"Particularly in a poor, rural state like West Virginia, these changes are going to be absolutely devastating," said Dr. Steve McCormick, a cardiologist who has practiced in Charleston since 1987 and is the president of the state's chapter of the American College of Cardiology.

McCormick said drastic reductions in Medicare payments set to take effect Jan. 1 will mean private practices will lose money every time they perform standard diagnostic tests.

The changes could force many of the state's 133 private practice cardiologists to leave the field or retire early, he said.

"It's a huge deal, and word is just starting to get out about what's happening," he said. "We're exploring other business possibilities in order to survive, and that's true for every cardiologist in private practice."

The 2010 reimbursement pay schedule -- cutting payments for diagnostic tests by between 25 and 42 percent while giving a slight increase to doctors providing primary care -- was unveiled in July. But cardiologists say many of their patients have learned of the changes only in recent weeks.

"My patients tell me they're very concerned," McCormick said. "They see this for what it is -- an issue of access to care. It's something that's going to hurt patients most."

Dr. Richard F. Terry, who has practiced in Wheeling since 1978, predicts the cuts would "essentially eliminate the private practice of cardiology everywhere in the country."

"Nobody can absorb cuts like this," he added. "You can't cut your income almost in half and stay in business."

In Martinsburg, Panhandle Cardiovascular Associates is likely to shut down in January, said one of the practice's owners, Dr. Neal Gaither.

"If this goes through, the Medicare payment for echocardiography would be cut by more than 40 percent," he said. "This is a test that's essential for seeing how the valves of the heart muscle are working, but it's not an inexpensive test. The imaging equipment can cost $100,000 and then you have the cost associated with running the test and reading the results. If the reimbursements are cut, we're not going to be able to afford to offer the test at all."

Instead, Gaither said, patients requiring the tests will be sent to the hospital.

Gaither said the rationale for the change can be traced to a survey that found offering the diagnostic tests in a hospital costs less.

"The survey clearly was flawed," said Gaither, who pointed out that the survey went out to 3,500 doctors. "Less than 5 percent of the surveys were returned and a large number of those were hospital-based and reported no overhead expenses."

Terry, Gaither and McCormick are urging patients and others concerned to get in touch with their representatives in Congress.