Final 2010 Medicare Pay Tough on Some Specialties


The Centers for Medicare and Medicaid Services issued the final physician fee schedule for 2010, and, as expected, Medicare reimbursement will be reduced by 21% overall unless Congress intervenes.

For some specialties, the cuts could be even deeper, thanks to a revamping of the relative value assigned to each specialty and to reductions in medical imaging payments.<

But primary care physicians are pleased, as the fee schedule makes good on the agency's promise to assign a higher value to their services. Internists, general practitioners, family physicians, and geriatric specialists will see pay increases of 5%-8%. And like all physicians, primary care doctors will also be eligible for a 2% bonus payment for participating in e-prescribing and another 2% if they take part in the Physician Quality Reporting Initiative (PQRI).

Even so, they, too, will be subject to the overall reduction, mandated by the Sustainable Growth Rate (SGR) formula.

The upshot is that primary care physicians will see a slightly smaller cut than other physicians, said Dr. Ted Epperly, in an interview. Congress will most likely step in and, as it has for the past 7 years, reverse the SGR-imposed reductions, said Dr. Epperly, chairman of the board of trustees of the American Academy of Family Physicians.

He said that he does not expect the House or the Senate to take on the SGR fix as part of the health reform package because at this point, it would add too much to that plan's cost. The House has proposed a separate, stand-alone permanent fix, but it's not clear that bill will pass, either.

In a statement, American Medical Association President James Rohack said the fee schedule “confirms that in 60 days physicians face steep cuts of 21.2%—the largest payment cut since Congress adopted the fatally flawed Medicare physician payment formula.” Dr. Rohack added that “permanent repeal of the payment formula is an essential element of comprehensive reform”.

Even if Congress does find a way to avert the SGR cuts or overturn the formula entirely, cardiologists will still take a huge hit, Dr. Jack Lewin, the CEO of the American College of Cardiology, said in an interview.

To calculate this year's fees, the CMS relied on self-reported expense data based on the Physician Practice Information Survey. That survey was designed by the AMA and was supposed to make payments more accurate.

Dr. Lewin said that cardiologists must have incorrectly completed the surveys because it resulted in an 11% reduction in payment. The CMS also said it would reduce how much it would pay for echocardiography and stress testing—two of the most commonly performed in-office diagnostics. In 2010, Medicare payments for echo will be reduced by 11% and stress by 8%. The cuts are slated to be even deeper going forward.

In a surprise announcement, the CMS also said it would reduce single-photon emission computed tomography payments by 37%. The ACC collaborated on creating a new single code for SPECT and expected a phasing-in of a reduced payment. Instead, it's coming in just 1 year. The ACC hopes that this was an error, said a spokesman for the organization.

The cutbacks could cause many community-based cardiologists to close their private practices and become employees of hospitals instead, Dr. Lewin said.

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