President's proposal pinches cardiology staffing, research

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 - variation, business

The 2014 budget proposed by President Barack Obama bumps up funding for healthcare research but it also slices into payments hospitals receive for medical training. Cardiology associations said the moves may have deleterious effects on the cardiac physician workforce and research.

The budget outlined numerous changes for fiscal year 2014, with funding for the Centers for Medicare & Medicaid Services (CMS) at the centerpiece. The budget called for a net increase of $60.2 billion over FY 2013 for CMS and projected Medicare savings of $371 billion and Medicaid saving of $22.1 billion over 10 years.

Funding for the National Institutes of Health (NIH) would total $31.1 billion in FY 2014, a 1.5 percent increase from FY 2012 funding. The National Heart, Lung and Blood Institute would receive just under $3.1 billion, up from $3.07 billion in FY 2012.

“While President Obama’s budget moves in the right direction by restoring the National Institutes of Health funding cut by the sequester, the administration’s proposal fails to fully account for medical research inflation and puts promising new research opportunities at risk,” American Heart Association CEO Nancy Brown said in a statement. “Over the past decade, the NIH has lost 20 percent of its purchasing power.”

The increase in research funding also fails to offset the 10 percent proposed cut to teaching hospitals that provide graduate medical education, according to the American College of Cardiology (ACC), which warned that the cuts in education will compromise patient care and training of future physicians and researchers. “These funding cuts could mean fewer medical professionals will be trained at a time when there is a growing need,” wrote ACC Advocacy Steering Committee Chairman M. Eugene Sherman, MD, in an email to Cardiovascular Business

The budget document cites Medicare Payment Advisory Commission (MedPAC) research that concluded Medicare add-on payments to teaching hospitals for medical education indirect costs exceeded incurred patient care costs. The proposed budget reduced graduate medical education payment by 10 percent, for a projected savings of $780 million in FY 2014 and $11 billion over 10 years.

The ACC also criticized an item in the budget that is designed to exclude certain services from the in-office ancillary services exception.

"While there are many appropriate uses for this exception, certain services, such as advanced imaging and outpatient therapy, are rarely performed on the same day as the related physician office visit,” according to the budget document. “Additionally, evidence suggests that this exception may have resulted in overutilization and rapid growth of certain services.”

Beginning in calendar year 2015, radiation therapy, therapy services and advanced imaging would be excluded, with some exceptions. The change would result in savings of $6.1 billion in over 10 years, according to the budget writers.

“Limiting these exceptions would force patients to receive services in a new and unfamiliar setting, increase inefficiencies, present significant barriers to appropriate screenings and treatments, and make healthcare less accessible,” Sherman wrote. “The medical profession has taken significant steps to ensure that only medically necessary and appropriate ancillary services are performed. These steps include the development and implementation of training guidance, appropriate use criteria, practice guidelines, and decision support tools that assist physicians in delivering the most appropriate care in the most cost-effective manner.”