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    Urgent Message About 2013 Medicare Physician Fee Schedule

    November 02, 2012

    Yesterday the Centers for Medicare & Medicaid Services (CMS) released the final 2013 Medicare Physician Fee Schedule announcing payment rates for the services we and other doctors provide to Medicare beneficiaries. In the bullets below, we discuss several of the key decisions relevant to the practice of Interventional Cardiology, but the over-riding message we wish to share with you, SCAI’s members, is this: In an overt effort to transfer funds from the payment of specialty procedures to primary care, CMS has targeted established procedures for bundling and revaluation, with the assumption that bundled services include economies and support lower values. CMS has increasingly ignored the coding and valuation recommendations developed through the AMA’s CPT and RUC processes. Now, in an unprecedented move, CMS is rejecting many of the new codes developed for PCI and announcing 19%-28% reductions in the base codes for stenting procedures. We are closely examining the calculations CMS made to ensure no errors were introduced and that related practice expense and malpractice values were captured with the bundled codes.

    While SCAI was successful in garnering the recognition of five coronary branches for payment in 2013 when CMS had previously recognized only three, the 2013 fee schedule indicates CMS will not pay for the new additional branch codes. The Final Rule asserts CMS’ intent is to block payment for the new branch vessels, it does not appear that CMS intends to try and block payment for the treatment of additional vessels.

    The steep discounting of PCI does not appear to be a terrible mistake that CMS needs to correct but rather a deliberate effort by the administration to shift payments from specialists toward primary care. Regardless of the explanation, SCAI is deeply concerned that the fee cuts for PCIs may ultimately result in the rationing of care for senior citizens. Let us assure you that SCAI will continue to fight for fair and just valuation for the work you do. 

    Key findings from the Final Rule include:

    • An overall cut of 2% reduction for Cardiology.
    • For diagnostic cardiac catheterization, the interim values assigned to the 2012 codes, representing a 10% reduction in 2012, have been upheld and stabilized with no further significant reduction for 2013.
    • The reduction in valuation for stent procedures range from 19% to 28%.
    • ACC is reporting that the new EP/ablation family of codes is slated to experience a roughly 27% reduction.
    • While CMS reduced the RUC-recommended values for the new endovascular TAVR codes, CMS did agree to pay for two co-surgeons at each procedure (rather than splitting the fee, each physician will get 67.5% of the fee schedule amount).
    • CMS upheld the RUC-recommended values for the new pVAD codes with the exception of the repositioning code, for which they elected to assign a slightly lower value than recommended.
    • Despite the objections of cardiology, ophthalmology, and even legislators, CMS is expanding the multiple procedure payment reduction on some in-office imaging and diagnostic procedures.

    What can you do now? First, do not miss SCAI’s free coding webinar to be held on Nov. 28 at 3 pm ET. With the Final Rule, CMS rewrote how the new PCI codes are to be used under the Medicare system. Please be wary of any coding guidance you may have received prior to the release of the Final Rule. The SCAI-ACC-HRS Webinar is the definitive source of coding guidance regarding these new codes. This is the first and best opportunity you and your coding staff will have to learn what you need to know for optimal and accurate coding of your services in 2013. We urge you to register today, and reserve time on your whole team’s calendar so that they, too, can learn first-hand from the experts who crafted the new PCI codes how to master them.

    Second, we need to hear from you. As mentioned above, SCAI’s Advocacy team of physicians and staff intends to take every action possible to ensure the fees announced yesterday by CMS have been properly calculated to reflect the complexity of the procedure you provide. But we need to hear from you as to what specific impact you anticipate such significant reductions in reimbursement will have on your practice’s ability to treat patients. Please email us promptly at president@scai.org

    Thank you. 

    Sincerely,

    J. Jeffrey Marshall, MD, FSCAI
    SCAI President (May 2012 - May 2013)

    James C. Blankenship, MD, FSCAI
    SCAI Advocacy Committee Chair