As Valentine's Day 2010 approaches, there is both good news and bad news for heart patients in New York. First, the good news. Over the last decade, the mortality rate for cardiovascular disease in the U.S. has dropped an unprecedented 30%. This tops the progress made in the fight against all other illnesses, including cancer. Cardiologists are successfully preventing heart attacks, and returning cardiac patients quickly to normal activities. This achievement is due to advances in treatment -- such as cholesterol-lowering drugs and blood thinners -- and more effective angioplasty and surgery. Another important factor leading to improvement in patient care has been the growth of office-based cardiac imaging, such as nuclear stress testing and echocardiography. These modalities, once available only at academic medical centers, have facilitated early diagnosis and treatment. People with possible cardiac symptoms can now be evaluated rapidly, in one office visit, and started immediately on appropriate, often life-saving therapy.
Now, the bad news. An arbitrary rule (The Rule), put into effect by the federal Center for Medicare and Medicaid Services, threatens the progress we have made by slashing reimbursement for cardiology office visits and in-office cardiac imaging by as much as 35%. "The Rule" was based on data from a survey of Physician Practice Expense Information that used seriously flawed data, collected from only 50 of the thousands of cardiology practices in the US. Many (20%) of the practices reported no expenses for nursing personnel, which clearly indicates they were not representative of a typical cardiology office. The cuts, which are currently in place and unrelated to any health care reform bill, curtail cardiologists' ability to make in-office diagnoses, and jeopardize the viability of private practice cardiology in New York State and throughout the country.
"The Rule" has already resulted in drastic layoffs in staff, elimination of imaging programs and even the closure of some offices. Upstate New York, with its many rural communities, has been particularly hard hit. For example, New York Heart Center in Syracuse reports that their nine person cardiology group has had to close its satellite office in Massena, is eliminating nuclear imaging at its office in Pulaski and has laid off one-third of its non-physician staff. Albany Associates in Cardiology has eliminated thirty-one staff positions. Other groups in the Capitol district have eliminated physicians, and terminated poorly-reimbursed programs such as cardiac rehabilitation, which historically has been financially subsidized by office imaging. "The Rule" has certainly had a negative impact on the availability of services and the employment picture in New York State.
Not surprisingly, the problem is not limited to New York. The Rule has created a crisis situation for many cardiology practices throughout the country. Large cardiology groups throughout the U.S. have been pushed to the financial brink, and have been sold to hospital "megasystems" in order to maintain patient care. Whether these hospital systems will maintain small, unprofitable outreach satellite offices at this point remains unclear.
The American College of Cardiology has been fighting "The Rule" for six months but has so far been unsuccessful. We need the help of our patients. Please write or telephone your Congressmen/Senators. Ask them to support H.R. 4371, initiated in the House of Representatives by Congressman Gonzalez of Texas, which will freeze cuts to cardiology and allow the impact on patient care to be assessed. Patients may learn more about the Rule, and also contact their legislators, by going to www.campaignforpatientaccess.org.
Take action by Valentine's Day! The life you save may really, in this case, be your own.