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  1. #1
    wcb22 is offline Elite Member
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    Medicare Reimbursements going up, finally!

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    Dear ACP Member:
    I am happy to report to you that on June 21 the Centers for Medicare and Medicaid Services (CMS) proposed changes to work relative value units (RVUs) that will result in payment increases averaging thousands of dollars per internist. Due to the leadership of ACP, CMS has proposed to make the largest increase in the work RVUs assigned to office and hospital visits and consultations--known as evaluation and management (E/M) services--since Medicare implemented its physician fee schedule in 1992. If implemented in January 2007 as CMS proposes, the increased work RVUs will result in a significant increase in Medicare payments to internists for their evaluation and management services.

    What Will the Impact be on Payments?

    The increases in work RVUs proposed by CMS, based on the Relative-value scale Update Committee’s (RUC) recommendations, include double-digit increases for some of the codes most commonly billed by internists:

    • The work RVU for a mid-level established patient office visit, 99213,
    would increase by 37%.
    • The work RVU for the highest-level initial hospital visit, 99223,
    would increase by 26%.
    • The work RVU for the mid-level subsequent hospital visit, 99233,
    would increase by 31%.

    Your Medicare payments will not increase by the same percentages listed in the above examples. Changes in physician work RVUs affect approximately 55% of the total RVUs (the rest are determined by changes in practice expense and medical liability RVUs), so the increase in work RVUs will determine just over half of the total payments per service.

    Further, by law, CMS must offset the total increases in work RVUs from the five year review with a separate adjustment so that 2007 expenditures are roughly equal to their 2006 level.

    Even after the budget neutrality adjustment is applied, 2007 Medicare payments for many E/M services would increase significantly, assuming continuation of the current 2006 dollar conversion factor. For example:

    • For CPT code 99213 the 2006 fee is $52.68, the 2007 fee would be $59.42.
    This is a 12.8% change.
    • For CPT code 99223 the 2006 fee is $157.29, the 2007 fee would be $173.27.
    This is a 10.2% change.
    • For CPT codes 99233 the 2206 fee is $79.21, the 2007 fee would be $90.95.
    This is a 14.8% change.

    Internists will benefit greatly from these changes because of the large amount of E/M services they furnish to patients. As a general rule, physicians who see the most Medicare patients in face-to-face E/M visits will experience significant increases in Medicare payments, while some physicians who provide fewer E/M services will experience payment reductions. ACP estimates that the average gain for internists will be between $4000 and $6000 in 2007 from Medicare alone, although some internists will gain more, and others less, depending on the mix of services that they provide. Since many private health plans use the Medicare-approved RVUs for determining their own fee schedules, the increases proposed by CMS are also likely to increase non-Medicare payments to internists. Such redistribution will begin to correct long-standing reimbursement disparities that are contributing to the looming crisis in access to primary care, and help ensure an adequate supply of internists and other physicians to care for an increasingly aging population.

    How Does Medicare Determine Fee-for-Service Payments?

    Medicare fee-for-service payments are determined by a formula that multiplies the relative values for services by a dollar conversion factor. The relative values assign different relative weights to each service, based on differences in the physician work involved, practice expenses, and medical liability costs associated with the service. Changes in relative value units will therefore increase or decrease the total amount of Medicare dollars that go to specific categories of services.

    Medicare law requires CMS to assess the accuracy of the relative values it assigns to physician services every five years. CMS last changed the work RVUs assigned to the E/M services in 1997. In Jan. 2005 the College asked CMS to include a re-examination of the physician work involved in the E/M codes in this “Five-Year Review,” based on evidence that the patient complexity and work involved in such encounters has increased substantially over the past decade. ACP organized and led a coalition of internal medicine subspecialty organizations, and other organizations that represent physicians who provide the most E/M services to Medicare patients, to make the case that many E/M services are undervalued compared to other physician services and that it is essential that their work RVUs be increased.

    Making the Case for Increased Reimbursement

    The College and its coalition partners used the evidence they developed to convince the RUC to recommend that the agency increase work RVUs consistent with that evidence. The RUC is an entity organized and chaired by the American Medical Association that is comprised of individuals appointed by organizations representing the major physician specialties, surgical as well as non-surgical, to make recommendation to CMS on work RVUs. After hundreds of hours of data gathering, preparation, and discussion, ACP volunteer physician leaders and staff, working with our coalition partners, were able to persuade at least two thirds of the RUC members to recommend to CMS that it implement very large increases in the work RVUs for dozens of E/M service codes.

    CMS has now proposed to accept all of the RUC’s E/M recommendations!


    What Can You Do to Make Sure the Proposed Increases are Implemented?

    ACP is encouraged by the CMS proposed changes. Because this is a proposed rule, CMS will be accepting comments before finalizing the changes later this year. We will urge CMS to implement the proposed E/M work RVUs in the 2007 Medicare physician fee schedule. We encourage you to do the same by sending a letter to CMS indicating support for the proposed E/M changes and describing the positive impact those changes will have on your practice. Your letter should include the following points:

    • Urge CMS to finalize the recommended work RVU increases for evaluation and management services.
    • Give examples from your own practice of how the complexity and work associated with taking care of patients during office and hospital visits and consultations has increased dramatically over the past ten years.
    • Explain that such changes will help assure continued access to primary care services.
    • Urge CMS to reject any comments that would lower the overall improvements in work RVUs for E/M services.

    CMS will accept public comments regarding the proposed rule through August 21, 2006. Comments can be submitted electronically by going to www.cms.hhs.gov/eRulemaking and clicking on “submit electronic comments on CMS regulations with open comment period.” Comments can be mailed by sending an original letter and two copies to:

    Centers for Medicare and Medicaid Services
    Department of Health and Human Services
    Attention: CMS-1512-PN
    P.O. Box 8014, Baltimore, MD 21244-8014

    Allow sufficient time for mailed comments to be received by the August 21 deadline.

    It will be essential that Congress also do its part to halt cuts in the Medicare conversion factor (the dollar amount that when multiplied by the new RVUs, determines how much is paid per service) to avert a scheduled 4.6% cut in 2007 that will occur because of the flawed Sustainable Growth Rate (SGR) formula. This cut, if it were allowed to take place, would eliminate much of the initial gain that would result from the five year review RVU increases for E/M services. For information on how you can help avert the SGR cuts, I urge you to sign up as a key contact for members of congress at ACP's Legislative Action Center: http://www.acponline.org/hpp/advocacy/lac.htm?in. Key contacts will receive regular alerts from ACP on upcoming votes on the SGR cuts and other issues.

    The increases in relative values and payments for E/M services is an important first step toward addressing the payment inequities that are leading to the collapse of general internal medicine and other primary care specialties, while also benefiting internal medicine subspecialties who provide E/M services. ACP is committed to advocating for additional reforms. We ask you to join with us now to assure that the increases proposed by CMS, as recommended by the RUC, are implemented on January 1, 2007.


    Lynne Kirk, MD, FACP
    President, ACP
    M.D., PGY-3 Internal Medicine

  2. #2
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    pstone09 is offline Junior Member 510 points
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    yay. their spending more money on us.

  3. #3
    wcb22 is offline Elite Member
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    nice car.

    i don't think i'll ever have one of those, unless i choose to continue living in a 700 sq ft apartment for the rest of my life, or become a cardiologist who never see's his home, so having a small place wouldn't matter anyway.
    M.D., PGY-3 Internal Medicine

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