CMS proposes 6.1% cut in 2011 Medicare payments

Jun 28, 2010

Medicare payments to physicians will be cut an additional 6.1% next year under the proposed 2011 Medicare Physician Fee Schedule (MPFS) published by the U.S. Centers for Medicare and Medicaid Services (CMS), unless Congress acts once again to delay cuts mandated by the sustainable growth rate (SGR) formula.

CMS' proposal was issued in the Federal Register on June 25, the same day President Barack Obama signed legislation that replaces the current 21.3% SGR cut with a 2.2% payment increase for services performed between June 1 and November 30 of this year.

The 6.1% cut is based on the conversion factor that was in play under 2010 payment rates, but it has been repeatedly put off by congressional action to avoid the larger, accumulated SGR cut. If Congress doesn't fix the SGR formula when this latest legislation expires November 30, MPFS cuts will be substantial, according to Pam Kassing, senior director of health economics and policy at the American College of Radiology (ACR) in Reston, VA.

"If the 2010 SGR reduction is combined with this newly proposed cut, plus accounting for the 2.2% increase physicians will have enjoyed since June, we could be looking at cuts in Medicare payments of almost 30% in 2011," Kassing said.

CMS is taking comment on the proposed MPFS rule until August 24, and the agency plans to issue a final rule on November 1.

Putting healthcare reform into practice

In addition to Medicare physician fee cuts, CMS' proposed rule would also implement key provisions passed in healthcare reform legislation in March (called the Patient Protection and Affordable Care Act [PPACA]), including:

Amending the in-office ancillary services exception to the Stark law as applied to MRI, CT, and PET so that physicians will be required to disclose to patients in writing at the time of referral that there are other suppliers available to perform the service, as well as a list of these suppliers in the patient's area

Adjusting the equipment utilization rate for advanced imaging equipment to 75%

Increasing payment for two dual-energy x-ray absorptiometry CPT codes (77080 and 77082) for measuring bone density for calendar years 2010 and 2011; payments for these services will use 70% of their calendar year 2006 relative value units (RVUs), and the 2006 conversion factor with current year geographic adjustment

Also on the radar: As of July 1, the PPACA increases the established MPFS multiple-procedure payment reduction for the technical component of certain single-session imaging services to consecutive body areas from 25% to 50% for subsequent procedures performed in the same session. In its rule, CMS is proposing that this type of payment reduction be expanded to include noncontiguous body parts as well, according to Kassing.

"We'll be looking at that [over the upcoming weeks] and commenting heavily," she said.

PQRI modifications

The proposed rule would also modify the Physician Quality Reporting Initiative (PQRI), first implemented in 2007 as a voluntary program to allow physicians and other eligible healthcare professionals to receive incentive payments for reporting data on quality measures related to services furnished to Medicare beneficiaries.

To incorporate provisions in PPACA, CMS proposes several changes to the program, including expanding the number of measures on which individual physicians may report, and creating a group practice reporting option that would allow group practices with fewer than 200 physicians to participate.

CMS is also proposing that the program's incentive payments be extended for years 2012 through 2014 by providing an incentive payment of 0.5% of the physician's estimated total allowed charges for covered professional services under Medicare Part B.

Noticeably absent

One issue CMS was noticeably silent on in last week's proposed rule is concerns about supervision requirements for radiologist assistants (RAs) or radiology practitioner assistants (RPAs), according to Tom Greeson, a partner at Reed Smith of Falls Church, VA, who specializes in radiology-related regulatory matters.

"In last year's final rule, CMS invited comments on how RAs and RPAs could be used in hospitals, and the American College of Radiology, the American Registry of Radiologic Technologists, and the American Society of Radiologic Technologists all made some sound recommendations that included changing the supervision requirements," Greeson said. "CMS has not addressed the issue in this proposed rule, and the silence is disappointing."

By Kate Madden Yee
AuntMinnie.com staff writer
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