The
Centers for Medicare & Medicaid Services has issued a
final rule with comment period that updates payment policies and rates for
physicians and nonphysician practitioners with regard to services paid under
the Medicare Physician Fee Schedule in 2012.
According to a Centers for Medicare & Medicaid
Services (CMS) news release, the final rule involves an expansion of the
“potentially misvalued code initiative,” an effort the agency noted
will ensure that Medicare is accurately paying for physician services and more
accurately managing the payment system. According to the release, CMS is
focusing on the codes billed by physicians in each specialty resulting in the
highest Medicare expenditures under the
Medicare Physician Fee Schedule (MPFS), so it can be
determined whether these codes are overvalued.
Changes coming
According to a CMS-issued 5-year review of work relative
value units (RVUs), orthopedic procedures will see — on average — an
approximate decrease of 1% in RVUs. Arthroscopic knee meniscectomy will receive
the most critical of these decreases, as CPT codes 29880 and 29881 have dropped
by 3.29 RVUs and 2.66 RVUs, respectively.
Further changes include a focus on how CMS adjusts
payment for geographic variations in the cost of practice. This involves
updating or replacing previous data sources. CMS will also be adjusting its
payments for the full range of occupations employed in physicians’
offices, as well as other adjustments called for in prior public comments.
Other changes, according to the release include:
- an expansion of the multiple procedure payment reduction policy to
the professional interpretation of advance imaging services to recognize
overlapping activities that go into valuing these services;
- the adoption of criteria for a health risk assessment to be used in
conjunction with annual wellness visits, for which coverage began Jan. 1, 2011
under the Affordable Care Act;
- the expansion of the list of services available to be furnished
through telehealth to include smoking cessation, as well as changes to the
criteria for adding services to the telehealth list so focus can be given to
the clinical benefit of making services available through telehealth;
- updates and modifications to a number of physician incentive
programs;
- the finalization of quality and cost measures that will be used in
establishing a new value-based modifier designed to adjust physician payments
based on whether they are providing higher quality and more efficient care; and
- the implementation of the third year of a 3-year transition into new
practice expense relative value units.
Reflecting current law
The final rule is designed to reflect current law, under
which providers will face across-the-board cuts in 2012 based on the
sustainable growth formula adopted in the Balanced Budget Act of 1997. Without
interventional action, this would mean a 27.4% reduction in Medicare payment
rates to providers paid under the MPFS. The 27.4% cut is less than the 29.5%
originally estimated by CMS, but is still seen as worrisome to physicians who
are impacted by the change.
“The decreased reimbursement from Medicare is
concerning,” Orthopedics Today Editorial Board member Peter
R. Kurzweil, MD, said. “Thirty percent is a huge number. Most offices are
not going to be able to continue doing business as usual with their Medicare
patients. Many of my colleagues will be unable to afford to see Medicare
patients, as offices will actually lose money when seeing them.”
“I personally enjoy taking care of the Medicare
population,” he added in an Orthopedics Today interview.
“I think how we treat our elderly is a reflection on the society in which
we live. It is a shame that the 30% cut will force the hand of many physicians
into no longer accepting Medicare.” – by Robert Press
References:
- Peter R. Kurzweil, MD, can be reached at 2760 Atlantic Ave., Long
Beach, CA 90806-2755; 562-424-6666; email: pkurzweil@aol.com.
- Disclosure: Kurzweil is a consultant to Orteq, Pierce
Medical Corporation, Smith & Nephew and DePuy Mitek. He also receives
educational support from DePuy Mitek and is part owner of a surgical center.