New Law Provides Short-Term Fix to SGR, Proposed 2011 Medicare Physician Fee Schedule Presents New Challenges

June 29, 2010

News from Washington

In response to vigorous advocacy by SCAI and other medical societies, President Obama has signed into law another temporary fix to the sustainable growth rate (SGR). Instead of the 21.3 percent SGR-mandated reduction, the new legislation provides a 2.2 percent across-the-board physician payment increase for the period between June 1 and Nov. 30, 2010.

Working to achieve this and other advocacy goals, SCAI leaders Dr. Larry S. Dean, Dr. Christopher J. White, Dr. Joseph D. Babb and Dr. Mark Turco spent much of last week on Capitol Hill. "The new law represents progress,” said SCAI President Dr. Dean, “but it will again take legislative intercession to avert the 23.5 percent reduction now slated to begin Dec. 1, 2010."

 

Proposed Fee Schedule for 2011

Even as Congress was putting a patch on the SGR’s impact until December, CMS was releasing the Medicare Physician Fee Schedule proposed rule for 2011, including an additional 6.1 percent fee cut due to the SGR.

"The timing of these two events – the SGR fix for 2010 and the release of another significant fee cut, also based on the SGR, for 2011 – demonstrates just how important it is to find a permanent solution to the problem of how to finance the Medicare system and structure reimbursement," said Dr. Dean.

The conversion factor illustrates the impact of SGR changes: The current conversion factor is $36.87. Without another fix, or better yet, a permanent solution, it will fall to $28.47 on Dec. 1, 2010, and $26.66 on Jan. 1, 2011.

Unrelated to the SGR, the relative value units (RVUs) for most cardiology procedures continue to suffer from the four-year phase in of the PPIS (Physician Practice Information Survey) data, which generally reduces practice expense values for cardiology procedures. Despite this, there is some good news in that malpractice and practice expense RVUs for most invasive and interventional procedures are rising for technical reasons.

The proposed rule for next year also continues to erode reimbursement rates for advanced diagnostic testing. The equipment utilization rate for "expensive diagnostic equipment" (e.g., CT, MR, PET) will now be stabilized at 75 percent by law. CMS had begun phasing in a 90 percent utilization rate for these services in 2010 while excluding MRA/CTA from the list of impacted procedures. Under the 2011 proposed rule, however, MRA/CTA will be subject to the 75 percent equipment utilization rate, driving reimbursement rates down for these services as well. In addition, CMS has proposed expanding the multiple-procedures discount to MR, CT, and ultrasound services. Traditionally, there had been a discounting exemption for the professional component of these services, and the multiple-procedures discount had been applied only to the technical component.

The proposed rule, CMS discusses the elimination of consultation codes in 2010 and claims that this reduction in payment was offset by increases elsewhere. Data gathered by the AMA disputes CMS's claim and we will join with the AMA in fighting for a return of consultation codes.

 

Reprocessing Claims

Medicare carriers are currently reprocessing all Medicare claims made between Jan. 1, 2010, and May 31, 2010, as a result of the technical correction SCAI convinced CMS to implement in mid-May. This correction moved invasive and interventional cardiology procedures into CMS's high malpractice risk category and increased payments by up to 7 percent. Now, to accommodate the SGR-fix, Medicare will also need to reprocess all claims made between June 21 and June 25, 2010. Watch for more details on CMS's plan for reprocessing claims.

 

Next Steps

"SCAI will continue to advocate for the protection of the value of interventional cardiology services," said Dr. Dean. "We need to work together as a specialty, and with the House of Medicine, to send a strong message to legislators and regulatory officials that this volatility in reimbursement rates makes it exceedingly difficult for physicians to run their practices and treat Medicare patients."

SCAI's Leadership, Advocacy Committee and staff will continue to advocate on your behalf to address the challenges presented in the 2011 Fee Schedule. Stay tuned for guidance on how you can help.