ACC's Lawsuit Against Medicare's Physician Fee Cuts Dropped

A lawsuit filed in December by the American College of Cardiology against the Department of Health and Human Services for cutting Medicare reimbursements for cardiology services has been dismissed by the U.S. District Court of Southern Florida, according to a report in American Medical News.


In a ruling on Jan. 12, 2010, the court said that it did not have authority to review Medicare payments. The ACC had asked the court to block the cuts and to prevent Medicare from using flawed data to make its decisions, according to the report.

According the current 2010 CMS physician fee schedule, physicians across the board will receive a 21.2 percent pay cut, which is set to go into effect on March 1. The additional cuts would see reductions of up to 40 percent for cardiology procedures and up to 45 percent for radiology, among other significant cuts for procedures across specialties, according to the report.

Debate over the methodology used to calculate these rates has been raised by many specialists who say that the Physician Practice Information Survey used by CMS does not provide an accurate picture of their costs. For example, only 55 cardiologists provided data for the PPIS and did not have the same overhead costs as typical private practice physicians, according to the report. Using the PPIS, CMS calculated a 40 percent reduction in the cost of providing cardiology care over the past five years, whereas ACC officials say most physicians experienced a 2 percent increase in overhead in 2009 alone.

HHS and CMS have defended their decisions, saying that ample time for comment by the public on their decisions was provided. The agencies also said in the report that the decision will keep healthcare services affordable and accessible for Medicare beneficiaries, according to the report. Officials from the American Medical Association, which spearheaded the PPIS with the participation of 72 medical organizations, said that the survey process was transparent and collaborative process and that data had not been updated in over a decade prior to the survey.

In a statement released on Jan. 12, ACC called the court's decision "a blow to physicians everywhere" and promised to continue to fight the changes. The statement reads:

"While we didn't win in court we did discover just how little CMS knew about the practice expense survey data used to determine the most drastic portion of the 2010 Medicare cuts . . . This information will be extremely useful as we move forward with CMS, Congress and, to the extent possible, the public to develop and implement a fair and just payment methodology that protects not only the private practice of cardiology, but patient access to timely and cost-effective care."

Read the AMNews's report about the ACC's lawsuit against HHS.

Read the ACC's statement on the Medicare lawsuit.

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