“Physicians are really frustrated that everyone in Congress agrees” that there is a problem, “but they aren't doing anything,” said Dr. Rick Kellerman, president of the American Academy of Family Physicians.
In the final regulation, CMS officials are giving with one hand and taking away with the other, Dr. Kellerman said. For example, the regulation outlines increases to the work RVUs for evaluation and management services often performed by primary care physicians, but uses an inappropriate mechanism to apply budget neutrality to the changes, he said.
CMS is required by law to keep the changes budget neutral, so officials at the agency will apply a 10.1% across-the-board cut to work RVUs without changing the number of RVUs assigned to each service. Making this adjustment to the work RVUs distorts the relative value system, Dr. Kellerman said. The budget neutrality adjustment should instead be made in the conversion factor, where the cut would be more transparent, he said.
But Dr. Kellerman praised the move by CMS to change the way it determines practice expense RVUs, which include the direct and indirect costs associated with a procedure.
Under the new system, practice expenses will take into account practice expense data from eight specialties. The changes to the practice expense RVUs are being phased in over 4 years.
The combined impact of the work and practice expense RVU changes are estimated by CMS to result in a 5% increase in charges for primary care specialties such as family medicine and internal medicine, and a 2% increase for neurology. However, once the 5% across-the-board SGR cut is made, neurologists will see a 4% cut in allowed charges under Medicare.
Although primary care specialties make out relatively well under the RVU changes, other specialties will face deep cuts under them.
For example, CMS estimates that cardiologists will face a 1% cut in allowed charges in 2007, and a 5% cut in 2010 based on changes to the work and practice expense RVUs. These cuts will be in addition to the 5% drop in reimbursement based on the SGR formula and the cuts related to in-office imaging services.