Learn More about the Final 2010
Physician Fee Schedule
The Centers for Medicare and Medicaid Services (CMS) on Oct. 30 released
its 2010 Medicare Physician Fee Schedule final rule, which includes policy
proposals that significantly reduce payments for cardiovascular-related
services. While CMS has attempted to mitigate the impacts of the cuts
by spreading them out over a four-year period, the impact of the cuts
is still enormous both for 2010 and beyond.
Learn more with the following resources and then take action with the
Campaign for Patient Access.
Also, visit the new Practice Management
section for an overview of the SPECT MPI coding changes that includes
tips on how to work with health plans in the transition, a practice expense
calculator and a question and answer about changes to consultation codes.
The ACC understands the very real impacts these cuts will have on your
practices, your staff and your patients. The College is exploring all
options and staff and leaders are working together to help you understand
all of your options. Read the following high-level summary of the rule
to better understand its effects.
RULE HIGHLIGHTS:
CMS’ final 2010 Physician Fee Schedule includes cuts to nearly
all services performed by cardiologists, ranging from 10 to more than
40 percent over four years beginning Jan. 1, 2010. These cuts are separate
from current health reform efforts and do not include the 21.2 percent
Medicare physician payment cut due to the sustainable growth rate (SGR).
The impact on individual cardiovascular practices is causing many practices
to take drastic measures according to a recent survey:
- 60 percent of private practice cardiology plans staff layoffs
- 46 percent of private practice cardiology plans to eliminate service
lines
- 17 percent of private practice cardiology will stop accepting Medicare
- 39 percent are considering integration into a hospital system
Overall, CMS projects an eight percent decrease in Medicare payments
for cardiovascular services in 2010, and a 13 percent decrease over the
next four years. These aggregate projections underestimate the impact
on individual private cardiology practices.
A large portion of these cuts is related to practice expense. CMS incorporated
the results of the American Medical Association’s Physician Practice
Information Survey into its formula for calculating practice expense relative
value units (RVUs). The cardiovascular community has serious concerns
about validity of the survey process and the quality of the data. CMS
is phasing the cuts in over a four-year period versus all at once. A few
key examples for 2010:
- SPECT Myocardial Perfusion Imaging (78452) – 36 percent cut
- Transthoracic echo with spectral and color flow Doppler (93306)--10
percent cut
- Coronary Stent (92980) - 4 percent cut
- EKG (93000 )-- 5 percent cut
- Level 4 established patient office visit (99214) -- 7 percent increase
As mentioned above, the ACC is exploring several options for stopping
the implementation of these cuts. CMS’ decision to phase-in the
cuts, while not what we would have hoped, is due in large part to your
tremendous efforts over the last few months. Your actions clearly had
an impact and we strongly encourage you to continue to email your congressional
representatives and CMS detailing the ramifications of these cuts as we
move into the next phase of challenging these cuts.
Several other policies implemented in the final rule also contribute
to the payment cuts to cardiology:
Bundled codes for myocardial perfusion/SPECT imaging:
In 2010 myocardial perfusion imaging/SPECT studies including wall motion
and ejection fraction will now be reported with a single code. CMS decided
to substantially reduce the payment for myocardial perfusion imaging as
part of this rule by reducing both the physician work value and the practice
expense value. Because there is a new code for the service, CMS is not
applying the four-year transition of the practice expense cuts and instead
is using the fully implemented value. The result is a 36 percent cut in
payment for 2010. This change alone accounts for more than one-third of
the projected payment cut to cardiology. Read
an overview of these new codes that includes tips on how to work with
health plans in the transition.
Consultations: Payments for consultations provided in
office and hospital settings are eliminated under the final rule. The
RVUs assigned to these codes will be redistributed to office and hospital
visits, and services now billed as consultations will be billed as hospital
or office visits. This will reduce payments to varying degrees for consultation
services. View
consultations Q & A.
Malpractice: CMS has chosen to update the malpractice
RVUs with data from a new survey of specialty-level malpractice premiums.
In addition, CMS has proposed a new method for determining malpractice
RVUs for technical component services. The proposed new malpractice RVUs
would reduce overall cardiology payments by 1 percent; however, the impact
is much greater for imaging services already being cut through other policy
changes.
Equipment utilization: CMS is implementing a new policy
that assumes that all diagnostic equipment with an acquisition cost greater
than $1 million is used 90 percent of the time an office is open, thus
driving down the practice expense RVUs for services using that equipment.
Cardiac MR and cardiac CT services will be subject to payments set based
on this utilization assumption.
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