However, the proposed changes are expected to increase payment rates to general practitioners, family physicians, internists and geriatric specialists by between 6 and 8 percent for primary care services.
Eight key proposed changes affecting physician payment rates have been introduced, which will affect the following areas: the practice expense component of physician fees, the inclusion of physician-administered drugs in the definition of “physician services,” payment for consultation codes, payment rates for the initial preventative physical exam, recognition for the cost of professional liability insurance, payment rates for high-cost imaging services, incentives for electronic prescribing and measures of the Physician Quality Reporting Initiative.
CMS has proposed the following eight changes:
- An update the practice expense 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, designed and conducted by the American Medical Association.
- The removal of physician-administered drugs from the definition of “physician services.” This change is for the purposes of computing the physician update formula in anticipation of enactment of legislation to provide fundamental reforms to Medicare physician payments. While the proposal will not change the projected update for services during 2010, CMS projects that it would reduce the number of years in which physicians are projected to experience a negative update.
- Stopping payment for consultation codes. CMS would stop paying consultation codes, which are typically billed by specialists and are paid at a higher rate than equivalent evaluation and management services. Resulting savings would be redistributed to increase payments for the existing E/M services, according to CMS.
- An increase the payment rates for the Initial Preventive Physical Exam. The rates for this plan, also called the “Welcome to Medicare” visit, would be changed to be more in line with payment rates for higher complexity services.
- Refine how Medicare recognizes the cost of professional liability insurance in its payment system. While these changes would have a modest impact, they will promote payment equity by redirecting the portion of Medicare’s payment for professional liability insurance to those physicians that have the highest malpractice costs, according to CMS.
- Addition of benefit categories for cardiac and pulmonary rehabilitation services, and for chronic kidney disease education, as dictated by the Medicare Improvements for Patients and Providers Act of 2008.
- Reduced payment for high-cost imaging services and plans to redistribute those savings to increase payments for other services, including primary care. CMS is also proposing that that suppliers of the technical component of advanced imaging services be accredited beginning January 1, 2012.
- Quality care and patient outcome provisions through revisions to the Electronic Prescribing Incentive Program and the PQRI. Eligible professionals or group practices that meet the requirements of each program in CY 2010 will be eligible for incentive payments for each program equal to 2 percent of their total estimated allowed charges for the reporting periods. CMS is also proposing to simplify the reporting requirements for the electronic prescribing measure and to provide eligible professionals with more reporting options. CMS is also proposing a new process for group practices to be considered successful electronic prescribers.
In addition, CMS is proposing to add more measures and more measures groups for eligible professionals to report under the PQRI, to provide a mechanism for participants to submit quality measure data from a qualified electronic health record and to create a process for group practices to use for reporting the quality measures.
CMS will accept comments on the proposed rule until Aug. 31, and will respond to all comments in a final rule to be issued by Nov. 1, 2009. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010.
Read the CMS news release on the proposed physician payment rate changes.
View the proposed rule in its entirety.
