How Much Money Should a Cardiologist Make?

FORBES
Peter Ubel
Pharma & Healthcare
12/07/2012 @ 10:32AM


How Much Money Should a Cardiologist Make?

The cardiologist inserted a catheter into his patient’s right leg, snaked it up toward the patient’s heart, skillfully twisted it so it entered the left anterior descending coronary artery (the LAD being one of three arteries feeding vital blood to his patient’s heart), then carefully inflated a balloon to open up the artery in a section of the vessel that had become dangerously narrow due to years of cigarettes and cheeseburgers. Sixty minutes after beginning the procedure, his work was done and the patient’s chances of experiencing a subsequent heart attack had been significantly reduced.



Nearby in the same medical center, a rheumatologist was evaluating a woman who had spent years suffering from a constellation of mysterious symptoms: transient rashes, intermittent pains, even occasional fevers. She had received untold numbers of tests to evaluate her problems, numerous rounds of ineffective antibiotics, and her symptoms had marched along unabated as if taunting all the doctors who’d tried to help her. Yet over the course of two office visits, a total of 60 minutes of his time, the rheumatologist was able to deduce that his patient was suffering from Lupus, and thereby prescribe medications that would reduce her symptoms.



Two sub-specialists, each trained in their clinical specialty for six years after completing medical school. Each spent the same amount of time making use of their expertise to alleviate a patient’s symptoms. Each clinician’s sixty minutes of work paid for by the U.S. Government, through its Medicare program. And yet, Uncle Sam decided to pay the cardiologist 800 some dollars for his services and only 50 or so bucks to the rheumatologist. These are rough estimates, and the cardiology payment isn’t limited to physician fees alone. But still: the average income for an interventional cardiologist last year in the US? Over $400,000. Rheumatology, by contrast: under $200,000.



Who decided that Medicare should pay cardiologists so much more money than rheumatologists? Would you be surprised to learn that cardiology pay is largely determined by . . . cardiologists?



Utilizing a mathematical formula devised by a Harvard research team, Medicare pays physicians according to a Resource Based Relative Value Scale (or RBRVS). You can find details of this program elsewhere. But briefly, the RBRVS formula attempts to account for how much skill, effort, training, time and resources go into each bit of physician labor. Therefore, when a family physician treats a patient’s rash, she receives less money than a dermatologist, the latter being deemed (correctly) as having more skill and expertise at evaluating and treating such conditions.



The RBRVS formulae are continually revised and revisited, a necessary process because medical care doesn’t stand still. New interventions arrive on the scene and Medicare needs to figure out how much to pay for them. Information accumulates, too, on the effort and skill required to perform specific activities, and Medicare adjusts its fee schedule accordingly in an effort to improve its payment schemes.



But Medicare doesn’t have enough person power to keep track of all these new interventions and data. So it relies on expert advisory committees made up of physicians from relevant sub-specialty societies. When a new cardiology procedure hits the hospitals, a committee heavily represented by cardiologists advises Medicare on how generously it should reimburse for such procedures. And Medicare takes such advice quite seriously, agreeing with such recommendations almost ninety percent of the time.



No doubt, cardiologists know more about cardiology procedures than anyone else. And Medicare would be foolish to make decisions about cardiology reimbursement without talking to expert practitioners. But with payment so skewed toward procedural care, our updates to reimbursement rates need to take a broader perspective.



Given our overreliance on subspecialists to revise their own pay schedules, is it any wonder that procedural sub-specialists have been so successful in maintaining their high fees?









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This article is available online at:

http://www.forbes.com/sites/peterubel/2012/12/07/how-much-money-should-a-cardiologist-make/