2009-09-10
On August 31 the
Government Accountability Office (GAO) released a report titled, “Medicare Physician Payments: Fees Could Better Reflect Efficiencies Achieved When Services Are Provided Together.” The report, published in response to a request
by Congress, examines if savings can be found when multiple services are
performed on the same patient on the same day. The Centers for Medicare & Medicaid Services (CMS) has already implemented a
multiple procedure payment reduction (MPPR) policy for certain imaging and
surgical services when two or more related services are furnished together. Under MPPR the full fee is paid to the highest price service and a reduced fee is paid for each subsequent service. The reduced fee reflects the efficiencies
found in the overlapping portions of the service when multiple services are
performed together. In this report the GAO estimates that CMS could reduce
payments by an estimated one half billion if the MPPR was also applied to
non-imaging and non-surgical services.
Under current policy,
the budget neutrality policy requires CMS to redistribute any savings from MPPR
to all other services in the physician fee schedule. Therefore CMS is not able
to realize any of these savings. The GAO recommends that Congress should exempt
these savings from the budget neutrality policy, thus allowing Medicare to
realize these savings. In response to this report, the Department of Health and
Human Services has indicated it agrees with GAO’s conclusions and is
beginning plans to review these services.
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