It's been interesting to hear my cardiology colleagues in the community discuss what the proposed CMS cuts might mean for their patients and the implications for therapy access for patients requiring cardiovascular services.
In one local group, 40% of the cardiologists are over age 55. Now imagine cutting their practice income between 11 and 42% this year, with the potential for additional cuts yearly afterward. Recall that payments collected must first pay for office overhead: staff, collection personnel, lease payments, rent or mortgage, taxes, etc. These expenses do not go down annually. Cardiologists' take-home pay will be the item ultimately affected by these cuts. If a cardiologist makes, say, an average of $350,000 and one assumes a 50% overhead cost for his practice before the cuts, then $175,000 must first go to support his overhead. If income to the cardiologist's office is reduced 20% (on average) in 2010, then of the total $525,000 that was collected last year will translate to only $420,000. Since the practice expenses remain (at best) constant, the cardiologist's salary will be $245,000. ($350,000-$105,000 = $245,000).
Most internists and primary care doctors are quietly smiling right now. "Serves 'em right!" they snicker under their breath.
But if we consider this threat, is there an incentive to order fewer tests to offset their losses as they struggle to pay their kid's college educations?
Further, recall the fact those "rich" cardiologists do not finish their training until age 30, on average, and that about a third of them are over age 55. We have to wonder if many will opt for early retirement instead of tolerating the bureaucratic hassles and salary cuts. After all, the nice thing about an MD degree is there are plenty of other options besides clinical care.
Alternately, in exchange for the dramatic salary reductions, they might demand a better life-style with better hours. If so, 90-minute door-to-balloon times might not be so easy to come by for hospitals. ER's might not find cardiologists quite so available, too, since the added 8% added to E&M codes won't offset the economic losses enough to warrant this extra workload. Hospitals' quality ratings will likely fall as they fail to meet their benchmarks and Medicare payments will dwindle to them, too.
While these cuts might help the Medicare budget very slightly and look good to policy pundits who have never had to go to a hospital at 2AM for an acute MI (heart attack), it's an entirely different thing in real life. Regretably, it's often the patients that lose.
Is this the price our system is willing to pay?
Perhaps. These cuts are certainly on the table. (Warning: pdf, 1277 pages).
But one thing's for sure, with these cuts will come consequences. Given the fact that cardiovascular problems are one of the most common ailments in man and a large number of cardiologists are approaching retirement age, these are going to be every tough times for doctors, hospitals and patients alike.
Is this who should be affected most by our current reform plans?