Cardiologists Fight Medicare Cutbacks

A move by the agency that oversees Medicare to cut payments Jan. 1 for certain cardiac procedures has resulted in cardiologists suing the federal government. Their push back is an example of how difficult it is to make even small changes in the health care system.

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In Atlanta this week, cardiologists are meeting to discuss new tests, diagnostic techniques and drugs. But in the hallway, theyll be talking about economics. Earlier this year, cardiologists saw the government cut payments for many tests they perform and they are not happy about it.

NPR's Joanne Silberner reports.

JOANNE SILBERNER: Seventy-three-year-old Hank Edelson(ph) couldnt be happier with his cardiologist, Dr. Joe Wilson.

Dr. JOE WILSON (Cardiologist): Hello, Hank.

Mr. HANK EDELSON: How are you?

Dr. WILSON: Good to see you. You're looking well.

SILBERNER: Wilson is dedicated to his patients.

Dr. WILSON: Here, have a seat. Let me take a listen to that heart of yours.

Mr. EDELSON: Okay.

SILBERNER: Wilson has a well-appointed office and a busy practice on the outskirts of Atlanta, Georgia.

Dr. WILSON: I will be happy to do anything and everything I can to keep your heart working. Okay?

Mr. EDELSON: All right.

Dr. WILSON: And all you have to is call me if there's any sense of that feeling coming back that you remember from '93. Okay?

Mr. EDELSON: Great.

SILBERNER: Out of the examining room and in his office, Bible on his desk, a picture of Martin Luther King on the wall, Wilson admits he loves his job.

Dr. WILSON: I enjoy my patients. And when I go in there and I close the door, all the difficulties we have with health care go away, and it's just a matter about me and my patients.

SILBERNER: Since January 1st, he's been dealing with a new difficulty: Medicare cut payments for tests that cardiologists do all the time, like echocardiograms and certain stress tests. So, Wilson will be getting less for treating his elderly and disabled patients on Medicare.

Dr. WILSON: The average community cardiology practice, over the next four years, will be looking at somewhere around a 30 percent reduction in reimbursement for Medicare patients.

SILBERNER: Joe Wilson feels his practice is threatened. The government officials who pushed for the change say theyve been paying cardiologists too much. Wilson won't say what he makes for taking care of people's hearts but he says it's not far from the national average, and thats $400,000 a year.

Dr. WILSON: I realize that that seems like a lot of money. But the average cardiologist, like my young associate here, did not really start making any money in cardiology until he was 33, 34 years old.

SILBERNER: He says cardiologists work long hours and are on call 24/7.

Dr. WILSON: And we take care of really sick people and we make life and death decisions every day. I am not embarrassed about the fact that we feel, in cardiology, that we work very, very hard for what we make.

SILBERNER: The American College of Cardiology filed a complaint against Medicare to stop the changes. But a federal court has so far declined to hear the case. Wilson's concerns? The lower fees will drive young doctors away from cardiology. It could be the end of community-based practices especially in rural areas, with doctors going for higher paid jobs in hospitals. Wilson may have to cut back on services he provides for free, like telephone consultations with his patients, for example.

One person who doesnt share his concerns is family physician Lori Heim. She's head of the American Academy of Family Physicians.

Dr. LORI HEIM (President, Academy of Family Physicians): Cardiologists make two to three times what a primary care physician makes. If family physicians can manage to keep their practices open and serve their communities, I think that cardiologists should be able to figure out how to do that, as well.

SILBERNER: At the same time Medicare reimbursements for cardiac care went down, reimbursements for primary care went up four percent. What the government is trying to do is encourage primary care docs and discourage expensive tests. The differences between the cardiologists and family physicians highlight the fight over health overhaul on the national level.

Physician economist Alan Garber of Stanford University says the real problem is more than just cardiology payments.

Dr. ALAN GARBER (Professor, Health Policy, Stanford University): The fundamental problem here, though, is that we're really paying for the wrong thing. That is, cardiologists and other doctors get paid for each procedure, each service they render.

SILBERNER: There's a solution, he says: pay the doctor not per procedure but a fixed rate, based on whatever disease the patient has. That happens to be the same solution that Joe Wilson wants and it's in the Senate health bill in a small way as a demonstration project, not jut for cardiologists but for all medical care.

Meanwhile, the cardiologist's trade group is pinning its hopes on another piece of federal legislation that would reverse the changes.

Joanne Silberner, NPR News, Atlanta.

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