Some specialists will see extra cuts in Medicare pay

Some specialty groups are loudly protesting new Medicare payment policies that will boost some primary care rates starting next year at the expense of rates for certain specialty services.

In the 2010 physician fee schedule, the Centers for Medicare & Medicaid Services adopted several major changes to the practice-expense portion of the relative value unit system that determines pay for individual services — along with more minor changes to the work and liability insurance RVUs. Because any changes must be budget-neutral, the expected results are modest increases in average Medicare pay for physicians traditionally considered to be in primary care, but larger reductions in average pay for some other specialists.

Why is this happening?  Actually, we finally have a readjustment to the RBRVS formula because the AMA collected new data on overhead expenses.

One big change for physicians who provide imaging services is a decision by CMS to increase the imaging equipment utilization rate assumption within the practice-expense RVUs.

The amount of time Medicare assumes that advanced diagnostic imaging equipment is in use during physician office hours will rise from 50% to 90% over the next four years, decreasing the amount the program pays for each service.

As a result, radiologists face an average 5% cut in Medicare payments next year and additional cuts over the following three years. That would be on top of a 23% reduction in medical imaging rates from the Deficit Reduction Act of 2005, which the American College of Radiology said already has produced a $13.8 billion hit against the specialty.

Physicians said the cuts could harm patients by increasing wait times for imaging exams.

So, at the risk of insulting my subspecialty colleagues, I cry "BS".  I (and many other observers) believe that the years of underpaying family medicine and internal medicine (both general internal medicine and many non-procedural subspecialties) has harmed patients greatly.  Those receiving cuts will still be making much more money than those who get a modest increase.

The CMS based some of its RVU changes on new information from the Physician Practice Information Survey, a joint effort led by the American Medical Association and including 72 specialty societies — among them the ACR and ACC — and other professional health care organizations.

More than 7,000 physicians responded to the PPI survey, of which about 3,600 provided practice cost information. The AMA said it provided specialty societies with frequent briefings throughout the effort.

While the specialty societies vowed to continue pressing CMS to obtain better rates, some physician organizations said they were pleased with the primary care portion of the final fee schedule and the methodology used to determine the 2010 rates.

"The PPI is a much more valid way of gathering data and provides a more current methodology," said Lori Heim, MD, president of the American Academy of Family Physicians. "If you want to establish a strong health care system, we need to have a strong primary care base, and the funding bases in the system currently don't do that. So this is a good step in the right direction."

The American College of Physicians also supports the PPI data and appreciates the attention being paid to undervalued primary care services, said Brett Baker, ACP's director of regulatory affairs. But he called for an ongoing process so CMS can listen to and consider concerns brought by the specialty community.

The AMA defended the methodology behind the PPI survey, saying it met all the criteria CMS established to replace existing practice-expense data.

"This group effort was spearheaded by the AMA at the request of national medical specialty societies and Medicare, and it is the first time in nearly a decade that this information has been updated for all medical specialties," said AMA President J. James Rohack, MD.

These adjustments do not right all the wrongs, but they are a step in the right direction.  We do have a zero sum game.  Primary care has been consistently on the wrong side of the game until now.  The PPI data confirm what we have stated for many years.  I find complaining about these adjustments unseemly.

Related posts:

1. Could primary care actually win?
2. Explaining the CMS adjustment one more time
3. Primary care payment – is win-win possible?
4. HR 2350
5. Medicare crisis – as considered 7 years ago

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