AMA to advocate for improved Medicare payments for office-based labs
The Society for Cardiovascular Angiography and Interventions (SCAI) spearheaded a resolution at the American Medical Association (AMA) House of Delegates (HOD) meeting seeking policy changes that would separate out high-cost medical supplies used in office-based labs (OBLs) from the Medicare Physician Fee Schedule. Currently, supplies for OBL procedures are rolled into traditional physicians payments.
SCAI was joined on the resolution by the American College of Cardiology (ACC), Society of Interventional Radiology (SIR), American Association of Clinical Urologists, American Vein and Lymphatic Society, American Venous Forum and Outpatient Endovascular and Interventional Society. Cardiology does perform some non-coronary procedures in OBLs, but the effort will likely have an even greater impact on other specialties such as interventional radiology and urology.
"Unfortunately, some of the devices we use are quite expensive and they sometimes come to more than the payment for the Medicare Physician Fee Schedule. This makes some of those treatments not accessible to our patients. So we're trying to get those high-price devices taken out of that Physician Fee Schedule. It's kind of crazy that these high-priced devices basically eat up all the reimbursement that we should normally get for caring for patients," explained Jeff Marshall, MD, an SCAI delegate to the HOD and interventional cardiologist ay Northside Hospital Cardiovascular Institute in Atlanta.
Resolution 115 was adopted by the HOD at its meeting this week in Chicago. It aims to address a financial barrier that makes it economically unfeasible to perform certain procedures in OBLs, facilities that offer patients convenient access to care at a lower cost outside of hospitals or ambulatory surgery centers (ASCs).
According to Marshall and co-delegate Edward Tuohy IV, MD, director of the cardiac cath lab at Bridgeport Hospital in Connecticut, the problem lies in how Medicare structures payments. Hospitals and ASCs receive separate payments for devices, but OBLs must absorb those costs within the physician’s fee, which can quickly become financially unsustainable.
"As much as we love delivering care as doctors, if we are losing money doing something, we cannot sustain it. And that's been a major driver of a lot of things that have happened in medicine," Tuohy explained.
Higher-cost items for cardiology of interventional radiology could include things such as stents, intravascular imaging catheters, and atherectomy or drug coated balloons for guide wires for treating peripheral vascular disease. For obstetricians, on the other hand, it could include hysteroscopy instruments. And for urologists, it could include lithotripsy catheters.
"We need a push for a parity in the OBL payment schedule for the delivery of these services," Tuohy emphasized.
He said this would allow savings overall that can be carried over to care delivery, where some procedures can be done in an OBL at a fraction of the price for the same procedure at a hospital.
Outpatient OBLs and ASCs have grown rapidly in recent years as alternatives to traditional hospital care, offering high-quality treatment in lower-cost settings. Some health systems now partnering with ASCs or OBLs for low-acuity, routine procedures, allowing hospitals to focus on more complex cases.
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: [email protected]