Results of impact of 2010 CMS Physician Fee Schedule survey released

The American Society of EchocardiographyNov 25 2009

The American Society of Echocardiography (ASE) has released the initial results of a survey about the impact of the 2010 CMS Physician Fee Schedule (PFS) on patients and practices. Of the 1,200 cardiologists and cardiovascular ultrasound technicians surveyed, 87 percent said the new fee schedule could force them to stop accepting Medicare patients, reduce staff or shut down their practice completely -- ultimately reducing patient access to echocardiography (heart ultrasound) and other vital services.

One cardiac sonographer surveyed said, "The negative effects of these cuts are immeasurable and numerous. If fully implemented, the result will be delays in service, higher hospital admissions and probably more deaths due to undiagnosed heart conditions." Another Arizona-based cardiologist said, "On many occasions we will do an urgent echo immediately following an evaluation, saving the patient's time and alleviating the anxiety of uncertainty about a serious heart condition. With these proposed cuts, this same-day service will not be available, thus prolonging the diagnosis."

Sixty-three percent of the respondents serve a patient population in which more than half are reimbursed by Medicare Part B. Almost a third of respondents provide services in an area that is rural, medically underserved or both, and the nearest provider of echocardiography services for 74 percent of the respondents is a hospital.

"If private practices close their doors because they can no longer afford to provide these services, patients will be forced to go to the hospital," said Dr. Ben Byrd, Advocacy Chair of ASE. "This could be a life or death situation for Medicare patients, especially those in rural areas who can't get to a hospital in a timely manner."

The survey showed that for the echocardiography service providers affected most directly by the PFS payment cuts, the actions currently being considered most often are:

• 64% would delay the purchase of echo equipment;
• 56% would lay off sonographers or other staff;
• 53% would reduce staff salaries;
• 47% might reduce staff benefits, such as 401K programs or healthcare;
• 23% would refrain from accepting Medicare patients for any services;
• 19% are considering closing a satellite office(s) or have already closed a satellite office(s); 60% of these are located in rural areas.

For those echocardiography service providers who will be indirectly affected by the payment cuts (those who receive payment through the Hospital Outpatient Payment System), the survey showed anticipated outcomes would include:

• Increased workload (74%)
• Longer wait times for patients (67%)
• Lengthened turnaround time for reports (44%)
• Increased overtime for staff or the need to hire additional cardiac sonographers (43%)

ASE collected regional anecdotes from almost 200 members who will be affected by the cuts. Many provided examples of patients who might have died had in-office echocardiography services not been available.

One respondent noted, "During an initial exam, a 55-year-old male was noted to have a diastolic murmur. He was scheduled for an echo at the hospital in two weeks. Our lab was able to fit him in within 24 hours. I discovered a 7.5 cm. ascending aortic aneurysm and 'wide open' aortic insufficiency. He had surgical repair that same day and has recovered nicely. One can't help but wonder what the outcome might have been had he waited for his hospital appointment."