Next week, the CMS will recognize interventional cardiologists as a subspecialty, which they say will allow more fair and accurate comparisons of physician performance. In the short run, it means they can bill Medicare for consultations requested by a general cardiology colleague. And for the moment, it means more paperwork.
The CMS announced its decision last spring and the new designation is effective Jan. 12, the agency said this week in response to a query from Modern Healthcare.
Duffy
Dr. Peter Duffy, chairman of the Society for Cardiovascular Angiography and Interventions' advocacy committee, said the CMS has not yet set up a way for interventional cardiologists to register their subspecialty with the agency electronically.
“It has to be done in writing,” said Duffy, medical director of the cardiovascular service line at the Reid Heart Center/FirstHealth of the Carolinas, Pinehurst, N.C. He urged his peers and colleagues to be persistent because, despite the paperwork burden, it will be important in the long run.
A CMS spokesman confirmed that physicians need to use a paper form to change their specialty designation. But he added that online enhancements are being made to allow doctors to update their specialty electronically.
In the current fee-for-service model, the designation brings the ability to collect between $73 and $144 per consult. Duffy said he suspects that payments for consults conducted in the weeks ahead will probably be made retroactively.
Without the CMS subspecialty designation, if a general cardiologist called in an interventional cardiologist in the same medical group, they could not bill Medicare for the second doctor's time. Both would be considered “cardiologists” by the CMS so it would be considered double billing—even if the interventional cardiologist spent more than an hour conducting an exam, ordering tests and reviewing results, and then entering findings and a diagnosis in the patient's record.
They would be considered the same even though general and interventional cardiologists are two types of doctors with different skill sets and personalities, said Dr. Stephen Ramee, chairman of the American College of Cardiology's Intervention Council.
“General cardiologists are 'cognitive' doctors, we're 'doing' doctors,” Ramee said. “It's akin to a general cardiologist being the general contractor, the electrophysiologists being the electricians and the interventional cardiologists being the plumbers.”
Cardiac electrophysiologists, who diagnose and treat heart-rhythm disorders, received subspecialty CMS recognition in 2011 (PDF) and emboldened the interventional cardiologists to go down the same path. Duffy credits his predecessor in the advocacy chairman's seat, Dr. James Blankenship at the Geisinger Medical Center in Danville, Pa., for getting the effort started.
Ramee
“We've had our own subspecialty since the 1980s and we called ourselves 'angioplasty doctors' back then,” said Ramee, medical director of the heart valve program at the Ochsner Health System in New Orleans. “For the last 15 years, we've been a distinct subspecialty with distinct training.”
The American Board of Internal Medicine began certifying interventional cardiologists in 1999, and the American Board of Medical Specialties reports that there are 5,884 doctors with active certification in the subspecialty.
The ABIM started certifying cardiac electrophysiologists in 1992 and heart-failure-transplant cardiologists in 2010. Ramee said CMS needs to complete the cardiology subspecialty-recognition circuit and designate heart failure-transplant cardiology as a distinct subspecialty.
According to SCAI, the new CMS designation for interventional cardiology will result in fewer claims denials, improved evaluation of performances and outcomes, and fairer comparisons in resource utilization.
The interventional cardiologists generally treated patients with more complex conditions than general cardiologists and often did not compare as well in terms of resource utilization or outcome measures such as length of stay.
“We're all for quality reporting and performance measures,” Duffy said. “But now, when quality metrics come down the line, it won't look like interventional cardiologists are outliers because our resource use is higher.”
Ramee agreed that interventional cardiologists welcome public reporting as long as it's placed in the right context. He added that interventional cardiology is “probably the most studied field in all of medicine.”
Most cardiologists may still operate in a fee-for-service environment, but most also know that volume-based payment is being phased out and recognize that future compensation will be linked to quality metrics, Ramee said.
This trend is being accelerated as more cardiologists move toward hospital employment and away from private practice, Ramee said. But he predicted more change was yet to come.
Ramee said reimbursement policies have already pushed cardiologists out of private practice and into hospital employment, but cardiology services were delivered at a lower cost when they were performed in physician offices rather than in hospital settings
So, more reforms are on their way, in part because “it's easier to control 5,000 hospitals than 20,000 cardiologists,” Ramee said. He added that he could see subspecialty board certification of CMS recognition being tied to hospital credentialing or employment.
Follow Andis Robeznieks on Twitter: @MHARobeznieks
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