What Can Hospitals Do to Support Their Electrophysiologists After the Medicare Reimbursement Cuts?

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EP LAB DIGEST. 2023;23(6):4.

Dear Readers,

Although it did not seem possible, dramatic cuts to physician reimbursement for electrophysiology (EP) procedures were finalized by the Centers for Medicare & Medicaid Services (CMS) in the last 2 years. In total, reimbursement and the associated relative value units (RVUs) for ablation procedures for supraventricular tachycardia (SVT) and atrial fibrillation (AF) were slashed by 32% and 36%, respectively, compared to 2021. Although electrophysiologists are now more efficient at performing catheter ablation procedures compared to 20 years ago, there has been no recent revolution in the procedure that is a sufficient argument for a reduction in reimbursement by one-third. Apparently, these cuts were based on physician surveys, not real numbers, which likely included unfounded and/or exaggerated procedural times. Furthermore, the change by CMS does not account for the continued advanced technical skills and risks associated with the procedure. Nor does reimbursement for AF ablation account for the increasing number of repeat ablation procedures that can be quite complex and prolonged but are still captured using the same billing codes.

Most physicians are compensated based on their productivity. The Heart Rhythm Society recently completed and published a survey of physicians who perform ablation procedures in the United States to assess the impact of these cuts.¹ Consistent with most electrophysiologists being hospital employees, about half of respondents reported that over 80% of their income is based on RVUs. Ninety-five percent of electrophysiologists felt that the cuts were unjustified, and 87% reported that their retirement plans would be affected. An immediate impact of these reimbursements was staffing cuts. About one-third of respondents reported that they have already seen cuts to the number of nurses, technicians, and administrative staff since the payment cuts were finalized, and more than one-third of respondents indicated that their institution had already decided to delay investment in new ablation equipment because of the cuts. In addition, 87% of respondents indicated that they would spend less time teaching as a result of the reimbursement changes, over 75% of respondents agreed that the reimbursement cuts would reduce access to ablations and lead to avoidance of complex ablations, and 90% felt that it was likely to decrease the number of trainees going into EP. Almost half of those who responded were contemplating against accepting Medicare patients.

The impact of the CMS cuts to physician reimbursement for ablation procedures will be devastating to both the EP field and our patients. What surprised most electrophysiologists, however, was that despite these cuts to the professional fees, hospitals received a 2% increase in reimbursement. So, what can hospitals do to help? A reasonable and immediate way for hospitals to mitigate these extreme reductions in physician reimbursement to electrophysiologists for important and critical catheter ablation procedures is for hospitals to share 1% of the revenue generated from the procedures. In the past, revenue sharing from the hospital was considered an illegal inducement to doctors to bring patients to that hospital. However, most physicians are now hospital employed. Sharing only 1% of the revenue generated by the hospital could keep electrophysiologists’ salaries stable. 

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.

Reference

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