Medicare Changes for 2010

Medicare’s 2010 final rule confirms that physicians face steep cuts of 21.2% in 2010. Permanent repeal of the flawed sustainable growth rate (SGR) formula is an essential element of comprehensive health system reform. In October, the Senate failed to pass a bill (S. 1776) that would fix the problem, while the House is expected to vote soon on a different bill (H.R. 3961) that would also fix the problem.

The rule includes other changes for EDX physicians as well. A proposal for Medicare to stop accepting consultation codes (99241-99245, 99251-99255) as of January 1, 2010 was finalized and included in the rule. Physicians will instead report the office visit codes (99201-99205, 99211-99215) to Medicare for these services. For inpatients, use hospital care codes (99221-99223) or initial nursing facility care visit (99304-99306) evaluation and management (E/M) codes for the first visit during a patient’s admission to a hospital or nursing facility. In its proposal to eliminate the consultation codes, Medicare cited continued provider dissatisfaction with Medicare documentation requirements, confusion between a consultation and a transfer of care, and similarity in the physician work of consults and office visits, despite the work higher value. The AANEM and many other entities commented in opposition to this change and the fast implementation to no avail.

To maintain budget neutrality the RVUs for other office visit E/M services will be increased proportionately, about 6%. Work RVUs for hospital and nursing facility visits will be increased approximately 2%. The table below shows how the removal of consult codes and subsequent redistribution of value affects key E/M codes.

* Calculated before 21.5% SGR cut is applied. **Inpatient codes have only three corresponding levels of service.

Finally, CMS currently utilizes practice expense (PE) data and physician hours from the 1995-1999 AMA Socioeconomic Monitoring System (SMS) survey to calculate “practice expense per hour” estimation and direct to indirect cost ratio for each specialty. This data and the accompanying PE and malpractice (MP) RVUs are being updated with new survey data from 2007-2008 that was compiled through joint efforts of AMA, CMS, and over 70 national health care organizations. Implementation of these data will redistribute practice expense payment among specialties during a 4-year transition period.

Physical medicine and rehabilitation physicians will receive a 2% increase from transitional practice expense RVU changes in 2010, increasing to a 6% increase in 2013. Neurologists will receive a 1% transitional increase in 2010, culminating in a 4% increase in 2013. As part of the redistribution, a number of other specialties will see net reductions in 2010 through the 2013 transition, as seen in this table.

Neuromuscular Ultrasound Position Statement

A new position AANEM statement addressing neuromuscular ultrasound was approved in October by the Board of Directors. The position statement defines neuromuscular ultrasound, specifies uses for the technique, and lists requisite qualifications necessary to perform it. The complete position statement is available here.

Medicare Physician Payment Reform Act of 2009

Call your U.S. Representative today!

Next week, a floor vote is planned in the House of Representatives on H.R. 3961, the “Medicare Physician Payment Reform Act of 2009.” This legislation would permanently repeal the sustainable growth rate (SGR) formula that calls for annual cuts in Medicare physician payments, and replace it with a new, more rational payment system.

In less than two months, Medicare payments will be slashed by more than 21 percent because of the SGR formula. Past short-term patches have only made the problem worse. This is the time to solve the problem once and for all, to preserve access to care and provide physician practices with the financial stability they need to help build a 21st century health care system.

It is imperative that you contact your U.S. representatives today to ask that they vote for H.R. 3961.

Call (800) 833-6354, the AMA Grassroots Hotline, to be directly connected with your representative.

Tell your representative:
•Congress must fulfill its obligations to Medicare patients and military families covered by TRICARE.
•Short-term patches that only make future cuts deeper and the cost of a permanent solution more expensive are not the answer.
•The fiscally responsible solution is permanent repeal of the SGR formula.
•Vote “YES” on H.R. 3961.

Send an e-mail directly to your representative through the AMA Grassroots Action Center at www.ama-assn.org/go/grassroots.

AMA Morning Rounds: FDA extends review of neuropathic pain drug

The AP (11/10) reports that the FDA "needs three more months to review an application to a neuropathic pain drug being developed by XenoPort Inc. and GlaxoSmithKline PLC," called gabapentin enacarbil, according to the companies. The companies said the FDA "should complete its review of the drug" by Feb. 9, 2010. The AP adds, "The FDA wanted the companies to develop a strategy to evaluate the drug's risks, and after GlaxoSmithKline submitted that strategy, the agency needed additional time to review it." The Triangle Business Journal (11/9) also covered the story.

AMA House of Delegates Committed to Health System Reform

As the House of Representatives passed a health reform bill this weekend, the AMA House of Delegates is holding its Interim Meeting in Houston. Delegates have introduced a number of resolutions related to health system reform. Some are supportive of current bills and measures, while others are critical. After lengthy testimony regarding health reform in reference committee hearings on Sunday, the HOD voted on Monday to reaffirm its committment to existing health reform policies in Substitute Resolution 203, maintaining support for H.R. 3962. View resources that show exactly which proposals are supported and opposed. 

AMA President J. James Rohack, MD noted, "H.R. 3962 is not the perfect bill, and we will continue to advocate for changes that help make the system better for patients and physicians as the legislative process continues." The AMA will continue to support H.R. 3961 to repair the broken Medicare SGR formula and keep pushing for liability reforms that will reduce the costs of defensive medicine.

House Passes Health Reform Bill

The U.S. House of Representatives passed a health reform bill Saturday night by a vote of 220-215.  The Affordable Health Care for America Act (H.R. 3962) makes many changes to the current health system. The key purpose of the bill is the expansion of health coverage to the uninsured and underinsured through subsidies financed by increasing taxes on high earners ($500,000 individual, $1,000,000 married filing jointly) and cutting costs in the current system. The Congressional Budget Office predicts the 10-year cost of these changes is $1.054 trillion. The bill does not make significant changes to medical liability laws or address the flawed Medicare SGR formula.

Senate leaders have been working to complete their own version of a health refrom bill that will be different from the House bill. If the Senate is able to pass a bill, then members from both chambers will have to reconcile the two different bills into a single bill that would then have to pass both chambers.

FTC Delays Red Flag Rules 3rd Time

The Federal Trade Commission recently announced its third delay in implementation of the Red Flags Rule. Implementation of the rules has been delayed until June 1, 2010. The AMA has been urging the FTC and Congress that physicians are not "creditors" and should not be subject to the rule. View the FTC's release for more information on the delay.

The AANEM encourages its members to be cognizant of these rules and will continue to report on anticipated implementation and the work of the AMA on this issue. The AMA has developed resources for implementation of these rules.

Highmark Corrects Max. Number of Studies Table

Through the efforts of AANEM's State Liaison in New Jersey, Dr. Alexander Pendino, Highmark Medicare Services has corrected the Maximum Number of Studies Table included within its local coverage determination. Highmark was notified during the comment period in February that the table it included was not accurate and should be modified. Dr. Pendino spoke with Dr. Eileen Moynihan, Medical Director at Highmark Medicare, and discussed the inaccuracy. The modifications were not included when the new policy was released in earlier this year. Ultimately, Dr. Pendino's persistence resulted a recent correction of the table.