First Word: Happy New Year, CMS!

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 - C.P. Kaiser

The smiles and lauds of “Happy New Year” are slowly being replaced by the droning realization that the reimbursement cuts in the 2010 Medicare Physician Fee Schedule are in full force. It’s difficult to discuss any topic in cardiovascular medicine without contemplating the influence of these drastic cuts enacted by the Centers for Medicare & Medicaid Services (CMS)—some as high as 40 percent.

The first question I asked the participants in our PCI Imaging Roundtable (see page 6) revolved around these reductions. The answers reveal fears of imaging centers closing, as well as an emphasis on scrutinizing all processes to ensure minimal waste of human and clinical resources.

The good news is that it is possible for any organization to adopt technology and a healthy attitude to overcome adversity. Our Facility Spotlight (see page 18) exemplifies how UMass Memorial rose from the despair of being publicly humbled by CMS for being an outlier in CABG mortality rates to becoming a source of pride for the Medicare agency. Strong leadership, a bold vision and cutting-edge technology have helped UMass become a beacon for other facilities to emulate.

Still, the American College of Cardiology will not sit idle while the bulk of its membership gets throttled by the payment cuts (see page 13). The college will continue its advocacy work on Capitol Hill. In the meantime, however, the outlook is bleak. Many members say they will have to cut service lines, reduce hours and lay off staff to accommodate the reduction in reimbursement. The ACC has many tools for members, namely, new and evolving practice management programs, to help weather these difficult times.

One trend that is particularly noteworthy is the increased interest in practice management software solutions that seems to be coinciding with the drive to adopt EMRs (see page 16). Sounds like the perfect marriage: tracking clinical and administrative data with one—or at least a dual—system. You can’t fix what you can’t measure and track and these joint systems will be hugely important.

Finally, when the underlying hardware, software and organizational infrastructures are in place, it might be time to assess adding service lines to your practice. New data about implantable devices could help boost this segment of electrophysiology, whose growth has been flat (see page 14). And atherectomy devices for peripheral arterial disease are finding a comfortable niche in endovascular treatment. Cardiologists would do well to acclimate themselves to more endo work with these tools, a reimbursable procedure (see page 20).

While the immediate outlook in terms of reimbursement looks dismal, cardiovascular medicine has always been challenged with one adversity or another. And it has always succeeded. So, don’t lose the holiday cheer too quickly!