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July 24, 2006

 

UPDATE! CMS-proposed changes to Physician Fee Schedule include substantial cuts to anesthesiology—Take action now!

CMS proposed changes to Physician Fee Schedule include substantial cuts to anesthesiology—Take action now!

In the June 29 Federal Register, CMS proposed a new practice expense methodology, as well as changes in work values stemming from the recently conducted Five Year Review. Federal law requires that these changes be “budget neutral,” meaning that more payments to some specialties have to be offset by cuts to everyone else. The government estimates 6% cuts in total payments to anesthesiologists due to the Five Year Review and an additional 1% cut every year through 2010 due to the practice expense changes.  This would amount to a 10% cut in Medicare payments to anesthesiologists over the next four years.

We are currently analyzing the Medicare PE methodology for possible errors, and are continuing our long battle to seek correction of Medicare’s undervaluation of anesthesia work within CMS and its processes.  While ASA is working diligently to counter these egregious cuts in Medicare payments to anesthesiologists, the help of every ASA member is needed to make the case to CMS and Congress for fair anesthesia payments.

ASA members are strongly encouraged to take the following steps to help mitigate these devastating cuts:

  • Submit comment letters to CMS. 

ASA will be providing CMS with extensive formal comments against the cuts to anesthesiology in the proposed rule, but additional correspondence from individual members is compelling and necessary. Please submit comment letters to CMS electronically at http://www.cms.hhs.gov/eRulemaking. Click on the link, “Submit electronic comments on CMS regulations with an open comment period.”  You may also mail letters directly to:

                        Centers for Medicare & Medicaid Services
                        Department of Health and Human Services
                        Attention: CMS-1512-PN
                        P.O. Box 8014
                        Baltimore, MD 21244-8014
           
            All comment letters must be received by 5 p.m. on Aug. 21, 2006.
           
            Please use the following points when communicating with CMS:

    • As the policy currently stands, anesthesiologists and other specialties face huge payment cuts to supplement the overhead cost increases for a handful of specialties.
    • The proposed change in PE methodology hurts anesthesiology more than most specialties, because the data that CMS uses to calculate overhead expenses is outdated and appears to significantly underestimate actual expenses.
    • CMS should gather new overhead expense data to replace the decade-old data currently being used.
    • ASA, many other specialties, and the AMA are committed to financially support a comprehensive, multi-specialty practice expense survey.  CMS should take immediate action to launch this much needed survey which will greatly improve the accuracy for all practice expense payments.
    • CMS must address the issue of anesthesia work undervaluation or our nation’s most vulnerable populations will face a certain shortage of anesthesiology medical care in operating rooms, pain clinics, and throughout critical care medicine.
  • Contact your Members of Congress about the SGR.

The proposed cuts in Medicare payments to anesthesiologists are particularly troubling in light of ongoing problems with the SGR formula that adversely affects all of Medicare Part B physician services.  Please ask your Representative and Senators for a positive 2.8% update in 2007, as recommended by MedPAC.  Congress should repeal the unworkable SGR formula and replace it with a system of positive updates based on the MEI.  You may contact your Representatives and Senators through the Capitol Switchboard at (202) 225-3121, or through the ASA CapWiz site.

  • Plan to participate in the multi-specialty practice expense survey.

Information will be forthcoming about the multi-specialty practice expense survey for CMS.  With the use of outdated overhead expense data, CMS will continue to undervalue anesthesia payments.  Please do your part to ensure that PE data is up-to-date by participating in the survey once it is launched.

ASA remains committed and well-positioned to help lessen some of the proposed cuts through the Committee on Economics’ work with the RUC and CMS, but every ASA member must join the effort to fight against excessive and imbalanced underpayment by Medicare.

Please take action today to work toward fair Medicare payments for anesthesiologists!