In the face of 3.37% Medicare payment cuts, the American Society of Nuclear Cardiology (ASNC) is intensifying its advocacy efforts to address reimbursement issues. ASNC President Lawrence Phillips, MD, spoke with Cardiovascular Business about the challenges and frustrations within the medical community over the medicare cuts, and outlines the society's approach to securing fair reimbursement policies.
The 2024 Medicare cuts that went into effect in January have left physicians concerned about their ability to provide high-quality care. Phillips emphasizes the immediate need to reverse these cuts to ensure a neutral financial environment for physicians. He also highlights the need for long-term reform, especially with these cuts happening at the same time as rising inflation, clinical staff shortages, rising wages and an aging population.
"There is tremendous frustration on the part of physicians, not just nuclear cardiologists, but all physicians in seeing the Medicare cuts that have now gone into effect, which is almost a 3.5% cut across the board. Which you think about it, it is crazy in this environment," Phillips explained.
Some providers have already started to turn away Medicare patients because the reimbursement is not worth their time or does not cover their actual costs, he said.
What is needed to reform Medicare and prevent patients from not receiving care?
In the short term, Philips said we need to reverse all these cuts and at least to get it back to a neutral number.
In terms of Congressional changes to the law to allow Medicare to be a better business partner with providers, he said inflation needs to be addressed. Currently, there is nothing built into the law to account for inflation and the rising cost of labor, supplies, and the costs of doing business.
Phillips said there are ongoing legislative efforts to rectify this. The proposed changes aim to mitigate the impact of inflation on healthcare costs and establish a more fair payment system.
Congress also needs to address the need for reform in budget neutrality policies, he added. The current policy requires the Centers for Medicare and Medicaid Services (CMS) to stay within its fixed budget. To maintain a neutral budget when the reimbursements reach the budget ceiling, cuts are made to what CMS pays for services and makes the physicians and hospitals eat the costs.
Phillips suggests adjustments to trigger thresholds and caps on conversion factors to bring stability to reimbursement rates.
"There is this trigger of $20 million where all of a sudden the whole pot gets confusing. Again, that's a really small number when we are looking at the entire amount of money that's expended by Medicare and there is a proposal to increase that, for example, to $53 million. That would in itself have a big impact on not seeing so much variability year to year," he explained.
Another area for possible reform is putting a cap on how much the reimbursement conversion factors can change in a particular year. Phillips said this makes it hard for physicians and health systems to formulate budgets for the next year when they do not know the numbers they need to work with until maybe Dec. 31. They usually do not know the numbers for sure until the start of the year after last-minute congressional lobby efforts and last-minute legislation to reduce the cuts each year.
"How do you plan and how do you make sure that you're able to build a system where patient care can continue at high quality levels?" Phillips asked.
As an imaging society, he said ASNC gets asked why it is so involved in advocacy issues, and Phillips said there are multiple reasons.
"It directly impacts our ability as nuclear cardiologists to provide care to continue to provide high quality care. The second [reason] is, it's important that all medical societies work together on this common goal of figuring out a fair approach to reimbursement so that we are all able to look at the patient in a holistic way and make sure that they're getting the care that they need," Phillips explained.
He argues that advocacy efforts are crucial not only for the financial well-being of physicians, but ensuring the future of Medicare patient care and making it financially sustainable.
When will Medicare reimbursement cuts reach a point where care is no longer provided?
Phillips acknowledged trends where some centers and physicians have already stopped accepting Medicare patients because of the low reimbursements. He stressed that in nuclear cardiology, payments are expected to go up. Nuclear cardiology is usually an integral part of a larger of a continuum of care, supporting a larger cardiology department. So in many places, it is unlikely they will be turning away patients.
"I think that it becomes very specific to the individual locations, the hospitals versus ambulatory practices, the location within the country, the density of physicians, and many other factors," he said.
Phillips said ASNC continues to advocate for structural changes within Medicare to ensure that reimbursement aligns with the costs associated with providing high-quality patient care in an ever-changing healthcare landscape.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com