Recently, all physicians including anesthesiologists faced a 25 percent cut in Medicare payments as a result of the Sustainable Growth Rate (SGR) formula. This 25 percent SGR payment cut was included in the final Medicare payment rule for 2011 released by CMS. The CMS final payment rule would have made the anesthesia conversion factor $15.81 which is down from the current rate of $21.57. The RBRVS conversion factor (the system used to determine the payments for the non-anesthesia services ASA members perform such as lines and pain) would have dropped to $25.52 instead of holding at $36.87.
Because of work the ASA and many other physician organizations did, the 25 percent SGR payment cut was averted for a year. Until CMS issues a new notice with the 2011 Medicare payment anesthesia conversion factor, ASA staff and the Committee on Economics cannot be certain of the exact conversion factor.
Through hard fought lobbying by ASA staff and members, ASA previously won a 4 percent increase as a result of the physician practice information survey. Currently, anesthesiologists are in the second of a four year phase in of the 4% gain.
However, as a result of Medical Economic Index (MEI) and Patient Protection and Affordable Care Act (PPACA) provisions, a small decrease is anticipated in the conversion factor, though it will be nowhere near the magnitude of what was in the original CMS final payment rule.
ASA staff in Washington are working with Dr. Stead, Chair of Committee on Economics to validate the limited and cryptic information in the original CMS final payment rule and any additional updates issued by CMS. In three of the last five years, ASA has found mistakes in the CMS final payment rules.
One item that may be of particular interest to ASA members is that while anesthesiologists are facing a 3 percent cut due to the MEI, nurse anesthetists are receiving a 4 percent cut. MEI is only one piece of what ultimately determines Medicare payments.
ASA staff in Washington will continue to update our members on the latest information regarding Medicare payments. Should you have questions on this particular topic, please contact Jason Byrd or Sharon Merrick at (202) 289-2222.