"I know of no safe repository of the ultimate power of society but people."
The drastic changes occurring within the U.S. government under the new Administration have left many Americans apprehensive, but Thomas Jefferson's words remind us not only that such transformations have taken place in U.S. history, but also that the democratic system allows its citizens to voice these concerns -- just as the American College of Cardiology (ACC) did when CMS proposed its 2010 physician pay cut.

On July 1, the Centers for Medicare & Medicaid Services (CMS) proposed a 21.5 percent rate reduction for 2010 to more than one million physicians and non-physician practitioners who are paid under the Medicare Physician Fee Schedule. In response, ACC President Alfred Bove said that the college was "shocked that CMS has proposed to cut payments to cardiology services by 11 percent in a single year," noting that the decision was based on a "few esoteric pieces of data." ACC is launching a campaign to fight the cuts.

In a busy week for government health organizations, CMS also proposed giving a small boost to hospital outpatient departments, by adjusting hospital pharmacy costs that would result in payments of the average sale price of a drug, plus 4 percent for separately payable drugs and biologicals. This increase would assist intensive cardiac rehabilitation services furnished in outpatient departments.

Also, policies and legislation have been aimed at cardiac image equipment utilization rate and potential overuse. On July 1, CMS recommended an increase in the equipment usage rate from the current 50 percent to 90 percent for equipment priced more than $1 million as part of its proposed rule, which, if approved, will have a drastic impact on practices and hospitals using molecular imaging equipment, CTs or MRIs.

Almost simultaneously, a bill was introduced in the U.S. House of Representatives to exclude "certain advanced diagnostic imaging services" from the in-office ancillary services exception to the Stark Law's prohibition on physician self-referral. 

Finally, in what may be a futile display, several U.S. hospital organizations have agreed to accept $155 billion less in reimbursements from the federal government in an attempt to offset costs if healthcare reform is passed with a public insurance plan.

As Jefferson said, "I am not an advocate for frequent changes in laws and constitutions, but laws and institutions must go hand in hand with the progress of the human mind." We, as consumers and advocates, simply need to decide if these changes in healthcare are fitting to this type of progression.

On these topics, or any others, feel free to contact me.

Justine Cadet