If these reimbursement changes come to pass, our 16 person group of Cardiologists will out of necessity have to make substantial cuts in our base of employees that support our group's efforts. These individuals, as with many practices, spend many hours each week discussing in particular with Medicare beneficiaries, their multiple medical problems as well as their cardiology problems. We have become in many cases the "de facto" primary care/cardiology physicians for these individuals. This free service will go away. Futhermore, after purchasing infrastucture for an EMR and hardware for this system at over 1 million dollars and going through echo and nuclear certification, leasing multiple echo machines with upgrades etc. we are yet again faced with the threat of major cutbacks in reimbursements. These concepts are mutually exclusive. If these cuts occur,along with the nuclear reimbursement cuts most likely to be enacted, it will be of little merit to have ancillary services in one's office. These changes will certainly impact the care provided to our many patients that come from a 4 state referral area. I could say more but I'll stop.  Thanks.

Dr Kraus and i have similar experiences with the substatntial investments we have made in our practice that were costly and time consuming (EMR and certifications). It is hard to understand how CMS comes up with a > 20% reduction in cost for practices.  If I try to look at this as a dispaasionate citizen and not as an affected physician what scares me most is that IF this is the data sets and conclusions that can be generated what will happen when CMS is enacting effectiveness guidelines in determinig what therpies will be acceptable.  Can the system generate verifiable and accurate data and conclusions???