The complaint alleges that Sec. Sebelius and the Centers for Medicare and Medicaid Services abused their discretion and acted arbitrarily and capriciously in violation of the Medicare statute and the Administrative Procedures Act by using the invalid PPIS in adopting the payment rates for cardiology services in the PFS. According to the complaint, clear and critical defects exist with respect to the methodology and data used to develop the PPIS, which was used to justify the cuts to Medicare reimbursement rates for cardiology, and which directly undermine the viability of community practices.
According to the ACC, these defects include CMS’ decision to use information from only 55 cardiologists to set reimbursement under Medicare for all of the cardiologists in the entire nation, when the results from that very small group were widely different from more reliable information that was available.
The complaint alleges that the number of PPIS responses used to determine the PFS Rule was too small to be representative and that the survey results were not in compliance with the federal regulations which govern precision standards, transparency and review. The complaint also alleges that the consultant group hired by HHS to analyze comments on the proposed rule noted to HHS that the PPIS data used to determine the PFS cuts were counter to all other widely recognized cost measures.
According to the ACC, the cuts in cardiology payment rates will force private cardiology practices to cut services and eliminate staff and will further push private practice physicians to consider hospital employment, which may decrease access to cardiology services for Medicare patients.
“These cuts will devastate patient access to care,” Alfred A. Bove, MD, president of the ACC, said in the release. “Already practices are closing their doors and their patients have nowhere to turn. Hospitals do not have the capacity or the specialized ability to absorb the influx of patients. Tests will be delayed, diseases will worsen and patients will become sicker and sicker. Many patients, especially those living in rural settings and urban centers will lose their access to critical cardiac care.”
The complaint was filed in the United States District Court for the Southern District of Florida. Co-plaintiffs include the American College of Cardiology, Florida Chapter; American Society of Nuclear Cardiology; the Association of Black Cardiologists; and the Cardiology Advocacy Alliance.
The complaint requests an enjoinment of the implementation of the PFS for cardiology based on this flawed survey data, and to require CMS to use more reliable, available data or conduct a new survey to determine a new 2010 PFS for cardiology services, according to the release.
Read the release on the ACC complaint against Sec. Sebelius.
