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In
an important victory for physicians, just before Thanksgiving
Congress passed a $400 billion Medicare reform package that
ensures physicians will receive a modest increase in Medicare
fees in 2004, instead of a 4.5 percent cut. The ACC worked
closely with the 13 other members of the Alliance of Specialty
Medicine and other physician organizations to convince legislators
that physicians could not bear another reduction in Medicare
fees without such a cut also affecting beneficiary access
to quality care.
“This result would not have been possible if not for
the strong grassroots efforts of ACC members who contacted
their legislators and urged them to act to prevent a cut,”
said ACC President Carl J. Pepine, MD. “This is the
second year in a row physicians have convinced Congress to
act. Although this is an extremely important victory, the
College is committed to taking the next step: working with
legislators to bring some stability to what is currently an
extremely volatile Medicare payment system.”
As passed, the reform package provides for a statutory update
to physicians’ Medicare fees of 1.5 percent in 2004
and 2005. However, beginning in 2006, physicians would face
several years of steep cuts to recoup the costs of the 2004
and 2005 increases. House and Senate members have committed
to working with the physician community to ensure that this
doesn’t happen.
The combination of statutory changes will result in the following
changes to 2004 Medicare fees for cardiovascular procedures:
| Type
of Procedure |
Change
in Fees |
| Echocardiography |
+2.7% |
| Heart
rhythm |
+0.5% |
| Nuclear |
+2.7% |
| Invasive
|
+4.1% |
| General |
+3.0% |
| Overall |
+2.9%
|
The
impact on thoracic surgery is +3.0%.
Additional changes in drug payments also may have an additional
beneficial impact on procedures done in physician offices.
Also, these numbers are tentative and likely to change when
the revised final rule on the 2004 Medicare Fee Schedule is
published.
Other highlights of the Medicare reform package specifically
important to physicians include:
- Increased payments to rural physicians and hospitals.
- Expanded coverage of preventive care, including lipid
screening.
- Incentive payments for physicians to work in physician
“scarcity areas.”
- A provision that potentially could have replaced the CPT
coding system used by physicians with the ICD-10-CM system
was dropped from the bill after the ACC and other physician
groups convinced legislators that such a change was not
necessary and would have adversely affected physician practices.
Medicare Fee Schedule Final Rule
Although the components of the 2004 Medicare fee schedule final
rule that relate to the conversion factor and the 4.5 percent
cut now are moot, other noteworthy changes are in the final
rule. In fact, the CMS made almost every change that the ACC,
often working in conjunction with other cardiovascular subspecialty
societies, recommended in its comments on the proposed rule.
Some of these changes include:
- Practice expense of catheterization and electrophysiology
recognized—Expansion and implementation of the
CMS proposal to account for the costs of clinical staff
in a physician’s office needed to arrange complex
invasive and electrophysiology procedures.
- Supplemental practice expense surveys—Extension
of the due date for supplemental practice expense survey
data to March 2004 for determining practice expense payments
in the 2005 fee schedule. The ACC is developing that data
now and 8,000 practice expense surveys were mailed to cardiologists
on October 27, 2003.
- Ambulatory blood pressure monitoring—The
CMS will now cover CPT code 93788 and has agreed to cover
three of the four CPT codes for ambulatory blood pressure
monitoring (ABPM) in 2004.
- Practice expense for external counterpulsation (ECP)—Relative
value units for ECP have returned to 2001 levels and payments
will drop by approximately 32 percent for this procedure
in 2004. According to the CMS, errors in 2002 and 2003 had
inadvertently raised payments for this procedure.
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