CMS Releases Proposed 2009 Physician Payment Rule

CMS yesterday released its proposed 2009 Medicare Physician Fee Schedule, which includes provisions for the revision of payments for physician services, including imaging. Under the rule, physician payments would be cut by 5.4 percent on Jan. 1, 2009 as a result of the flawed SGR formula.

The rule also includes the following proposals:

• RVUs: The rule identifies the fastest growing higher cost procedures, including services with potentially unexplained high RVUs and procedures that have not been reviewed by the RUC since the fee schedule was created. CMS has requested that the RUC begin reviewing the identified codes immediately, but anticipates that this process may take a number of years due to the large number of services involved. Several cardiology services are among those identified for review.
• PQRI: The rule proposes a total of 175 measures for reporting under the Physician Quality Reporting Initiative (PQRI) in 2009, an increase of 56 measures from 2008. The proposed rule would allow claims-based reporting either for individual measures or for Measures Groups (ie. Preventive Care, Coronary Artery Disease and Coronary Artery Bypass Surgery). CMS is also proposing to conduct another self-nomination process so that additional registries can submit quality measures data. In addition, if the 2008 Measure Testing Process is successful, CMS proposes to begin accepting data from EHRs for a limited subset of the proposed 2009 PQRI quality measures starting January 1, 2009. Finally, Congress has not specifically authorized funding for bonus payments in 2009 and the proposed rule includes no provisions for bonus payments to physicians meeting the reporting threshhold.
• Anti-Markup Rule: The rule proposes two alternatives to revising the anti-markup rule -- a rule designed to capture a broad number of physician arrangements that the agency believes are potentially subject to fraud and abuse through prohibited self-referrals. The first alternative would not require application of the anti-markup rule to diagnostic testing services provided by a physician who shares a practice with a single physician or physician organization. In all other cases, the anti-markup rule would apply. The second alternative would clarify anti-markup provisions that were finalized in last year's rule by providing guidance pertaining tovarious terms of the rule, including what would constitute the "office of the billing physician or other supplier" and other concepts such as "outside supplier."
• E-Prescribing: CMS proposes to retain provisions that would allow for use of computer-generated faxes in instances of temporary/transient transmission failure or communication problems that preclude the use of the adopted NCPDP SCRIPT standard, and add an exemption for computer-generated faxes used by dispensers to request refills from providers that are not capable of receiving and processing refill requests using the adopted NCPDP SCRIPT standard.
• Diagnostic Testing Services: CMS is proposing to require that physicians and non-physician practictioners (NPPs) who furnish diagnostic testing services meet most of the quality and performance standards required for Independent Diagnostic Testing Facilities (IDTFs). This would represent an additional and unreasonable burden to practices.

The ACC is currently reviewing the rule and more information will be provided over the coming weeks regarding specific impacts to imaging and other cardiovascular services, coding changes, and possible implications for PQRI. For more on the rule, click here.

Meanwhile, the release of the proposed 2008 Fee Schedule underscores the need for all members to contact their senators and representatives as soon as possible and tell them to reverse the payment cut due to be implemented today. Given last week's failure by Congress to stop the 10.6 percent cut before the 4th of July recess, physicians are facing tough decisions regarding their patients and practices over the next few months. Congress needs to hear directly from each and every one of us on the impacts of these cuts on our ability to provide quality care! You can reach your members using the ACC's toll-free grassroots hotline (800-210-7193) or by going to http://app1/sde/Attachments/sde/1674\www.acc.org/can.