CMS Proposes Pay Increases to Primary Care and Pay Cuts for Specialists (Call for Comment Period)
Recently, the Centers for Medicare & Medicaid Services (CMS) announced proposed changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and non-physician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The proposals include an update to the practice expense component of physician fees, and include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association (AMA).
What this means for Doctors
Based on current data, CMS is projecting that physicians will be paid 21.5 percent less in Medicare reimbursement for 2010. As a result, CMS is trying to improve Medicare payments to physicians by increasing payment rates for primary care services, including an update to the practice expense component.
CMS is also proposing to remove physician-administered drugs from the definition of “physician services,” to hopefully reduce the number of years in which physicians are projected to experience a negative update.
In addition, CMS proposes to stop making payment for consultation codes. These codes are typically billed by specialists, and are paid at a higher rate than equivalent evaluation and management (E/M) services. Instead practitioners will use existing E/M service codes, which would increase payments for the existing E/M services. Furthermore, CMS is proposing to increase the payment rates for the Initial Preventive Physical Exam (IPPE), also called the “Welcome to Medicare” visit.
Next, CMS is proposing to refine how Medicare recognizes the cost of professional liability insurance in its payment system. They hope to redirect professional liability insurance to physicians that have the highest malpractice costs.
Accordingly, these measures combined would increase payments to general practitioners, family physicians, internists, and geriatric specialists by between 6 and 8 percent (before the proposed update and other proposed changes to the fee schedule).
The proposed rule implements cardiac and pulmonary rehabilitation services, and chronic kidney disease (CKD) education, beginning January 1, 2010, as part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). CMS is further proposing two changes to Medicare Payment Advisory Commission (MedPAC) and the U.S. Government Accountability Office (GAO): reduce payment for services that require the use of expensive equipment, and require suppliers of the technical component of advanced imaging services be accredited beginning January 1, 2012 by designating accrediting organizations (AOs).
The proposed rule revises the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative (PQRI) through 2.0 percent incentive payments fo their total estimated allowed charges. They will simplify the reporting requirements for the electronic prescribing measure, provide eligible professionals with more reporting options, and consider successful electronic prescribers. Additionally, CMS wants to add measures to report under the PQRI, and to provide a mechanism for participants to submit data from an electronic health record.
CMS will accept comments on the proposed rule until August 31, and will respond to all comments in a final rule to be issued by November 1, 2009. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after January 1, 2010.
The most notable proposal is the elimination of reimbursement for the higher-paying consultation codes currently used by specialists, and clarify an aspect of the "stand in the shoes" provisions of Stark self-referral regulations.
For more information on the proposed rule, please see:
www.federalregister.gov/inspection.aspx#special or
http://www.archives.gov/federal-register/public-inspection/index.html
A Fact Sheet providing more information about the e-Prescribing Program and PQRI proposals can be found at:
That was inspiring,
Keep up the good work,
Thanks for bringing this up