The 2010 Medicare physician fee schedule (PFS) is projected to increase payments to general practitioners, family physicians, internists, and geriatric specialists by 5 to 8 percent, prior to application of the negative update required by the standard growth rate (SGR), according to the PFS Final rule released on October 30. For calendar year 2010, the conversion factor will be -21.2 percent, the preliminary estimate for the SGR will be -8.8 percent, and the conversion factor will be $28.4061. Physician-administered drugs will be removed from the definition of “physician's services” for purposes of computing the SGR and the levels of allowed expenditures and actual expenditures.
Congress is considering legislation that will either replace the SGR formula entirely, or delay the statutorily required reduction in physician payments for at least one year. So far, however, neither the House nor the Senate has approved legislation that would avoid the cuts to physician payments in 2010.
CMS has finalized its proposal to include data from the Physician Practice Information Survey (PPIS) for purposes of establishing practice expense relative value units (PE RVUs). The PPIS is a multispecialty, nationally representative, practice expense survey of both physicians and nonphysician practitioners. CMS will transition from the current PE RVUs to the PE RVUs developed using the new PPIS data over a four-year phase-in period.
CMS will also stop making payments for consultation codes other than the G codes that are used to bill for telehealth consultations, and redistribute the resulting savings to increase payments for the existing evaluation and management services.
The equipment usage rate will be increased from 50 percent to 90 percent for all diagnostic equipment that costs in excess of $1 million, in light of studies from the Medicare Payment Advisory Commission (MedPAC) that suggest that physicians and suppliers would not typically make significant capital investments in equipment that would only be utilized 50 percent of the time.
In addition, CMS will increase the payment for the Initial Preventive Physical Exam, also known as the Welcome to Medicare exam.
MIPPA provisions
The PFS Final rule implements several provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (PubLNo 110-275). For instance, the PFS makes various changes to the Physician Quality Reporting Initiative (PQRI), which provides incentive payments to eligible professionals who satisfactorily report data on quality measures during a specified reporting period. Beginning in 2010, participants may earn an incentive payment of 2 percent of the eligible professionals' estimated total allowed charges for professional services covered under Part B. The PFS moreover adds individual PQRI measures and measures groups, and an electronic health record-based reporting mechanism to promote the use of electronic health records.
The PFS also makes changes to the E-Prescribing Incentive Program, which promotes the use of electronic prescribing by authorizing incentive payments to eligible professionals or group practices who are successful electronic prescribers. CMS will broaden eligibility for the e-prescribing incentive by including professional services furnished in skilled nursing facilities, domiciliary care, or the home care setting as part of the list of services for which the electronic prescribing measure is reportable, and enable group practices to qualify for a 2010 e-prescribing incentive payment based on a determination at the group practice level, rather than at the individual level.
CMS will also cover cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and kidney disease education services for beneficiaries diagnosed with Stage IV CKD who require dialysis or a kidney transplant.
The Final rule will be published in the Federal Register on November 24, and a pamphlet with the text if the Final rule will be included in a future Report. The text of the advance release is at ¶180,897.
Source: CCH Chicago Bureau, Oct. 30, 2009
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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