Major Declines in Physician Reimbursement in Electrophysiology

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EP LAB DIGEST. 2023;23(12):6.

Dear Readers,

In recognition for all the hard work by cardiac electrophysiologists during the COVID-19 pandemic, the federal government imposed severe cuts in physician reimbursement for ablation procedures. Since 2021, the Centers for Medicare & Medicaid Services (CMS) cut reimbursement for ablation procedures for supraventricular tachycardia and atrial fibrillation by 32% and 36%, respectively.¹ Despite an actual increase in hospital reimbursement for those same procedures, there appears to be little appetite by hospital administrators to support compensation for electrophysiology (EP) physicians. In November 2023, CMS delivered another blow to electrophysiologists when they announced what is effectively an additional 3.4% pay cut to physicians in 2024 by reducing the Calendar Year (CY) 2024 conversion factor from $33.8872 in 2023 to $32.7442 (see CY 2024 Medicare Physician Fee Schedule final rule without comment period²).

So, what has happened to EP reimbursement over the past few years? Let’s look at reimbursement for a mature procedure performed by electrophysiologists that has not changed much in decades: implantation of a pacemaker. The CMS Physician Fee Schedule was used to look at reimbursement for implantation of a dual-chamber pacemaker each year since 2000 using CPT code 33208.³ Based on these data, reimbursement for CPT code 33208 has been about the same since 2000—about $600 for the past 20 years and a bit less now (Figure). Reimbursement for pacemaker implantation in 2000 was $697 compared to $588 in 2023. But that amount of $588 is misleading for 2 reasons. First, that amount does not account for inflation or the cost of living, and second, that amount is what the practice receives, not the doctor. What if pacemaker reimbursements were adjusted for inflation? The dollar amounts each year from the CMS Physician Fee Schedule were adjusted for inflation using an online calculator that links to the US Consumer Price Index (https://www.calculator.net/inflation-calculator.html) and are included in the Figure. The purchasing power of $588 today is equivalent to $332 in 2000. Incredibly, that represents a 52% reduction in reimbursement by CMS over the past 20 years. Furthermore, the RVU credit in 2023 for a dual-chamber pacemaker implantation is 8.52 RVUs. At most academic medical centers with physician compensation plans providing under $45/RVU, that translates into an actual payment to the physician of under $400 per pacemaker implant.

It is well documented that physician compensation represents a minor driver of rising health care costs in the United States. With recent cuts by the federal government in EP reimbursement and the demonstration that reimbursement for invasive EP procedures such as pacemaker implantation has declined by over 50% in the past 20 years, it is difficult to sit back and watch. Our professional organizations need to do a much better job lobbying for electrophysiologists. It is trends like these that lead to collective bargaining and organized labor efforts. 

References

1. Morin DP, Cheung JW, Chung MK, et al. Impact of reductions in Medicare reimbursement for cardiac ablation in the United States: Heart Rhythm Society’s follow-up survey. Heart Rhythm. 2023;20(5):656-657. doi:10.1016/j.hrthm.2023.03.018

2. 42 CFR Parts 405, 410, 411, 414, 415, 418, 422, 423, 424, 425, 455, 489, 491, 495, 498, and 600. CMS. Accessed November 13, 2023. https://public-inspection.federalregister.gov/2023-24184.pdf

3. Search the Physician Fee Schedule. CMS. Accessed November 13, 2023. https://www.cms.gov/medicare/physician-fee-schedule/search

Disclosures: Dr Knight has served as a paid consultant to Medtronic and was an investigator in the PULSED AF trial. In addition, he has served as a consultant, speaker, investigator, and/or has received EP fellowship grant support from Abbott, AltaThera, AtriCure, Baylis Medical, Biosense Webster, Biotronik, Boston Scientific, CVRx, Philips, and Sanofi; he has no equity or ownership in any of these companies.