Cardiologists from across the state have been banding together, bending the ears of lawmakers in Washington and even holding a rally in Orlando, all to protest Medicare cuts that they say will have devastating consequences for their patients and their practices.
The latest example was a large advertisement in Monday's St. Petersburg Times. Framed as a letter to members of Congress from 50 Pinellas County cardiologists whose names appear in the ad, it warns of "lengthy delays in diagnosis and treatment of heart disease." It asks Floridians to contact lawmakers to keep cardiologists' Medicare reimbursement rates at 2009 levels.
"This is huge," said Dr. David Mokotoff of the Bay Area Heart Center, a Pinellas group of 12 cardiologists whose names appear in the ad. He says doctors in Florida, which has so many older residents who get Medicare, are taking a greater share of the cuts.
"It's getting to the point where one starts to question, 'What am I doing here' " in Florida, he said.
The cardiologists are upset over two proposals by the Centers for Medicare and Medicaid Services. One is a 21 percent reimbursement cut that cardiologists and other specialists face starting March 1. Plus, the cardiologists also face cuts Jan. 1 in payments for some services, such as nuclear stress tests.
"It's a tremendous hit for all of the outpatient cardiology practices out there," said Dr. Alberto Montalvo, president of the Florida chapter of the American College of Cardiology.
Some savings from the cuts will be used to increase payment rates for general practitioners, family physicians, internists and geriatric specialists by 5 percent to 8 percent. It's part of an effort by the Obama administration to invest more in preventive care.
As the baby boomers age, many policy advocates say, there won't be enough primary care doctors to handle the demand. Salary disparities — primary care practitioners earn between $150,000 and $200,000 compared with cardiologists' $330,000 to $560,000, according to a 2008 survey — have made primary care less attractive to new doctors.
The rate changes are separate from the health reform legislation that's fighting its way through Congress. But such details matter little to heart doctors, who question how the cuts were calculated.
The 21 percent cut was based on a "sustainable growth rate," a formula that last month was repealed by the U.S. House. Montalvo says the cuts in reimbursement for services such as stress tests and cardiac catheterizations, were based on a survey by the American Medical Association that included input from just a few cardiologists.
CMS officials also have taken issue with the growth rate formula. Jonathan Blum, director of the CMS Center for Medicare Management, said in October that the administration tried to halt the cuts.
Dr. Trevor Law, a St. Petersburg cardiologist, says the cuts represent "probably the biggest financial impact on my practice since I've been practicing."
"Obviously, as physicians we have to do our duty. We're not going to stop doing these tests," he said. But Law, Montalvo and Mokotoff said Medicare patients may have to wait longer to get stress tests, or have to go to a hospital, where tests could cost patients and Medicare more.
Mokotoff thinks cutting pay to specialists in order to help primary care physicians is a "divide and conquer" approach.
"They want to pit one group against another," he said.
In anticipation of the cuts, some practices have frozen salaries or stopped hiring. The greatest impact likely will be on practices with three or fewer cardiologists, Montalvo said.
Jay Wolfson, an expert on health policy at the University of South Florida, says it's not the first time that the government has sought to increase reimbursements for primary care by cutting specialist payments. It happened in the late '80s to early '90s in an effort to compensate primary care doctors for the time they need to spend with patients to better manage their care.
The cardiologists got a break over the weekend when the Senate voted to delay the 21 percent cut from January to March, which may buy lawmakers time to find another answer.
"A lot of it also can depend on what happens in the next several weeks, with health care reform," Wolfson said.
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330.