Dermatologists could see a 3% increase in their Medicare payments next year, provided Congress steps in to stop a projected 21.5% across-the-board payment cut.
The estimates on reimbursement were part of the 2010 Medicare Physician Fee Schedule proposed rule, from the Centers for Medicare and Medicaid Services.
The proposal also includes increased pay for primary care physicians, decreased pay for some specialists, and a potential way to get rid of the sustainable growth rate formula. A final rule is expected in November.
Dermatologists could end up with a positive update mainly due to increases in the practice expense relative value units, which were recalculated based on new survey information.
But overall, the proposed fee schedule is not good for dermatologists or any specialist, said Dr. Brett Coldiron, of the department of dermatology at the University of Cincinnati and a member of the board of directors of the American Academy of Dermatology.
The main problem, he said, is the loss of consultation codes. Under the proposal, the CMS would eliminate the use of all consultation codes except telehealth codes starting Jan. 1. At the same time, the agency would increase the work relative value units for new and established office visits, increase the work values for initial hospital and initial nursing facility visits, and incorporate the increased use of these visits into the practice expense and malpractice relative value unit calculations.
“We believe the rationale for a different payment for a consultation service is no longer supported because documentation requirements are now similar across all [evaluation and management] E&M services,” the CMS wrote in the proposed rule.
The elimination of consultation codes will hurt academic dermatologists the most because they perform a lot of consults for patients with complex conditions, Dr. Coldiron said. “I think we ought to be supporting medical dermatology.”
The proposed rule is considered good news for primary care. For example, the proposed rule includes plans to increase payments for E&M services and increased payment for the Welcome to Medicare physical, which focuses on primary care, health promotion, and disease prevention.
The CMS estimates that the combination of the various proposals would mean a 6%-8% payment increase for primary care physicians, excluding the impact of the 21.5% cut.
Another major part of the proposal is a plan to remove physician-administered drugs from the sustainable growth rate (SGR)—the statutory formula used to set physician payment rates under Medicare. Physicians' organizations have sought the repeal of the SGR for many years saying that it is flawed and does not reflect the true cost of providing medical care. A major criticism of the formula is that it counts the price of physician-administered drugs, over which physicians have little control, as a physician service.
Since the SGR is designed to cut payments when health care expenditures rise above a certain target, the inclusion of drugs has caused physicians to exceed those targets more rapidly and has contributed to pay cuts over the years.
The removal of physician-administered drugs from the SGR should reduce the number of years that physicians see pay cuts, according to the CMS. And the American Medical Association is betting that the change will make it less expensive for Congress to repeal the SGR, which would also benefit physicians.
Even if enacted, the proposal will not stop the 21.5% pay cut slated to go into effect on Jan. 1, 2010. However, several physicians interviewed said they were hopeful that Congress would step in again this year to roll back this cut, whether through health reform legislation or in a separate bill.
The fee schedule proposal also includes policy changes related to imaging. The proposed rule would cut payments for certain high-cost imaging services by assuming that imaging equipment priced at more than $1 million is used 90% of the time, compared with the current assumption of use at 50%.
The proposed change is based on studies from the Medicare Payment Advisory Commission (MedPAC) showing that the use of high-cost imaging equipment is higher than previously thought.
For example, MedPAC found that in certain markets, MRIs were being used an average of about 46 hours a week, or 92% of a 50-hour workweek.
The agency said it will continue to examine the data for equipment valued at less than $1 million but is not proposing a change at this time.
Overall, the proposed fee schedule is not good for dermatologists or any specialist.
Source DR. COLDIRON