Medicare Makes Expected Announcement that
Physicians’ Pay Will Be Cut 21 Percent in 2010
Also issues other policy updates adjusting pay for
hospital outpatient care, home health care
Nov. 2, 2009 - The Centers for Medicare & Medicaid
Services issued several policy updates for 2010 late Friday that
included a two percent pay hike for home health care agencies and an
inflation-based boost of 2.1 percent in their payment rates for
outpatient departments. The big one, however, is a 21.2 percent pay cut
for doctors that will once again start the cries that this action will
cause even more doctors to stop treating Medicare patients.
The annual pay cut for doctors results from a law
requiring Medicare use a prescribed formula for determing physicians’
pay. Every year it says Medicare should reduce pay rates for doctors and
every year there is a massive political battle and the pay cut is
over-turned by Congress.
Doctors face 21% pay cut from Medicare in 2010; same
annual quandary Democrats tried to fix; senior citizens many find it
harder to get a doctor; AMA issues new list of states with problems
By
Tucker Sutherland, editor & publisher
SeniorJournal.com
This year the formula had already kicked out its
Medicare/TRICARE pay mandate for 2010 that said physicians’ pay should
be cut by 21 percent in 2010.
Democrats recently
joined the American Medical Association in saying, “Enough is enough.”
The formula had to be changed. Democrats tried to pass
legislation to cure this annual problem but it was defeated by
Republican-led opposition.
In the absence of Congressional action for the CY
2010 physician update, the final rule with comment period will reduce
the conversion factor for services on or after Jan. 1, 2010 by 21.2
percent rather than the -21.5 percent projected in the proposed rule.
The difference is due to the use of the most recently available data on
CMS spending for physicians’ services.
Medicare
& You 2010 books are currently in distribution. Pdf copy
available online –
click.
CMS Friday announced final changes to policies and
payment rates for services to be furnished during calendar year (CY
2010) by over 1 million physicians and nonphysician practitioners who
are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS
sets payment rates for more than 7,000 types of services in physician
offices, hospitals, and other settings. Today’s action complies with
federal law, which requires these policies and payment rates to be
announced by Nov. 1.
Current law requires CMS to adjust the MPFS payment
rates annually based on an update formula which requires application of
the Sustainable Growth Rate (SGR) that was adopted in the Balanced
Budget Act of 1997.
This formula has yielded negative updates every
year beginning in CY 2002, although CMS was able to take administrative
steps to avert a reduction in CY 2003, and Congress has taken a series
of legislative actions to prevent reductions in CYs 2004-2009.
“The Administration tried to avert the pending fee
schedule cut in the FY 2010 budget proposal that it submitted to
Congress, and remains committed to repealing the SGR,” said Jonathan
Blum, director of the CMS Center for Medicare Management.
“In the meantime, CMS is finalizing its proposal to
remove physician-administered drugs from the definition of ‘physicians’
services’ for purposes of computing the physician fee schedule update.
While this decision will not affect payments for services during CY
2010, CMS projects it will have a positive effect on future payment
updates.”
CMS Refines Pay for Some Services by Physicians
In the final rule with comment period, CMS is also
adopting several refinements to Medicare payments to physicians which
will improve payment rates for primary care services relative to other
services.
For 2010, for purposes of establishing the practice
expense (PE) relative value units (RVUs), CMS had proposed to include
data about physicians’ practice costs from a new survey, the Physician
Practice Information Survey (PPIS), designed and conducted by the
American Medical Association. CMS is finalizing the proposal, but will
phase it in over a four year period. In addition, CMS will not use the
PPIS data to determine the practice expenses for medical oncology, but
instead will continue to use specialty supplemental survey data , as
indicated by the Medicare Prescription Drug, Improvement and
Modernization Act of 2003 (MMA).
CMS is also finalizing its proposal to stop making
payment for consultation codes other than the G codes that are used to
bill for telehealth consultations, and to redistribute the resulting
savings to increase payments for the existing evaluation and management
(E/M) services. CMS will adjust the payment for the surgical global
period to reflect the higher value of the office visits furnished during
the global period.
In the final rule with comment period, CMS is
adopting two significant modifications to its proposal to increase the
equipment utilization percentage that is assumed for purposes of setting
PE RVUs. CMS will increase the equipment utilization rate assumption
used to determine the practice expense for expensive equipment priced
over one million dollars from 50 to 90 percent but will phase in this
change over a four year period. CMS also will not apply this change to
expensive therapeutic equipment.
CMS is increasing payment for the Initial
Preventive Physical Exam (IPPE), also called the “Welcome to Medicare”
visit to be more in line with payment rates for higher complexity
services. Originally established in the MMA, the IPPE benefit now pays
for an initial assessment of key elements of a beneficiary’s health
within one year of the beneficiary’s enrollment in Medicare Part B.
Taking all changes in the final rule with comment
period into account, CMS projects that payments to general
practitioners, family physicians, internists, and geriatric specialists
will increase by between 5 and 8 percent, prior to application of the
negative update required by the SGR.
The final rule with comment period also implements
a number of provisions in the Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA) including:
● Adding new Medicare benefit categories for
cardiac and pulmonary rehabilitation services and for chronic kidney
disease (CKD) education beginning Jan. 1, 2010. The final rule with
comment period outlines what these programs will entail, how they will
be paid under the MPFS and the criteria for covering these services.
● Increasing the Medicare share of payments for
outpatient mental health services to 55 percent from 50 percent,
beginning a gradual transition to bring payment parity for mental health
and medical services furnished to Medicare beneficiaries.
● Implementing a requirement that suppliers of
the technical component of advanced imaging services be accredited
beginning Jan. 1, 2012. The accreditation requirement will apply to
mobile units, physicians’ offices, and independent diagnostic testing
facilities that create the images, but will not apply to the physician
who interprets them. CMS will address suppliers’ accountability,
business integrity, physician and technician training, service quality,
and performance management through additional guidance.
The final rule with comment period contains a
number of provisions to promote improvement in quality of care and
patient outcomes through revisions to the Electronic Prescribing
Incentive Program (e-Prescribing Program) and the Physician Quality
Reporting Initiative (PQRI).
Specifically, the final rule simplifies
the reporting requirements for the electronic prescribing measure,
provides eligible professionals with more reporting options, and
establishes a new process for group practices to be considered
successful electronic prescribers.
Eligible professionals or group
practices that meet the requirements of each program in CY 2010 will be
eligible for incentive payments for each program equal to 2.0 percent of
their total estimated allowed charges for the reporting periods.
In addition, CMS is adding measures for eligible
professionals to report under the PQRI, providing a mechanism for
participants to submit quality measure data from a qualified electronic
health record and creating a process for group practices to use for
reporting the quality measures.
The final rule with comment will appear in the Nov.
25, 2009 Federal Register. CMS will accept comments on designated
provisions of the final rule with comment period until Dec. 29, 2009,
and will respond to all comments at a later date. Unless otherwise
specified, the new payment rates and policies will apply to services
furnished to Medicare beneficiaries on or after Jan. 1, 2010.
To view a copy of the final rule with comment
period, please see:
The Centers for Medicare & Medicaid Services (CMS)
today announces a 2.0 percent market basket update to Medicare’s
calendar year (CY) 2010 home health prospective payment system (HH PPS)
rates and modifications to the home health outlier policy. These
improvements are evidence of CMS’ continued efforts to ensure
appropriate payments, to prevent fraud and abuse, and to protect
beneficiaries in the Medicare home health program.
Home health agencies (HHAs) receive additional
payments (outlier payments) for 60-day home health episodes of care that
carry unusually high costs. For CY 2010, CMS will cap home health
outlier payments at 10 percent per HHA and target total aggregate
outlier payments at 2.5 percent of all HH PPS payments. The current
(2009) target for aggregate outlier payments is 5 percent of total HH
PPS expenditures. By lowering the total outlier payment target to 2.5
percent, this final rule increases home health base rates by 2.5 percent
for CY 2010.
“This final regulation builds on Medicare’s
efforts to refine its payment systems while working to reduce waste,
fraud and abuse,” said Jonathan Blum, director of CMS’s Center for
Medicare Management. “Through the use of up-to-date home health data, it
also provides a clearer focus for oversight of the program while
encouraging better coordination of Medicare’s home health benefits.”
In this final rule, CMS continues its current
policy of a 2.75 percent reduction to national standardized 60-day
episode payment rates and non-medical supply factors in CY 2010.
Retention of this policy will help offset the increase in the home
health case-mix that is not associated with any underlying change in the
actual clinical conditions of home health patients.
This CY 2010 reduction is the third year of a
four-year phase-in of HH PPS rate adjustments, which were made final in
the HH PPS Refinement and Rate Update for the CY 2008 final rule.
Historically, home health payment rates have been
updated annually by either the full home health market basket index or
by an adjustment to the home health market basket index by Congress.
CMS uses the home health market basket index – an inflation measurement
of the costs of the mix of goods and services offered by home health
agencies.
The Deficit Reduction Act of 2005 (DRA) provided
for an adjustment to the home health market basket percentage update for
CY 2007 and subsequent years depending on quality data submissions by
HHAs.
Through implementation of new payment and
enrollment safeguards, this final rule will reduce Medicare’s
vulnerability to fraud, abuse and improper payments. HHAs currently
submit Outcome and Assessment Information Set (OASIS) data as a
condition of participation in Medicare. Beginning Jan. 1, 2010, the
final rule will require HHAs to submit OASIS data as a condition of
payment under HH PPS.
CMS is implementing an improved version of OASIS,
called OASIS-C, to collect data on all episodes of care beginning Jan.
1, 2010. This data will document important aspects of the patient’s
health status including clinical condition, functional abilities, and
service needs. As a result, a clinician will be able to capture a clear
and accurate picture of the patient which will assist in development of
an appropriate plan of care. Documentation provided through OASIS-C also
could be used to signal concerns about patient health, encourage
preventive care, identify needs for additional patient treatment, and
record patient immunizations and vaccinations.
CMS Home Health Compare Web site
In CY 2010, CMS will publicly report 12 nationally
accepted and approved quality measures plus 13 new process measures on
its CMS Home Health Compare Web site (www.Medicare.gov/HHCompare).
HHAs that submit required quality data will receive
payments based on the full home health market basket update of 2.0
percent for CY 2010. The home health market basket index percentage
will be reduced by 2 percentage points to 0.0 percent for CY 2010 for
those HHAs that do not submit the required quality data. For CY 2012,
CMS will require HHAs to report, as part of the required home health
quality measures, the Consumer Assessment of Healthcare Providers and
Systems (CAHPS®) Home Health Care Survey for Medicare and/or Medicaid
beneficiaries.
To qualify for the Medicare home health benefit, a
Medicare beneficiary must be under the care of a physician and: have an
intermittent need for skilled nursing care; need physical or speech
therapy; or, have a continuing need for occupational therapy. The
beneficiary also must be homebound and receive home health services from
a Medicare approved HHA.
This final rule went on display at 4:15 pm Friday
(10/30/2009), and will be published in the Federal Register on Nov. 10,
2009. The effective date is January 1, 2010.
CMS Gives Most Hospitals 2.1 Percent Rate
Increase for Outpatient Care (CMS News Release)
The Centers for Medicare & Medicaid Services (CMS)
today announced that most hospitals will receive an inflation update of
2.1 percent in their payment rates for services furnished to Medicare
beneficiaries in outpatient departments. As required by Medicare law,
CMS will reduce the update by 2.0 percentage points for hospitals that
did not participate in quality data reporting for outpatient services or
did not report the quality data successfully, resulting in a 0.1 percent
update for those hospitals.
CMS also announced that ambulatory surgical centers
(ASCs) will receive a 1.2 percent inflation update beginning Jan. 1,
2010. CMS projects that the aggregate Medicare payments to more than
4,000 hospitals and community mental health centers in CY 2010 will be
approximately $32.2 billion, while aggregate Medicare payments to
approximately 5,000 ASCs will total $3.4 billion.
The payment updates are included in a final rule
with comment period that revises payment policies and updates the
payment rates for services furnished to beneficiaries during calendar
year (CY) 2010 in hospital outpatient departments under the Outpatient
Prospective Payment System (OPPS) and in ASCs under a revised
ratesetting methodology that was implemented Jan. 1, 2008.
"The payment rates we are announcing for 2010 are
intended to ensure that Medicare beneficiaries continue to receive high
quality and efficient care in the most appropriate setting," said
Jonathan Blum, director of the CMS Center for Medicare Management.
The final rule with comment period implements
provisions of the Medicare Improvements for Patients and Providers Act
of 2008 (MIPPA) that extend Medicare coverage to important
rehabilitative and educational services intended to improve the health
of patients diagnosed with certain respiratory, cardiac, and renal
diseases.
Beginning Jan. 1, 2010, hospitals will be able to bill
Medicare for new pulmonary and intensive cardiac rehabilitation services
furnished in hospital outpatient departments to Medicare beneficiaries.
The final rule with comment period also provides payments to rural
hospitals for kidney disease education services furnished in outpatient
departments to Medicare beneficiaries with Stage IV chronic kidney
disease.
The final rule with comment period incorporates a
payment adjustment for the hospital pharmacy overhead costs of
separately payable drugs and biologicals. This adjustment better
recognizes the overhead costs for these drugs and biologicals relative
to those for drugs and biologicals that are packaged into Medicare's
payment for the associated ambulatory payment classification (APC).
As
a result, CMS will pay hospitals for most separately payable drugs and biologicals administered in hospital outpatient departments at the
manufacturer's average sales price (ASP) plus four percent. In order to
maintain beneficiary access to safe, cost-effective health care, the
final rule with comment period also modifies CMS's requirements for
physician supervision to ensure that hospital outpatient services are
appropriately supervised by physicians or other qualified practitioners.
In addition to hospital outpatient departments, the
final rule with comment period includes policy changes and payment rates
for services in ASCs and continues to expand the list of surgical
procedures that Medicare will cover when performed in ASCs. The final
rule with comment period seeks to ensure that beneficiaries have access
to outpatient services in all appropriate settings, while improving the
quality and efficiency of service delivery.
Under the Hospital Outpatient Department Quality
Data Reporting Program (HOP QDRP), hospitals that did not participate in
the program or did not successfully report the quality measures will
receive an update in CY 2010 equal to the annual inflation update factor
minus 2.0 percentage points for a net update of 0.1 percent.
CMS will continue to require HOP QDRP participating
hospitals to report the existing seven emergency department and
perioperative care measures, as well as the four existing claims-based
imaging efficiency measures for the CY 2011 payment determination.
CMS also will phase in a new HOP QDRP validation
requirement to ensure that hospitals are accurately reporting measures
for chart-abstracted data. In addition, CMS established procedures to
make quality data collected under the HOP QDRP publicly available
beginning with the third quarter of CY 2008.
The CY 2010 OPPS/ASC final rule with comment period
will appear in the Nov. 20 Federal Register. Comments on designated
provisions are due by 5:00 p.m. EST on Dec. 29, 2009. CMS will respond
to comments in the CY 2011 OPPS/ASC final rule.
For more information on the final CY 2010 policies
for the OPPS and ASC payment system, please see the CMS Web site at:
Nov. 2, 2009 - The Centers for Medicare & Medicaid
Services issued several policy updates for 2010 late Friday that
included a two percent pay hike for home health care agencies and an
inflation-based boost of 2.1 percent in their payment rates for
outpatient departments. The big one, however, is a 21.2 percent pay cut
for doctors that will once again start the cries that this action will
cause even more doctors to stop treating Medicare patients.
