ACC LEGISLATIVE CONFERENCE -- 2009 Salman H Siddiqui, MD
I recently had the privilege of attending the 2009 Legislative Conference organized by the American College of Cardiology in Washington, D.C. While this may be an annual event, given the current public discourse on health care, attendance this year promised to be particularly exciting. In the words of a legislative aide , "You couldn't have come at a better time -- this is the busiest week on the Hill in decades!" Even though it seems, as the debate on health care reform unfolds, just about every part of the health care sector will be affected in one way or the other -- patients, providers, insurance companies, pharmaceutical and medical device industries, tax payers, and government to name just a few -- perhaps no single medical specialty is expected to see as much a quantum change in its structure, organization, and most importantly, ability to provide care to patients, than the field of Cardiology if some of the reforms currently under consideration are to go into effect. This was the backdrop on which the ACC convened its Legislative Conference for 2009. More specifically, the agenda focused largely on the proposed cuts in reimbursement rates for cardiovascular services by the Centers for Medicare and Medicaid Services (CMS). CMS is using data from the Physician Practice Information Survey (PPIS) conducted by the American Medical Association over a two year period. In this survey, over three thousand five hundred Cardiologists were asked to report on their practice expenses -one hundred forty five responded and ultimately data from only fifty five surveys was used to calculate the 2010 Medicare Physician Fee Schedule. What has been concerning for the overwhelming majority of Cardiologists and cardiovascular care providers across the country is that the data from this survey is not representative of the true cost of running a Cardiology practice and providing quality care for patients. What has also been concerning is that the CMS has broken from tradition and precedence and adopted this data without subjecting it to the thorough, rigorous, and independent analysis that it ought to have undergone. Twenty percent of Cardiology respondents reported no nurses or medical assistants in their practice and an even larger proportion reported no overhead expenses. It is no surprise then that the CMS thinks cutting reimbursement rates for cardiovascular services -- over forty percent in some cases -- is the way forward. This would be in addition to the twenty one percent reduction in the Medicare Sustainable Growth Rate (SGR) intended to control the growth in aggregate Medicare expenditures for physician services. The reality, however, as one can well imagine, is somewhat different. Few, if any, practices would be able to operate without the help of nurses and medical assistants and even fewer would agree that they could successfully operate their practices without any overhead expenses. When asked, thirty four percent of Cardiologists said that, if the cuts were to go forward, they would have to limit the number of Medicare patients that they accept into their practice; another thirty percent said that they would have to reduce their staff; and twelve percent said that they would have to close their practices altogether. Cuts of this magnitude would clearly have devastating consequences for patients especially in terms of access to the quality care they have so heavily relied upon for years. This is indeed somewhat of a paradox -- on the one hand with an ageing population the demand for cardiovascular services is only expected to continue to increase yet on the other with these proposed cuts one can only foresee a reduction rather than an increase in cardiovascular services. Attending the ACC Legislative Conference as a member of the Ohio delegation allowed me the opportunity to meet with the cardiovascular community not just from Ohio but from across the country. This proved to be a very positive exercise -- I was able to exchange ideas and share experiences with people from academia and