Practice Manager Insider

ACCC Criticizes Proposed Changes to RVUs

The Association of Community Cancer Centers (ACCC) has expressed concern about the Centers for Medicare & Medicaid Services (CMS) proposed changes to the work relative value units (RVUs) under the physician fee schedule, and to the practice expense methodology. These were published in the Federal Register on June 29, 2006 and covered in Practice Manager Insider on July 5. They are scheduled to take effect on January 1, 2007 and would be phased in over 4 years.

ACCC expressed concern that the proposals would reduce beneficiary access to quality cancer care. It recommended that CMS:

Postpone any changes to the RVUs that would reduce reimbursement for drug administration services, including administration of radioimmunotherapies, until CMS can ensure that beneficiary access to care will not be reduced. The proposed method for calculating practice expense RVUs would reduce RVUs for many drug administration services by 2% to 8% in 2007, according to ACCC. When fully implemented, RVUs for many drug administration services would fall by 4% to 33%.

Postpone reductions to RVUs for imaging services until CMS has measured effects of the payment decrease for certain multiple imaging services. CMS in 2006 reduced payment for the technical component of multiple imaging procedures on contiguous body parts by 25%. It also has separately proposed limiting payment for multiple imaging procedures to the amount paid when those services are performed in hospital outpatient departments.

Finalize the proposed work RVUs for radiation oncology services, delay changes in assumptions regarding equipment utilization, and review the proposed practice expense RVUs for medical physics services in radiation oncology. ACCC notes that CMS has proposed reducing practice expense RVUs drastically for medical physicists’ services – eg, by nearly 77% over 3 years in the case of the CPT code for “set radiation therapy field.”

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/06-5665.pdf

http://www.accc-cancer.org/PUBPOL/pdf/pubpol_PFScomments.pdf

CMS Warned Organ Transplant Programs Failing to Meet Standards

The Centers for Medicare & Medicaid Services (CMS) funds the majority of US transplant centers and requires them to achieve certain benchmarks. The Los Angeles Times reported in June that 20% of the 236 federally funded heart, liver, and lung transplant programs do not meet minimum CMS standards for the number of procedures performed and for survival rates. A total of 9 lung transplant programs and 36 heart transplant programs did not meet CMS standards. Those programs accounted for 71 more deaths than expected under normal conditions, based upon a government analysis of survival rates. CMS can revoke the certification of transplant programs that do not meet its standards.

The Los Angeles Times reported earlier this month that CMS sent warning letters to about 35 programs that have failed to meet its standards, offering them a last chance before taking enforcement action. That action could include loss of federal funding. The failing transplantation centers have not been identified publicly.

CMS plans to issue revised standards for transplantation programs before the end of 2006, rather than in 2007 as previously planned.

http://www.latimes.com/news/local/la-me-transplant4aug04,1,3858771.story?ctrack=1&cset=true

CMS Plans to Propose a 5.1% Cut in 2007 Physician Rates

Medicare payments to physicians are governed by a statutory formula. The Centers for Medicare & Medicaid Services (CMS) has recently recalculated the projected reimbursement rate to be proposed for 2007, and arrived at the -5.1% figure. The proposed fee schedule is expected to be published in the Federal Register on August 22 as part of a proposed rule including other suggested policy changes. Comments will be accepted until October 10, and a final rule will be published in the fall.

Other proposals put forth by the CMS include:

• Exempting the colorectal cancer screening benefit from the Part B deductible, eliminating a potential financial barrier to using this benefit.


• Changes in how to consider the bundling of drug discounts and other parameters in calculation of the average sales price on which Part B reimbursement is based.


• Maintain a 25% reduction in payment for the technical component of multiple imaging procedures on contiguous body parts. CMS has indicated that it would increase the reduction to 50% in 2007 but is not proposing to do that at this time.


• Cap payment for multiple imaging procedures to the amount paid when those services are performed in hospital outpatient departments.


• Propose assigning work relative value units to medical nutrition therapy services (CPT codes 97802, 97603, and 97804, and HCPCS codes G0270 and G0271).

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1939

http://www.accc-cancer.org/MEDIA/media_newsfeed.asp

Senators Sponsor Bill to Forestall Cuts in Imaging Reimbursement

A bipartisan group of nearly 70 senators is cosponsoring a bill that calls for a 2-year hold on changes in Medicare reimbursement for medical imaging that are projected to result in deep cuts. The reductions will limit payment for imaging services in a physician’s office or imaging center to no more than that of a hospital outpatient department. This change is projected to reduce reimbursement rates for physician offices or imaging centers by 30% to 50%. The change in payment is scheduled to take effect on January 1, 2007.

The bill, S. 3795 (Access to Medicare Imaging Act), also requests that the Government Accountability Office (GAO) study the use of such imaging services by Medicare beneficiaries. The House already had introduced a similar bill. The Medicare savings projected to result from the change in payment account for more than one-third of the total Medicare savings in the Deficit Reduction Act of 2006.

80 Senators Urge Higher MD Medicare Rates

In a letter sent recently to the Senate majority and minority leaders, the senators urged that Congress act before its pre-election October adjournment to avert projected cuts of about 5% in the Medicare physician reimbursement rate.

The reduction is projected due to the Medicare sustainable growth rate formula, which the 80 senators called “flawed.” If no action is taken, the roughly 5% reduction would take effect January 1, 2007. “At a minimum, we must provide physicians with a positive Medicare payment update for 2007,” the letter states. Average 2006 Medicare physician reimbursement rates, said the senators, are equivalent to those of 2001. “If the 2007 cut is imposed, then the aggregate payment rates since 2001 will have fallen 20% below the government’s conservative measure of inflation for medical practice costs,” the senators asserted.

The letter quotes a 2006 American Medical Association survey as stating that if the payment cuts go into effect in 2007, then 45% of physicians plan to decrease the number of new Medicare patients they accept.