2010 Medicare Fee Schedule Published

Final Rules for 2010 Medicare Physician Fee Schedule

For more information, please contact Barbara Tomar.

  • Pay Cut: Congress passed a defense appropriations bill in December that included a provision for a 2-month moratorium on the 21.2% cut in the fee schedule. It will expire on February 28, 2010 and the cut will be imposed unless Congress acts again. The conversion factor would be reduced to $28.40, down from $36.06.
  • SGR:  CMS will take drugs out of the SGR pool retroactive to 1996/97, which will decrease the cost of replacing the formula with another way to update physician payment.
  • Practice expense:  Results of the AMA-coordinated practice expense survey (PCPI) have been incorporated by CMS and will be phased in over a 4-year period. Emergency medicine will realize a slight (2%) increase in practice expenses, with a small increase in levels 4 and 5 and larger increases in levels 1-3.  The American College of Cardiology, which had reductions to PE, is planning to take its fight to Congress to have the survey discarded. ACEP strongly supported the survey.
  • Consults:  CMS eliminated physician consultative fees and replaced them with initial hospital visit or office visit codes. Savings from consult codes have been redistributed to E/M office and hospital visits, something that the Administration supports, as it will increase payment for primary care physician services as well as consulting specialists. 
  • Imaging:  CMS has increased amount of time that complex diagnostic imaging machines (> $1M) are used in practices from 50% of the time to 90%. This will affect the technical component only, but will significantly reduce practice expenses for many physicians who perform complex imaging services in their offices. Policy will be phased in over 4 years.
  • PQRI:  The PQRI program will continue to provide a 2% bonus to successfully participating physicians through 2010. Legislation is required to continue bonus payments beyond 2010.
    • Physician groups of 200 or more are permitted to submit data on selected quality measures if all the physicians reassigned benefits to the group.
    • Rules for reporting are much the same as 2009, but the rule contains much more discussion of reporting using registries and EHRs, as well as claims-based reporting.
    • Measures must be NQF-endorsed by July 1, 2009 in order to be considered for inclusion in the 2010 PQRI quality measure set and there are 168 possible measures.
    • CMS will publicize the names of eligible professionals and group practices that satisfactorily submit quality data for the 2010 PQRI.
    • Several individual measures applicable to emergency medicine are included, and the pneumonia measures have been included as a measures group, providing an additional reporting method for emergency physicians to report.

Proposed 2010 PQRI Measures Applicable to EM: Individual Measure Reporting

  • 28 - Aspirin at Arrival for Acute Myocardial Infarction (AMI)
  • 31 - Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage
  • 54 - 12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain
  • 55 - 12-Lead Electrocardiogram (ECG) Performed for Syncope
  • 56 - Community-Acquired Pneumonia (CAP):  Vital Signs
  • 57 - Community-Acquired Pneumonia (CAP):  Assessment of Oxygen Saturation
  • 58 - Community-Acquired Pneumonia (CAP):  Assessment of Mental Status
  • 59 - Community-Acquired Pneumonia (CAP):  Empiric Antibiotic

Proposed 2010 PQRI Measures Applicable to EM: Measure Group Reporting

Measures for 2010 Community-Acquired Pneumonia Measure Group

  • 56 - Community-Acquired Pneumonia (CAP): Vital Signs
  • 57 - Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation
  • 58 - Community-Acquired Pneumonia (CAP): Assessment of Mental Status
  • 59 - Community-Acquired Pneumonia (CAP): Empiric Antibiotic

These lists remain tentative, as measure specifications are not yet available; CMS expects to publish final specifications on or before Dec. 31, 2009.

The reporting period for both individual and group measures applicable to emergency physicians is from January through December 2010. 

Notes:

  • CMS retired and replaced measure 34 - Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA) Considered, as it was "analytically challenging."
  • Measure Group Reporting Criteria: Report at least 1 measure group, and report for at least 30 Medicare Part B FFS patients (patients do not have to be consecutive; a change from 2009).

Code

Description

2009 Work RVUs

2010 Work RVUs

2009 Facility PE RVUs

2010 Facility PE RVUs

2009 Total RVUs

2010 Total RVUs

2010 payment
CF =$28.40

99281

ED visit

0.45

0.45

0.09

0.10

0.56

0.58

$16.47

99282

ED  visit

0.88

0.88

0.17

0.24

1.09

1.12

$31.80

99283

ED visit

1.34

1.34

0.27

0.34

1.7

1.71

$48.56

99284

ED visit

2.56

2.56

0.47

0.57

3.17

3.21

$91.17

99285

ED visit

3.80

3.8

0.69

0.76

4.72

4.74

$134.64

99291

Crit care 1st hr

4.50

4.50

1.17

1.24

5.88

5.99

$170.12

G0396

SBIR

 

.65

 

.18

.82

.86

24.42

G0397

SBIR

 

1.30

 

.39

 

1.76

49.98

Medical Liability component is approximately .03 and included when configuring total amounts.
SBIR=alcohol/substance abuse screening and brief intervention.
Conversion Factor = $28.40

Medicare Outpatient Hospital Payment Final Rule

Hospital OPDs will get an average of 2.1 % annual inflation update from Medicare. Expenditures are projected to be $32.2 billion in CY 2010. 

  • Payment:  APC Codes for hospital ED visits show slight increase with two exceptions  (see table)
    • Type A ED facility payments increase by 2%.
    • For 2010, CMS added a Level V Type B APC, which is $184 less than the Type A level V payment. (Last year, Level V Type B was paid at the same level as Type A)
    • CMS is reducing payment for trauma response with critical care. (While the $101 is a significant reduction, payment from 08 to 09 increased by over $600. CMS has more claims to review and adjusted median costs accordingly.)
  • Quality Reporting Measures: OPPS payment inflation update is reduced by 2.0 percentage points for hospitals that do not meet quality reporting requirements starting from 2008. 
    • No new quality measures were proposed for 2010.
    • Hospitals will continue to report data on seven quality measures of emergency department and peri-operative surgical care. 
    • CMS is considering an ED throughput measure for CY 2012 payment determination, "Median Time from ED Arrival to ED Departure for Discharged ED Patients." The measure specifications can be found at http://www.qualitynet.org/ in Appendix P of the specifications manual under Hospital –Outpatient.
    • CMS is establishing a process to make HOP quality measure data publicly available as early as June 2010.
  • Health care Acquired Conditions:  As we requested, CMS did not propose any measures for 2010 acknowledging the complexity of implementation in the outpatient setting, as well as lack of analysis of the current data from the inpatient hospital acquired conditions initiative started in 2008.
  • Facility Coding for ED Visits: CMS is content to allow hospitals to use their own coding guidelines, again citing stability of claims distribution over the past several years.

HOP

 Outpatient Payment for APCs of Interest to EM

APC

Group Title

SI

Payment Rate 2008

Payment Rate 2009

Final Payment Rate 2010

Payment Change 2009 - 2010

% Payment Change 2009 - 2010

609

Level 1 Type A Emergency Visits

V

$50.76

$52.66

$53.16

$0.05

.09

613

Level 2 Type A Emergency Visits

V

$83.67

$86.14

$87.85

$1.171

2.00

614

Level 3 Type A Emergency Visits

V

$132.17

$136.70

$140.18

$3.48

2.54

615

Level 4 Type A Emergency Visits

V

$212.59

$217.91

$223.17

$5.26

2.41

616

Level 5 Emergency Visits

V

$315.51

$323.90

$329.73

$5.83

1.80

617

Critical Care

S

$466.02

$485.39

$495.38

$9.99

2.10

618

Trauma Response with Critical Care

S

$330.28

$935.12

$833.93

($101.19)

-10.82

626

Level 1 Type B Emergency Visits

V

 

$45.18

$45.81

$0.63

1.43

627

Level 2 Type B Emergency Visits

V

 

$61.45

$62.21

$0.76

1.41

628

Level 3 Type B Emergency Visits

V

 

$88.64

$98.22

$9.58

1.20

629

Level 4 Type B Emergency Visits

V

 

$159.16

$141.83

($17.33)

-10.9

630

Level 5 Type B Emergency Visits

V

 

 

$232.32

 

 

659

Hyperbaric Oxygen

S

$99.23

$103.56

$107.04

$3.48

3.4

8002

Level I Extended Assessment & Management Composite

V

$351.04

$375.70

$381.34

$5.64

1.50

8003

Level II Extended Assessment & Management Composite

V

$638.66

$674.73

$705.27

$30.54

4.50

G0396
432*

Alcohol/subs interv 15-30mn

S

$19.92

$26.85

 40.53

13.68 

50.90 

G0397
432

Alcohol/subs interv >30 min

S

$19.92

$26.85

 40.53 

 13.68

50.90 

GO396 and 397 have been assigned to APC 432 – Health and Behavior Services

Feedback
Click here to
send us feedback