NASHVILLE, Tenn., June 3 /PRNewswire-USNewswire/ -- Cardiologists around the country are speaking out against drastic payment cuts that could force the closure of many outpatient catheterization labs, creating long waits and dramatically increasing out-of-pocket costs for thousands of Medicare beneficiaries.
Under proposed changes from The Centers for Medicare and Medicaid Services (CMS), reimbursement for cardiac catheterization procedures performed in non- hospital outpatient labs would be reduced 47 percent by 2010. Once fully implemented, non-hospital cath labs would receive reimbursements several hundred dollars below the cost of performing the procedure. Because private insurers typically follow CMS's lead, the cuts could create a dangerous domino effect that would reduce reimbursements from all payor sources, driving many non-hospital labs out of business.
More than 45 members of the Cardiovascular Outpatient Center Alliance (COCA), a non-profit organization representing more than 60 cardiology practices across the nation, recently met with members of Congress to ask them to intervene and request that CMS set fair and reasonable reimbursement consistent with the cost of the procedure.
"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, the federal government would incur $45 to $50 million in increased costs, defeating the very purpose of these reductions."
Based on published 2008 Medicare reimbursement numbers, 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 U.S. Senator Mary Landrieu (D-La.). "I believe CMS should establish reasonable reimbursement that will allow these important patient care facilities to stay in business."
Ironically, while the proposed changes would significantly lower payments to non-hospital labs, hospitals performing the same procedure continue to receive increased reimbursement. Since 2006, hospitals have experienced a 25 percent increase in reimbursement for outpatient cardiac catheterizations even though research has shown that a hospital lab's cost structure is the same as that of a non-hospital lab.
Despite similar procedure costs, hospitals typically charge more to perform a cardiac catheterization. Non-hospital outpatient facilities can deliver the same service at a lower cost to the payor 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, M.D., 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."
"The simple reality is that if CMS doesn't fix this problem quickly many of the more than 90 outpatient cath labs around the country will be forced to close," said Blades. "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. With the looming healthcare crisis our country is facing, it's more important than ever that we ask CMS to make rational, sound choices that not only contain costs but also benefit patients."
COCA (www.cocaheart.org) is a non-profit organization representing more than 60 U.S. cardiology practices and organizations and 1,000 cardiologists who own and operate outpatient cardiac catheterization facilities. The group and its members are dedicated to advancing the quality and accessibility of outpatient cardiac catheterization services through education, research and legislative advocacy.
SOURCE Cardiovascular Outpatient Center Alliance