2010 Medicare physician payment final rule
The 2010 Medicare physician payment notice of proposed rulemaking (NPRM) was published in the Federal Register of July 13 with a deadline for public comments of August 31. Read AMA August 31, 2009, comment letter.
The major highlight of the NPRM is that it retroactively removes drugs from SGR calculations, restoring $130 billion to funding for physician services over the next 10 years. More information.
CMS also proposes to use results from a new practice expense survey sponsored by the AMA and 72 specialty societies and other health care professional organizations. The new practice expense values produce some significant redistributions among specialties. CMS proposes to use only the data from the new multispecialty survey and to discontinue use of data from older multispecialty surveys and from specialty-specific surveys that some societies had commissioned. CMS also proposes to move to the new values all at once in 2010 and does not propose a transition. Further information on the PPI survey and data provided to CMS is available at www.ama-assn.org/go/ppisurvey. Another significant practice expense change in the rule is that, for equipment that cost more than $1 million, the practice expense values would assume the equipment is in use 90% of the time that an office is open instead of the 50% assumption used currently.
The rule proposes to eliminate Medicare payment for consultations and use the money from these services to increase payments for visits. The impacts of this change are minimal since the proposed 2010 values for new patient visits will be pretty close to what consultation payments have been.
Updates are proposed in the professional liability insurance (PLI) relative values to reflect more current data. The rule also proposes a significant increase in the relative value for the Welcome to Medicare visit, with the work value going from 1.34 up to 2.30. Geographic adjustment factors (GPCIs) are not updated this year and changes are not proposed to locality configurations, but the NPRM includes a discussion of comments received on the locality report that CMS issued last fall.
There are some positive changes proposed for the e-prescribing incentive program. CMS recognizes that it is administratively burdensome for physicians to have to report one of three codes on 50% of their office visit claims in order to prove that they are e-prescribing and get the 2% incentive payment. Instead, in 2010, there will only be one code instead of three, and physicians will only have to report the code 25 times instead of reporting it for 50% of visits. In addition, eligible services will be expanded to include home and nursing home visits, and there will be a reporting option for group practices.
CMS also proposes a new group practice reporting option in the Physician Quality Reporting Initiative (PQRI). The agency has proposed new quality measures and measures groups for 2010 and it discusses the possibility of being able to report PQRI measures using electronic health records.
