First Word: Uncertainty and Shock Keep Plans on Hold

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 - C.P. Kaiser

Is it February already? It seems like only yesterday that hospital executives and cardiovascular professionals were bracing for the dramatic reimbursement cuts scheduled for 2010. It’s still early to gauge their effects, but word on the street is that everyone is pretty much still in shock.

“There’s a real sense of uncertainty in the market,” says Jeffrey Fine, PhD, president and CEO of J &J Medical, which is focused on cost-effective growth solutions in the disease prevention arena.

As a result, hospital and practice administrators are in a wait-and-see mode. The sentiment, according to Fine, is that they realize personnel and service cuts are inevitable, but want to postpone such moves until the future picture becomes clearer.

Stephen J. Green, MD, chief of cardiology at North Shore University Hospital in Long Island, N.Y., says that imaging centers with high expenses, especially those offering nuclear stress testing and cardiac CT, might have to close if their profits are marginal.

A flip side to that coin is that Green has seen an uptick in his outpatient nuclear imaging volume and attributes it to the downturn in smaller centers. He says that if the American College of Cardiology (ACC) cannot reverse the reimbursement cuts, more imaging centers will drop their nuclear service. The college is trying to do just that.

In December 2009, ACC sued the government alleging it unlawfully adopted the payment rates for cardiology services. In mid-January, however, a judge threw out the case, saying that federal courts do not have jurisdiction to review Medicare physician payment determinations. ACC CEO Jack Lewin said the ruling sets a troubling precedent for CMS to have “unchecked control over physician reimbursement.”

In the meantime, hordes of entrepreneurs have gone to Texas following a law that went into effect Sept. 1, 2009, requiring insurance companies to pay for heart attack preventive imaging tests—either a coronary artery calcium score with CT or a carotid intima-media thickness ultrasound exam. It’s like the Wild West as everyone scrambles to get a piece of the prevention pie, says Fine.

While the events in Texas might seem extreme, they do suggest the need of many providers to supplement or at least contain their declining profits. Cath lab managers are doing their best to keep inventory levels low. Some have begun stocking the newly approved antiplatelet prasugrel, but widespread adoption of the drug is slow, even though some cost-effective analyses for the agent are favorable.

Regarding vascular closure devices, the overriding prerequisite for determining what gets stocked seems to be physician preference, despite unsettled questions about safety and comparative effectiveness research.

On the bright side, the government finally proposed criteria for “meaningful use” of EHRs (see page 8). The 500-plus-page tome is daunting, but vendors are guaranteeing their products will meet the standards and are offering creative financing options.
Many executives, physicians and cardiovascular professionals are hoping that 2010 proves far better than 2009. The uncertainty and shock will eventually subside and everyone will do what they need to provide quality care without breaking the bank. If that doesn’t work, pack up your ultrasound scanner and head to the Lone Star State.