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News July 02, 2009

CMS Releases Proposed 2010 Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) has released the proposed 2010 Medicare Physician Fee Schedule. ASA is reviewing and analyzing the 1128-page rule, and will provide membership with additional information about proposed changes. Comments on the rule will be due by August 31 and filed by ASA.

The proposed rule includes a number of key provisions relevant to anesthesiology:

  • Medicare Anesthesiology Teaching Rule Payment Update – Beginning January 2010, CMS will provide full Medicare payment when a teaching anesthesiologist oversees anesthesiology residents on two overlapping cases, consistent with the Medicare Anesthesiology Teaching Funding Restoration Act of 2007, which became law last year.

  • Removal of Physician-Administered Drugs for Purposes of Computing Update – CMS is proposing to remove physician-administered drugs from the definition of “physician services” for purposes of computing the physician update formula. While the proposal will not change the projected update for services during CY 2010 unless Congress acts this year, CMS projects that it would reduce the number of years in which physicians are projected to experience a negative update.

  • Physician Payment Update – Under the proposed rule, and consistent with current law, CMS plans to implement the slated rate reduction of -21.5% for CY 2010. Since 2003, however, Congress has acted to avert significant reductions in Medicare physician payments, with the latest of these interventions occurring last July via the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). MIPPA provided physicians with a 0.5% update for the remainder of 2008 followed by a 1.1% update through December 31, 2009, thereby preventing what was at the time a projected 10.6% Medicare payment reduction.

  • Physician Payment Refinements to Practice Expense (PE) – CMS proposes several changes intended to refine Medicare payments to physicians, which are expected to increase payment rates for primary care and other physicians, including anesthesiologists. The proposals include an update to the PE 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 (PPIS), designed and conducted by the American Medical Association (AMA) and over 60 medical specialty societies including ASA.

  • Physician Quality Reporting Initiative (PQRI) – For 2010, participants may earn an incentive payment of 2.0% of the eligible professional’s estimated total allowed charges for covered PFS services under Medicare Part B provided during the reporting period. The incentive program generally operates on a calendar year basis. For the CY 2010 PQRI, there are a number of proposed reporting options and reporting periods available. Some options require data to be submitted by December 31, 2010. However, data reported through registries would not be due to CMS until 2011. Key changes for CY 2010 include:
    • Proposed inclusion of the Perioperative Temperature Management measure, which would provide a third measure for anesthesiologists (including Measures 30 (Timing of Prophylactic Antibiotics) and 76 (Prevention of Catheter-Related Bloodstream Infections: Central Venous Catheter Insertion Protocol);
    • Implementing provisions of MIPPA that would enable group practices to qualify for a 2010 PQRI incentive payment based on a determination at the group practice level, rather than at the individual EP level, that the group practice has satisfactorily reported data on PQRI quality measures;
    • Adding an electronic health record (EHR)-based reporting mechanism to promote the adoption and use of EHRs and to provide both eligible professionals and CMS with experience on EHR-based quality reporting.

ASA members should be ready to participate by submitting comment letters to CMS when called upon. More information will be provided in the coming weeks.

In the meantime, if you have specific concerns or knowledge about key portions of the rule, and would like input to be considered when ASA crafts its comments to CMS, please send an email to [email protected], subject line: 2010 proposed rule.