CMS proposes drastic reimbursement cuts to outpatient cath labs

Reimbursement to outpatient cath labs threatened. Source: Intermountain Healthcare

Under proposed changes from the Centers for Medicare and Medicaid Services (CMS), reimbursement for cardiac catheterization procedures performed in non-hospital outpatient labs would be reduced 47 percent by 2010.

Once fully implemented, non-hospital cath labs would receive reimbursements several hundred dollars below the cost of performing the procedure. Because private insurers typically follow CMS's lead, the cuts would reduce reimbursements from all payor sources, driving many non-hospital labs out of business.

More than 45 members of the Cardiovascular Outpatient Center Alliance (COCA), a non-profit organization representing more than 60 U.S. cardiology practices, recently met with members of Congress to ask them to intervene and request that CMS set reimbursement rates aligned with the cost of the procedure.

"In addition to closing outpatient cath labs around the country, the proposed cuts would have a devastating effect on the entire healthcare system," said Steve Blades, president of COCA. "Patients would be forced back into crowded hospital settings where the cost of the same procedure is significantly higher, resulting in long waits and greater out-of-pocket expense. As a result, the federal government would incur $45 to $50 million in increased costs, defeating the very purpose of these reductions."

Based on 2008 Medicare reimbursement numbers, patient co-payments also would increase by $500, or 157 percent, while access to catheterization services would be diminished, according to the alliance. COCA said that Medicare beneficiaries currently pay $326 for a catheterization procedure performed in a non-hospital lab while out-of-pocket costs for the same procedure in a hospital outpatient lab total $839.

“I'm concerned the severe reimbursement cuts initiated by CMS for non-hospital outpatient cardiac catheterization lab procedures will threaten access and quality for the Medicare beneficiaries in my state and throughout the nation,” said Sen. Mary Landrieu, D-La. “I believe CMS should establish reasonable reimbursement that will allow these important patient care facilities to stay in business.”