to perform a cardiac catheterization while non-hospital outpatient facilities can deliver the same service at a lower cost to the payer and the patient while providing enhanced convenience and better access to care.
“Our facility offers patients a quiet, convenient environment and a location that better meets their needs than a hospital-based facility, which must give priority to emergency patients,” said Bruce E. Murphy, MD, president of the Little Rock Cardiology Clinic. “Additionally, we have all of the tools clinicians need to expedite their diagnoses, which allows the physician to spend more time with the patient discussing options for treatment.”
More than 45 members of COCA recently met with members of Congress to ask them to request that CMS set fair and reasonable reimbursement consistent with the cost of the procedure.
“Until the government recognizes non-hospital cath labs as a separate and distinct entity and begins reimbursing them as such, we will continue to be a square peg they are trying to fit into a round hole,” said Blades.