PROPOSED LETTER TO CONGRESSMEN

Re: Devastating Proposed Cuts in Medicare Fees for Cardiac (Thoracic) Surgery

Dear (Senator or Congressman):

I am writing to ask your help with an issue that is of great concern to me as a surgeon who cares for many Medicare patients: setting the proper practice expense reimbursement for cardiac and thoracic surgery under the Medicare Fee Schedule.

As you know, the Balanced Budget Act of 1997 required HCFA to redo its earlier work on this subject, directing HCFA this time to "recognize all costs, not just those that could be tied to specific services." HCFA did in 1998 change its methodology, using a data base from the American Medical Association to propose new practice expense values.

The data base used for cardiac and thoracic surgery was very small - the AMA had gathered only 34 responses from this specialty - and statistically unreliable. Fortunately our specialty had asked the AMA to sample a larger group of cardiac and thoracic surgeons, and this much superior data, from 104 respondents, has been submitted to HCFA.

We had expected that HCFA would utilize this new data in its first round of revision of the "interim" rule. Unfortunately, they have not done so. But more appalling, in revisions proposed on June 22, HCFA has now proposed to cut from its allocation formula all costs incurred by surgeons for their staff who assist them in hospitals.

This proposal would lead to cuts of an additional ten percent of adult cardiac surgery, on top of the 16 percent already pending during the transition. For lung cancer surgery, additional cuts are in excess of five percent. The total impact on our profession is disastrous. We are profoundly concerned that this dramatic shift in medical priorities will jeopardize the health and safety of our Medicare patients who need these vital procedures.

We ask:

1. That Congress consider freezing the current practice expense values now in place until HCFA is able to make substantial progress on the annual refinement of the interim values called for in the Balanced Budget Act, including action on the following two points.
2. That HCFA utilize the superior data on practice costs for cardiac and thoracic surgery now provided by the American Medical Association.
3. That HCFA suspend a decision on deleting costs of staff in hospitals pending review of this issue by the Practice Expense Advisory Committee and its own contractor.

I would appreciate your writing to HCFA Administrator DeParle. A more complete position statement is enclosed.

Thank you again for your assistance in preserving a proper balance under the Medicare Fee Schedule and continued access to cardiac and thoracic surgery for Medicare beneficiaries.

Sincerely,

(YOUR NAME)