The proposal “recognizes that an office visit is more intense and more complex than it was 10 years ago,” Dr. Felger said.
Specialty Societies Speak Out
Although primary care groups have expressed support for the CMS proposal, some specialties are complaining about the way the practice expense changes were calculated. The agency put out a notice asking various specialties to submit their own data for consideration by CMS. One member of the Practicing Physicians Advisory Council, which advises the CMS on issues affecting physicians, took the agency to task at the council's May meeting for allowing only some specialties to submit new data.
“I am more than a little frustrated that there [already] was a data set which admittedly was old, but it was collected from all specialties at the same time,” said Dr. Tye Ouzounian, an orthopedic surgeon from Tarzana, Calif. “Now some specialties have selectively submitted new data, which is 10 years newer, which is probably going to be more extensive. Those societies are being allowed to use new data, whereas other societies were not allowed to use new data, and that's not fair.”
The only way to make things fair, he continued, “is to allow all societies to participate equally on the same footing with the same survey at the same time. To cherry-pick data that are 10 years newer from 4 or 7 specialties is not fair to the groups that didn't do it.”
Don Thompson, senior technical advisor to the CMS, said that although he had heard similar comments from specialty societies that didn't participate in the survey, “we also received comments from those specialty societies that did do surveys. The thrust of their argument is that other medical specialty societies had an opportunity to do surveys and chose not to, and their assumption was those societies felt the value they had was correct.”
Mr. Thompson added that the agency had invited all the specialty societies to do surveys, “and we had criteria ahead of time about what we would [need] to accept surveys. The surveys that were done that met the requirements—random surveys, internally consistent—we had proposed to use them on that basis.” Ideally, he said, “we would like to see more recent survey data for all specialties.”
Dr. Ouzounian noted that the American Medical Association was discussing coordinating a survey of practice expenses for a large number of specialties. Mr. Thompson seemed receptive to that idea. “We would be supportive of the AMA going out and doing a survey, and if the data that resulted are better than what we have now, we'd want to incorporate that into our methodology,” Mr. Thompson said.
Although the increased payments for evaluation and management services and surgical postoperative care are needed, they are accompanied by an average 5% across-the-board cut in payments, according to the AMA. That cut is the result of the budget neutrality adjustment that the CMS is required by law to make whenever changes in RVUs cause an increase or decrease in overall physician fee schedule outlays of more than $20 million. The proposed work RVU changes are estimated to increase expenditures by about $4 billion, according to the CMS.
The proposal was published in the June 29 issue of the Federal Register. The CMS is accepting comments until Aug. 21.
The proposed rule is available online at
www.cms.hhs.gov/PhysicianFeeSched
This Month's Talk Back Question
How optimistic are you about plans to boost Medicare payments for evaluation and management services?