Payments for cardiovascular Medicare patients may go down by 50% under HHS new rules on January 1.

[madfloridian]

I had heard about this previously, but this letter today by two doctors today is really quite alarming. They have been to DC to talk to the WH about it, but have gotten nowhere.

I can not imagine this is happening, and it is being done without public debate or approval.

Medicare Fee Rule for Cardiovascular Care to Raise Costs, Cut Access

On Jan. 1, Medicare patients across the state of Florida will confront a new reality in cardiovascular care. The Obama administration released the final 2010 Physician Fee Schedule on Nov. 1, severely cutting cardiovascular payments for Medicare patients - some by as much as 50 percent. These cuts have nothing to do with the battle over health care reform currently taking place in Congress.

This new rule has taken place without public debate or approval. The cuts have been mandated by the Centers for Medicare and Medicaid Services under the direction of Health and Human Services Secretary Kathleen Sebelius. These are the primary tools for early diagnosis and treatment of cardiovascular disease. Many of the tests will now be done in a hospital where the costs (and co-pays) are higher.

Such drastic cuts will inevitably force some cardiology offices to close because the cost of equipment, supplies, and salaries for office staff cannot be sustained.

..."On Dec. 8, members of the Florida Chapter of the American College of Cardiology travelled to Washington to urge Congress and the White House to stop the implementation of the fee schedule. Florida cardiologists have met with CMS to advocate against the implementation of this rule with no effect since July.

[leftstreet]

1. And how does the HCR bill address this?

:shrug:

[madfloridian]

2. Apparently has nothing to do with it.

I guess CMS answers only to HHS...and HHS answers to..?

[chandler2]

3. I am so glad that I voted for change, aren't YOU? nt

[juno jones]

4. K&R!

Medicare will be well and fatally defunded before any of us supposedly eligible poor folk get to participate.

[AngryAmish]

5. Looks like a few cardiologists will have to make do without a new boat in 2010

It must be so embarrassing at the yacht club not to be able to get a new boat every year. Like reusing toilet paper or something.

[madfloridian]

7. Hm.mmm I was thinking of seniors.

[SharonAnn]

12. Me too. Now that doctors won't overcharge Medicare, more can be treated.

[madfloridian]

18. That's the new argument to cut payments. It's working...

Just like everything else is working right now.

[SharonAnn]

Many doctors have added their own labs and facilities to rake in $$$.

And perhaps the Medicare payments were too high?

Gee, you don't suppose that the doctors thought they were entitled to get paid too much?

And yes, that's how Medicare fees are analyzed and arrived at. Nothing new here.

[madfloridian]

13. It is good to have many procedures done in the offices...

instead of the hospital.

[madfloridian]

16. If you think Medicare payments are too high...

ask a friend on Medicare. Or ask a doctor.

[AngryAmish]

20. Thus a doctor is presented with a choice: treat Medicare patients or be greedy

[madfloridian]

21. It is nice you assume doctors are greedy. Way to go.

[SOCALS]

23. American doctors are greedy, it is a fact

[Hannah Bell]

32. the ruling class is greedy.

[Freddie Stubbs]

15. Or they will see more patients with private insurance and less patients with Medicare

Kind of like what they do with Medicaid patients.

[SOCALS]

22. I am happy that our government

started dealing with outrageous rates American doctors set for patients. American cardiologists are nothing special and do not deserve half a million dollar salaries

[madfloridian]

30. The cardiologist that saved my hubby's life is a dedicated special man.

He earns every bit of money he makes. So did the cardiac surgeon.

[nadinbrzezinski]

29. You think all doctors make millions, don't you?

Some, a FEW, are overpaid, but guess what the average is driven by those who are not.

There are days... no, not everybody is Dr. Leakey...

[AngryAmish]

34. No, I think the average cardiologist makes $282,299

<http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_hc07000051.html>

After this reform they might make $272,299

It makes baby Jesus cry.

[nadinbrzezinski]

35. AVERAGE driven by high salaries like that of Leakey

in Houston who's income is in the MILLIONS.

Do people in the US lack a true understanding of what AVERAGE means?

[AngryAmish]

37. And the 25th percentile makes how much?

on edit: Who is this Leakey guy and why are you banging on and on about him?

[nadinbrzezinski]

39. Leakey is a millionaire a few times over

he developed one technique used these days all the time. He was of national and international fame, and he ran what I consider a factory, not a proper medical practice. Yes he started in the morning and ended up at night, he did the bypass, and his assistants closed up. He went from OR to OR... by the way you do know that Houston is one of the worst places for medical practice.

He and a few others earn millions, driving the average that high. That means the OTHER HALF of cardiologists make less than what you listed.

Now don't get me wrong, doctors should most likely not make that much, but given that many of them have to pay for their own malpractice insurance... which is a MINOR part of the systemic problems we have. They also have to pay for their loans, which is not that minor by the way. Many doctors spend the first 20 years of an actual career paying quite a bit of money back to the banks

You want salaries to be lower? We need to find a way to train doctors that don't cost students as much as they do. That would be a first step. (We also need more GPs and less specialists but that is another discussion, to a point)... I wish people understood these things instead of going... LOOK HE IS RICH! When in reality it would be more properly called WEALTHY.

[AngryAmish]

40. My point (and yours are very valid) the 283k wage is a median, not a mean

Mean is when you take the wages of all cardiologists, add them up and divide by number of cardiologists. Then the numbers skew up if there are a few high wage outliers.

Median is when you take all the cardiologists and put them in a row. Then you take the person in the dead center (half make more, half make less).

Mode (which may be the most germain) is the most common wage.

[nadinbrzezinski]

41. And as I said, yes the salaries perhaps need to go down

but a lot needs to change system wide for that to happen. It will not happen. I know doctors, hell my brother is not even close to that... and all the doctors I know, some specialists, some not... DO NOT make that much. Yes a few are cardiologists too.

Now a few fear that the system will be socialized (RUN FOR THEM HILLS), but hey that is the power of propaganda.

I argue with them at a policy level... but I also know that the country I am visiting right now has a far better vaccination coverage than the US could ever hope to... and darn it, it is not even a "first world economy."

[NobleCynic]

44. Median salary is $282,299

25th %ile = $217,993
75th %ile = $371,059

http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_hc07000051.html

Yes. People in America understand the difference between mean and median. Cardiologists are exceptionally well paid.

[SOCALS]

38. Wait for people to start saying

that doctors have to study for 12 years and... take loans to pay for education! Of course it justifies ripping off working Americans

[NobleCynic]

45. Self-delete

[Thothmes]

33. Or maybe they will decide not to treat medicare patients.

[FLDCVADem]

48. we have a winner

That's exactly what will happen.

I listened to the head of a non-profit hospital in VA a few months ago, talking about Medicare patients. He says his hospital loses money on every single Medicare patient they treat. How do they make it up? By patients using insurance, which raises everyone's rates.

[Thothmes]

50. Sad but true

my GP is in a clinic practice with two other GPs. She told me a few months ago that the limit their medicare patient load to no more than 20%. She said that any more than that puts the financial stability of the practice in jeopardy. Same reason stated above. Reimbursment rates for medicare patients result in red ink.

[TwilightGardener]

6. Without hearing the HHS/Medicare rationale, it's really hard to assess this.

[madfloridian]

10. They are cutting billions from Medicare to pay for the new health care...

"reform".

I wrote about it earlier, will have to find it.

[CreekDog]

8. Full reimbursement of cardiologists is on my list of things to be concerned about

it's 438th. :D

[Freddie Stubbs]

9. Medicare for all, indeed

[defendandprotect]

17. Well . . . do you think the privatization of this health care deform . . .

is going to protect Social Security or Medicare from privatization????

Or do you think privatization is a good thing?

[OnceUponTimeOnTheNet]

11. Hold on Folks, another Wormhole dead ahead!

That's what it starts feeling like, somedays 3 or 4 wormholes to hold on and navigate.

[defendandprotect]

14. In the corporatism of this health care deform . . . what will follow is privatization of

Social Security and Medicare --

In other words, Obama is carrying out a DLC-Repug corporatist agenda --

but we haven't known that since day one????

[leftstreet]

19. Yep, they're coming after SS and Medicare next

Privatize! Privatize!

:banghead:

[StreetKnowledge]

27. Yep, and they'll privatize it, Wall Street will fuck up again, and Americans......

......will find out they have no savings, health coverage and no ability to pay their bills. And many of those over 65 will die as a result.

But the rich will get richer. Just like they have every year for a generation, while average working stiffs gain nothing. How about next time, we vote in third-party candidates, because neither of the big parties have any interest in helping us.

[dysfunctional press]

42. that WILL bring out the pitchforks.

after what happened to people's 401k's over the past couple years will make it practically impossible to sell to even a public as gullible as ours.

[RagAss]

46. No...we have become a society of beating victims...no pitchforks in our lifetime !

[dysfunctional press]

47. that's probably what they're thinking, too...

but there will be a straw that breaks the camel's back.

and social security is a pretty heavy bale of hay...

[madfloridian]

24. Now we are happy that cardiac patients will be hurting?

[nadinbrzezinski]

36. Well people do not realize what needs to be done

and this bill ain't doing, so far. Nor do I expect it either.

[cutlassmama]

25. I read it was going to be 21% for all doctors across the board. Soon there won't

be any doctors that take Medicare patients...and then what?

[madfloridian]

26. They stalled the 21% cut for two months.

The Senate will take it up again then.

[Blue_In_AK]

28. Alaska is pretty much there now.

See http://www.heartland.org/publications/health%20care/article/25300/Fewer_Alaska_Doctors_Take_New_Medicare_Patients.html

[laughingliberal]

31. Medicare is wonderful but they shoot themselves in the foot like this all the time

Why? Same reason we got the industry friendly HCR bill we have now. Follow the money. Rather than keep fee schedules for cardiologists in place so that treadmills and echocardiograms and such can be handled there at less cost, they will now be paying the overpriced hospital based diagnostic centers to do the tests for more money. I understand the underlying reason and that this, like all their rulings like this, was meant to save money. No effort to save money by giving the hospitals more control will ever work. The for-profit hospital industry is one of the major players in out of control medical costs in this country.

[Motown_Johnny]

43. Such drastic cuts will inevitably force some cardiology offices to close because the cost of

equipment, supplies, and salaries for office staff cannot be sustained.





Hmmm........

Any numbers on their previous profit margins?


The entire argument is based on that statement which I don't trust but can't disprove. I would need to see the math involved on how many of their patients will be effected by this change as well as how much money they have been making.

[Quantess]

49. I'm going to read this when I have more time.

[Vidar]

51. K&R.