| On
Aug 1, 2005, the Centers for Medicare and Medicaid Services
(CMS) released a Notice of Proposed Rulemaking (NPRM) detailing
policy changes and proposed payment rates under the 2006 Medicare
Physician Fee Schedule. As predicted, CMS forecasts an across-the-board
cut of 4.3 percent to physicians effective Jan. 1, 2006. On
top of this cut, cardiologists can expect an additional reduction
of -0.2% for a total cut of -4.5% in overall Medicare payments.
Continued
use of the flawed sustainable growth rate (SGR) formula is
the source of the 4.3 percent cut. The physician community
had been hopeful that CMS’ proposed rule would have
retroactively removed the cost of office-administered drugs
out of the physician payment formula, thereby alleviating
the magnitude of the cut in 2006. The lack of administrative
action squarely places the responsibility on Congress to act
legislatively to halt this draconian cut.
The
cuts to cardiologists are further exacerbated by CMS’
proposal to alter the method for determining practice expense
relative value units (RVUs), decreasing payments for many
services cardiologists provide in 2006 and in future years.
The impact on individual cardiologists will vary depending
on the mix of services they provide. Click
here to see how payments for a number of important cardiology
services will be affected.
Over
the past several months, the cardiovascular community has
worked aggressively to educate CMS officials about the growth
in medical imaging services. In its proposed rule, CMS cites
growth in imaging services and other ancillary services as
contributors to growth in Medicare physician spending, The
American College of Cardiology is pleased that CMS has acknowledged
that trends in growth for these services need to be better
understood. CMS also noted the need to evaluate whether changes
in utilization are associated with “important health
benefits.”
In
a move that was anticipated, CMS proposes to discount payments
for multiple imaging services performed on contiguous body
areas and to add nuclear medicine services to the list of
designated health services covered under the Stark law restrictions
on physician self-referral.
ACC
and other cardiovascular organization staff are now analyzing
the rule. The full text of the NPRM is available at http://www.cms.hhs.gov/physicians/pfs/ama.asp?URL=/regulations/pfs/2006/1502P.zip
Highlights
of major provisions of the proposed rule follow.
Sustainable
Growth Rate (SGR)
The SGR formula, which is used to calculate the conversion
factor, determines physician payments on an annual basis.
Under this formula, when physician expenditures exceed the
formula’s expenditure target, physicians receive a negative
payment update. The physician community has asserted for years
that the formula does not accurately account for the true
cost of providing Medicare services and does not appropriately
account for changes in laws and regulations. These flaws have
resulted in announced payment reductions that have repeatedly
been blocked by Congress, with the exception of the cut that
was allowed to occur in 2002. Without congressional action
to reform the payment formula, CMS forecasts an update of
-4.3% in 2006, with further negative updates in future years,
averaging about -5% per year.
For
more information about the SGR and what the ACC is doing to
address the proposed cuts in Medicare payment check out the
ACC Medicare Fee Cut Resource Center at http://www.acc.org/advocacy/advoc_issues/rc_medicare.htm.
Practice
Expense RVUs
CMS
is proposing changes in its methodology for determining resource-based
practice expense RVUs. The changes would result in cuts to
cardiologists that would total 2.1 percent when fully phased
in over a four-year period (2006-2009). In 2006, aggregate
Medicare payments to cardiologists would fall by -0.5 percent
as a result of the practice expense methodology change alone.
In
2004, the cardiovascular community joined together to submit
supplementary practice expense per hour data to CMS. CMS acknowledges
that had cardiology not provided this data, the impact would
have been much worse – an 11 percent payment cut.
Multiple
Procedure Reduction for Diagnostic Imaging
Adopting
a MedPAC recommendation to reduce the technical component
payment for multiple imaging services performed on contiguous
body parts, CMS proposes a 50 percent reduction in the payment
for the technical component of “subsequent procedures.”
That is, when a physician performs more than one diagnostic
imaging procedure with a designated family of procedures,
the technical component payment for the second and any subsequent
procedures would be reduced by 50 percent.
CMS
has identified 11 families of imaging procedures by imaging
modality (CTA, MRI, and MRA) and contiguous body area to which
the new payment rates would apply. National Correct Coding
Initiative edits already in place preclude billing for multiple
cardiac CT and MRI procedures within the families of codes
CMS has proposed for the multiple imaging procedure discount.
Thus, the multiple procedure discount will not negatively
affect Medicare payments to cardiology.
Malpractice
Relative Value Units
Thanks
to a joint effort by ACC, HRS and SCAI, CMS corrected the
malpractice RVUs for several complex and high-risk cardiovascular
procedures (92975, 92980 to 92998 and 93617 to 93641). CMS
had mistakenly deleted the high-risk designation from these
services in January 2004.
Physician
Referral Restrictions for Nuclear Medicine Services and Supplies
As
expected, CMS proposes to add nuclear medicine services and
supplies to the definition of radiology services included
as “designated health services” under the “Ethics
in Patient Referrals Act,” more commonly known as the
Stark law. This means that physicians would be prohibited
from referring patients for nuclear medicine services and
supplies to facilities in which they or an immediate family
member have financial relationships. The proposed policy change
preserves all current Stark exceptions, such as the exception
for rural health care and the exception for in-office ancillary
services physicians perform in their own offices.
Public
Comment Period
There
is a 60-day public comment period for the proposed rule. CMS
will consider comments submitted by Sept. 30 in developing
the Final Rule for the 2006 Medicare Physician Fee Schedule,
due to be released in early November. ACC will develop comments.
Watch the ACC Web site for additional information.
|
