Several private cardiology practices in San Antonio are having to lay off employees. They say declining reimbursements from the government are making it harder and harder to recover the costs of doing business.

Dr. Charles Rabinowitz is a cardiologist. He loves his job, loves taking care of patients, using the knowledge and skills he s honed from years in school and years in business to help save people s lives.

He hates what he sees as the changing face of health care. Doctors are being forced to move away from thinking about what s best for the patient, Rabinowitz commented. And they re going into a mode of having to think well, how am I going to keep my practice viable. How am I going to continue to make a living?

At issue for practices like South Texas Cardiovascular Consultants are declining reimbursements from the government for Medicare and Medicaid patients. Cardiology services were cut by a fourth January 1, 2020, and another 20% cut in Medicare payments across the board kicks in in March.

More than 10 employees for this group have lost their jobs. More layoffs loom. More than half of cardiology patients are on Medicare, but some specialists may stop accepting new Medicare patients.

At some point, doctors are going to tell their Medicare patients you know, I really can t afford to keep taking care of you, Rabinowitz predicted.

His practice is handing out a letter about its concerns to patients, using them to contact their Washington representatives, calling for action to sop what they consider devastating cuts.

Rabinowitz predicts patient waits for visits will be longer and the visits themselves much shorter as doctors try to fit in more patients to make up for lost income. At the heart of the matter is an uncertain future for private cardiologists.

It s not really my choice, Rabinowitz said. It s not my preference to start practicing like that. But I m being forced to practice like that because otherwise, I ll be out of business and I won t be practicing at all.

Cuts in Medicare reimbursements are scheduled to continue for the next four years. That s at a time when baby boomers are reaching the age when they ll be added to the Medicare rolls.

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