Primary Care Wins, Imaging Loses, Under New CMS Proposal – ht to Vinny Arora who retweeted AbbieCitron – Twitter does increase the speed at which I learn about important articles.

Primary care physicians are cheering—and radiologists are jeering—a new CMS proposed change to the Medicare Physician Fee Schedule that will cut reimbursements for imaging services by as much as 30% and use the savings to raise reimbursements for primary care by as much as 8%.

“I am surprised. We all kind of knew this sort of thing was coming, but until you see it in writing you don’t believe it,” says Ted Epperly, MD, president of the American Academy of Family Physicians. “We’ve been there before and never saw it. Putting it out now in the heat of the debate is a big deal. It sends a strong message.”

“I’m impressed that CMS is actually doing stuff to reformulate the system toward primary care. Of course, the devil is in the details and we will see what the final product looks like, and it’s not a total fix, but it’s a step in the right direction,” he says.

The AMA has always argued that enhancing primary care should not come at the expense of other physicians.  I have remained skeptical, because they have benefited at the expense of family physicians and non-procedural internists.

I like much of what CMS is proposing:

CMS is also proposing to:

• Remove physician-administered drugs from the definition of “physician services” in anticipation of enactment of legislation to provide fundamental reforms to Medicare physician payments. While the proposal will not change the projected update for services during 2010, CMS projects that it would reduce the number of years in which physicians are projected to experience a negative update. AMA President J. James Rohack. MD, called the proposal “a major victory for America’s seniors and their physicians.”
• Implement a mandate in the Medicare Improvements for Patients and Providers Act of 2008 that suppliers of the technical component of advanced imaging services be accredited beginning Jan. 1, 2012 by designated accrediting organizations. The accreditation requirement would apply to mobile units, physicians’ offices, and independent diagnostic testing facilities that create the images, but would not apply to the physician who interprets them.
• Implement provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program and the Physician Quality Reporting Initiative. Professionals or group practices that meet the requirements of each program in 2010 will be eligible for incentive payments for each program equal to 2% of their total estimated allowed charges for the reporting periods. CMS is proposing to simplify the reporting requirements and is also proposing a new process for group practices to be considered successful electronic prescribers.
• Refine Medicare payments to physicians, which are expected to increase payment rates for primary care services. The proposals include an update to the practice expense component of physician fees. For 2010, CMS is proposing to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey, designed and conducted by the AMA.
• Stop making payments for consultation codes typically billed by specialists at a higher rate than evaluation and management services. Physicians will instead use existing E/M service codes when providing these services. The resulting savings would be redistributed to increase payments for the existing E/M services.
• Increase the payment rates for the so-called “Welcome to Medicare” visit to be more in line with payment rates for higher-complexity services.
• Refine how Medicare recognizes the cost of professional liability insurance in its payments. These changes would have a modest impact, but they will promote payment equity by redirecting the portion of Medicare’s payment for professional liability insurance to those physicians that have the highest malpractice costs.

Taken together, CMS says refining the practice expenses, eliminating payment for the consultation codes and revising the treatment of malpractice premiums would increase payments to general practitioners, family physicians, internists, and geriatric specialists by between 6% and 8%.

I have not read the CMS proposal, but this morning it looks very interesting.

Related posts:

1. Medicare rules improve some pay, decrease others
2. Primary care payment – is win-win possible?
3. Finding enough primary care
4. Universal health care will require fair pay for primary care
5. ACP on having enough adult physicians

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