2009-07-02
On July 1, the Centers for Medicare & Medicaid Services (CMS) posted a display copy of the proposed Medicare physician fee schedule for 2010. ASH will be developing a complete summary of the proposed rule and analysis of its impact on hematologists as soon as possible. The following are major provisions of the proposed rule of interest to practicing hematologists/oncologists. Of particular concern, hematology/oncology is estimated to experience an impact of minus 6 percent from the combined changes to practice and work Relative Value Units in the 2010 proposed rule. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after January 1, 2010.
CMS projects a negative update of minus 21.5 percent for the proposed 2010 Medicare Physician Fee Schedule due to the application of the Sustainable Growth Rate formula. This formula has yielded negative updates every year since 2002, although Congressional action has averted payment reductions since 2003. Congressional action will be needed again in order to avoid a payment reduction in 2010.
CMS is also proposing to stop making payment for consultation codes. Practitioners would have to report existing Evaluation and Management (E/M) service codes when providing these services instead. This change would negatively impact specialists who predominately report consultation services. These services are paid at a higher rate than E/M services. Resulting savings would be redistributed to increase payments for the existing E/M services.
The proposed rule contains a number of provisions to revise the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative: 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 will simplify and expand opportunities for participation.
ASH will be providing comments to CMS by the August 31 deadline. If you have any specific concerns or questions, please contact please contact ASH Senior Manager, Policy & Practice, Carol Schwartz at 202-776-0544.
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