The Cost of Living

How cardiologists used the press

Containing the runaway cost of medical care is the thorniest of all the thorny issues in the health-reform debate. There’s been tons of talk from politicians, advocates, and even health-care stakeholders about the need to reduce the nation’s rate of spending on medical treatment and keep a lid on price increases. Yet many policy experts say that the “acceptable” cost-containment options in the House and Senate bills are weak and will actually lead to more health-care inflation, which would mean that even more people could not afford insurance or care. It is a complicated, charged, and crucial issue; the press needs to dig in and own it. With this post we begin a periodic series that will scrutinize how well it does that.

“Cardiologists battle Medicare over payment cuts” read the headline of a Miami Herald story last weekend, and the lede got right to the point:

In a striking example of the conflict between controlling healthcare costs and providing quality service, a group of South Miami cardiologists has written a letter to patients complaining that huge cuts in Medicare rates may force many heart specialists out of business or mean reduced services for their patients.

That sounds dire. The Herald’s story, by John Dorschner, said the doctors were complaining that Medicare had reduced “reimbursement for cardiac services on average by 40 percent,” and that another 21-percent cut was coming March 1. The doctors’ letter warned that they “will be either forced out of business or forced to drastically increase the number of patients seen, most likely with physician assistants or nurse practitioners.” Oh, oh. The specter of rationing and inferior care—and from nurse practitioners no less!

Dorschner’s story described a new Medicare rule, which took effect January 1, that cut projected total revenues for cardiologists by 13 percent on average over four years while increasing the revenue of internists, family doctors, and general practitioners. Think of it as income redistribution designed to make primary care more attractive to med students and increase the supply of those kind of docs. (At a minimum, the health-reform debate has illuminated payment disparities between the primary-care doctors and the high-priced specialists who have always commanded big bucks.)

Heart doctors across the country—not only in Miami—cried foul, and Jack Lewin, who heads their trade group, the American College of Cardiology, vowed “to do everything we can in the legislative, legal and regulatory arenas to stop these cuts.” Lewin could have added the media to that list of arenas, because the ACC pulled out all stops to sound the alarm with the nation’s press and public through its Campaign for Patient Access.

The Herald’s story was the best of a bunch of news articles that for the most part passed along the cardiologists’ complaints, threats, and warnings without any hint that there was another side to the story. Between the slanted newspaper articles and audio news releases from the ACC, millions of Americans learned that the incomes of heart doctors, which can be upwards of $400,000, could take a hit. As an example of the kinds of cuts Medicare envisioned under the new rule, the administrator of one Florida heart practice explained that the reimbursement for a nuclear stress test could drop from $850 to $600. Presumably he said it with a straight face.

In December, the ACC sent news releases to media outlets in places like Denver, Colorado Springs, Birmingham, Chicago, Wilmington, Delaware, and Fort Myers, Florida. The association used local doctors as spokesmen and women and featured local cardiology practices that would be in deep trouble when the cuts take effect. There was plenty of scary rhetoric, like the lead of the release for Colorado Springs: “As early as January, two of Colorado Spring’s largest cardiovascular care practices will be forced to cut back on patient services and reduce staff…both moves will significantly impact patient access and care in the Colorado Springs area.” Essentially the same lead was used in Birmingham and Denver.

ACC spokesman Amy Murphy described the press campaign as very successful. For example, in Denver, KMGH 7 News published a story on its Web site that featured the two cardiology practices named in the ACC press release, Aurora Denver Cardiology Associates and South Denver Cardiology Associates, along with this quote from the CEO of Aurora: “Our staff has not had a raise since 2007.” There was no context for the rule and the rate cuts, no opposing views. The reporter did ask why cardiologists were bearing the brunt of the proposed cuts. “I think there was a bureaucratic snafu of huge proportions,” replied the president of South Denver Cardiology Associates. None of that malarkey about closing the payment gap between specialists and family doctors.

The release the ACC crafted for the Ft. Myers area provided some handy sources for reporters: three practices that warned of cutbacks to services. The News-Press in Ft. Myers found them useful, featuring one Dr. Brian Taschner, of Coastal Cardiology, who claimed that “with these cuts we’re barely going to be able to afford our overhead.” So did the Naples Daily News, which transcribed from the press release the following quote from Dr. Murali Muppala, of Advanced Heart Center: “I doubt hospitals will be able to accommodate the volume of patients that would need diagnostic tests if private-practice physicians cut back.”

The ACC has argued that if doctors will send patients to hospitals for these diagnostic tests, that it could end up costing Medicare even more money because of the higher reimbursement rates for hospitals. Most of the news stories didn’t explore this claim, which brings me back to The Miami Herald. Dorschner did explore these assertions. Ellen Griffith, a Medicare spokeswoman, told Dorschner that it was difficult to compare payments for tests done in a doctor’s office with those done in a hospital because the services were not always comparable. Dr. Robert Berenson, who was once in charge of payment policies for Medicare, and is now a fellow at the Urban Institute, told the paper that, “If the hospitals are getting paid too much, the answer is to reduce their payments.”

Given this aggressive PR strategy, we need journalists to keep a critical eye on the doctors as the cost-control debate staggers on. As Berenson put it to me: “If we can’t address the problem of highly paid, and some would say overpaid, cardiologists, then we’re not serious about getting our health care costs under control.” Therein is the seed for more stories to come.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.