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Late on Friday, October 30, 2009 the Centers for Medicare and Medicaid Services (CMS) released the Final Rule for the 2010 Medicare Physician Fee Schedule (MPFS). Provisions of most immediate concern to cardiology include:
· Overall Cardiology Impact: Policy changes finalized in the Rule reduce Medicare payments to cardiology by 8 % in 2010 and by 13 % over the next four years, not including the 21.2 % conversion factor cut required by current law.
· AMA Physician Practice Information Survey (PPIS): A 4 year phase in of data from the PPIS cuts aggregate cardiology payments by 10%. Although CMS did not withdraw the proposal to use PPIS, as ACC had recommended, the decision to implement a transition period is a response to the concerns cardiology raised.
· Equipment Utilization Rate: A 4 year phase-in of a 90 % equipment use rate assumption for diagnostic equipment priced over $1 million limits CT and MR payments.
· Malpractice RVUs: Implementation of updated malpractice premium data will increase malpractice RVUs slightly for EP procedures, while a new resource based formula for technical component services cuts RVUs for imaging services.
· Bundled Codes for SPECT MPI: Interim RVUs published for the new bundled code for nuclear perfusion imaging studies show a 36% payment cut for this core cardiology service, mainly because CMS has not applied the 4-year phase in of the PPIS data to this newly numbered code and cut work RVUs even more than the AMA/Specialty Society RVS Update Committee (RUC) recommended. This is a priority for ACC action.
· Consultations: Medicare will no longer pay for the consultation codes. Physicians will now code these services for Medicare patients with the office or hospital visit codes. RVUs for office and hospital visits have been increased.
· MPFS Update and SGR for 2010: CMS will finalize its proposal to remove Part B drugs from the Sustainable Growth Rate calculation. As required by current law, the Final Rule implements a 21.2% cut to the Medicare conversion factor. The SGR for 2010 is estimated at -8.8%.
· PQRI: New measures groups, which require physicians to report on only 30 patients instead of 80% of eligible patients to qualify for a 2 % bonus, have been added for CAD and heart failure. Most cardiology measures, along with the new measures groups, can only be reported through a registry, effectively eliminating the claims submission option for most cardiologists.
· E-prescribing: CMS finalized its proposal to require reporting of e-prescribing for only 25 eligible patient encounters to qualify for the e-prescribing bonus.
· New codes for cardiac CT, MR: In positive news, CMS accepted the RUC recommendations for new cardiac CT and MR codes.
· Revised RVUs for Cardiac Device Monitoring Services: ACC and HRS successfully challenged interim RVUs assigned to several cardiac device monitoring services. New, higher RVUs will be implemented for 2010.
For discussion or for further information, please contact me at anytime:
Thad Waites, Governor for Mississippi, ACC
601-408-0720 cell
thadwaites@gmail.com
Also, the Lewin Report, a blog from our CEO is always helpful. http://lewinreport.acc.org/
- And, The ACC strongly encourages you to use the following resources:
Email grassroots@acc.org to communicate directly with ACC National with any thoughts or comments on these cuts
The final 2010 PFS is at http://federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf
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