Alfred Bove was chief of cardiology at Temple University Hospital for 18 years and one of the Sixers' doctors for 22. But these days he's finding himself thinking more about his 35 years with the Navy, including a three-month stint in Operation Desert Storm with the reserves.

As president of the American College of Cardiology, Bove is point man in a contentious campaign to protect pay for its 37,000 members as the government makes cuts that would shift money from heart specialists like himself to primary-care doctors.

His new role involves frequent lobbying on Capitol Hill. His association last month took the unusual step of filing suit against Kathleen Sebelius, secretary of the Department of Health and Human Services, in an effort to stop what it sees as unjustified cuts based on flimsy evidence.

Bove's new environment, with its high levels of change and uncertainty, feels "a little like a war," he said. "There's a lot of ad hoc decision making on the fly. That's the kind of stuff I like to do."

The College of Cardiology asked a U.S. district judge to grant an injunction against a new fee schedule for heart specialists that took effect Jan. 1. A hearing was scheduled for today.

But the cardiologists have already lost this battle. Yesterday, the judge said no; he can't legally step in.

That made Bove think of what the Sixers would say if they'd lost a game. "We're going to fight hard and win the next one," he said.

The cardiologists will now have to follow the government's complaint procedure to the end before considering a suit. They will step up efforts to get Congress to delay the cuts. And they will collect data on how lower payments affect doctors and patients, Bove said.

The Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, estimates the pay changes would reduce overall Medicare spending on cardiology this year by 8 percent. Because the cuts are deepest for diagnostic tests, such as echocardiograms and stress tests, Bove said doctors whose offices received a high proportion of income from testing could see reductions of 20 to 40 percent.

"It'll take a lot of private practices and reduce their income to the breaking point," Bove said.

He contends the pay cut will make doctors give up their private practices and work for hospitals. That, he says, not only could make it harder for patients to find doctors and tests - especially in rural areas - but could drive up costs because hospitals are paid more for the same tests. Patients also often make higher co-payments for tests done in hospitals.

Payments for doctors' visits rise 6 to 8 percent under the new rules, Bove said, but that will not offset cuts of up to 40 percent for procedures.

While cardiologists are paid by many insurance companies, Medicare sets the tone, Bove said. "What normally happens within a year is the privates all come into line with Medicare," he said.

The new fee schedule has nothing to do with health-care reform, but Stephen Zuckerman, a health economist with the Urban Institute, said more disputes such as this were likely. Congress has promised cuts in Medicare spending as part of reform. When Medicare decides it is overpaying for certain services, "the people who provide this particular service will scream."

Zuckerman said spending on nuclear stress tests per Medicare beneficiary doubled between 2000 and 2006. Such growth, he said, was often a sign that the tests were "financially attractive" to providers.

A report last year by the Medicare Payment Advisory Commission said that doctors who own their own imaging equipment were more likely to order imaging tests than doctors who don't.

Bove said orders for nuclear stress tests have stabilized since 2006.

Mark Victor, a cardiologist who runs Cardiology Consultants of Philadelphia, a big regional cardiology practice, said the stress tests, which combine heart imaging with a treadmill test, are much better than previous options. They are so reliable, he said, that his practice has been able to order fewer cardiac catheterizations, which cost more.

The College of Cardiology argues that Medicare based its new payment schedule on a faulty survey. The survey, conducted by the American Medical Association among doctors of all types, collected a full set of data from only 55 cardiologists. It showed that practice costs had declined 40 percent over five years ending in 2007. Meanwhile, Bove said, surveys by the Medical Group Management Association (MGMA) and MedAxiom showed increases of about 4 percent a year. The cardiologists want a new survey.

The AMA said it had "spearheaded" a group-survey effort that included medical-specialty societies. It did not address the quality of the cardiology survey.

Ellen Griffith, a CMS spokesman, said CMS was "pleased" with yesterday's ruling. "We strongly believe that Medicare beneficiaries will continue to have access to the services provided by all physicians while ensuring that physicians are paid appropriately," she said.

Under the new payment schedule, which is meant to be budget neutral, CMS estimates that primary-care doctors would see slight increases in income. Bove said he did not want to reduce pay for primary-care doctors, who many experts believe are underpaid. "Get the primary guys paid appropriately, but don't take it away from specialty care," he said.

MGMA estimates that cardiologists in this area make an average of $450,000 a year. Bove said they typically made less than $300,000 in academic settings, but deserved high pay after years of training. "A primary-care guy won't come in and fix your heart attack in the middle of the night," he said.

Bove said he was undeterred by yesterday's judicial setback. "They're all challenges," he said. "Challenges, I think, are what make life interesting."