Reverse Practice Expense Cuts

In the 2010 Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) confirmed that the data from the American Medical Association (AMA) Physician Practice Information Survey (PPIS) will be used to update the practice expense per hour (PE/HR) rates. CMS will transition the data from the AMA’s PPIS over a four-year period. The AMA PPIS data shows a substantial drop in practice expense per hour for cardiology services.

In response to the concerns expressed by the cardiovascular community about the validity of the data, Representative Charles Gonzalez (D-TX), along with 55 cosponsors, introduced H.R. 4371, legislation that would reverse the practice expense cuts scheduled to take effect January 1, 2010, requiring CMS to use the 2009 Medicare Practice Expense Relative value units for certain cardiology services.

Under the legislation, the Secretary of Health and Human Services would also be required to contract with an independent entity to conduct a study of the practice expense methodology to verify the accuracy of the PPIS data and to report the results of the study, as well as recommendations for determining practice expense, to Congress before January 1, 2011.

Contact your Representative and ask him or her to protect Medicare patients’ access to heart rhythm care by co-sponsoring H.R. 4371.

To learn more, read the December 14, 2009 joint letter (PDF, 16K), signed by 10 cardiovascular associations including the Heart Rhythm Society, which asks representatives to cosponsor the legislation to mitigate the cuts to cardiovascular services while allowingpayment increases to other specialties included in the fee schedule to be implemented.

The letter notes "We have made remarkable strides in the fight against cardiovascular disease as a direct result of advancements in medical imaging, medications, and care over the past few decades. These drastic cuts are a step backwards and will negatively impact the remarkable gains."