2009-11-02
The
Centers for Medicare & Medicaid Services (CMS) released a final rule that updates payment
policies and rates under the Medicare Physician Fee Schedule (MPFS) for
calendar year 2010, beginning January 1, 2010.
Current law requires that CMS adjust the MPFS payment rates annually
based on an update formula, which requires application of the sustainable growth rate (SGR). The formula has
provided negative updates every year since 2002, and each year the cuts have been
averted by Congress. For 2010, Medicare payments to doctors are scheduled to
drop 21.2 percent, resulting in a conversion factor of $28.3769 unless Congress
intervenes. CMS and the White House have
said that they remain committed to working with Congress to avert the physician
payment cut. Currently, accompanying
legislation (HR 3961) to the House health reform bill would provide permanent
reform of the Medicare physician payment system and would repeal the 21 percent
reduction scheduled for 2010; in the Senate, the Finance Committee
health reform bill would create a one year
fix.
CMS
is also adopting several refinements to Medicare payments to physicians that will impact hematology:
- There is anticipated to be a 1 percent reduction in
oncology services for 2010. This is part
of a four-year phase-in of a 6 percent total cut in payment attributed to other changes
in reimbursement for allocation of practice expenses.
- CMS will not use the Physician Practice Information Survey data to determine
the practice expenses for medical oncology, but instead will continue to use
the specialty supplemental survey data.
This change will help to avoid further decline in reimbursement.
- CMS is finalizing the proposal to stop making
payments for consultation codes other than the G codes for telehealth
services. Instead of consultation codes,
hematologists will need to rely on existing evaluation and management
services. The result will most likely be
less reimbursement to specialists and increased reimbursement to primary care
physicians.
- The final rule contains several provisions to
promote quality-of-care improvement through revisions to the Physician Quality Reporting Initiative, including the provision of more reporting options
for practitioners and group practices and simplified electronic reporting.
ASH
will be further analyzing the impact of the rule and providing additional
information online. In addition, the
ASH Practice Forum on December 5 in New Orleans will present the latest
information about physician payment and health reform.
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