CMS Releases Final Rule for 2010 Physician Fee Schedule

ASA is extremely pleased to report that in the recently-released final rule for the 2010 Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) will fully implement Medicare anesthesiology teaching rule reforms beginning Jan. 2010 as intended by Congress and advocated by ASA.

The final rule represents a culmination of many years of work by ASA members, leadership and legislative and regulatory staffers in the Washington, D.C. office, to rectify the 50 percent payment penalty for anesthesiology teaching programs.  The newly-released rule will correct this payment inequity, strengthening residency programs in the process.

“This is a huge triumph for the medical specialty of anesthesiology, and ASA members are to be commended for their dedication to this legislative and regulatory priority,” said ASA President Alexander A. Hannenberg, M.D.  “After a long- and hard-fought battle, academic programs will finally receive full Medicare payment for the expert anesthesiology medical care they provide to patients.  This victory proves what ASA can achieve through unrelenting advocacy efforts.”

Due in large part to the overwhelming response to the ASA calls to action to submit comments to CMS, the Agency did not formally address the issue of anesthesia “handoffs” in its final rule.  Thus, different anesthesiologists in the same anesthesia group practice can be considered the teaching physician when fulfilling the statutory requirement that the teaching anesthesiologist be present at the key or critical portions of the anesthesia service.  ASA is pleased that the Agency followed legislative intent and did not focus on unrelated topics.

Other key provisions of the proposed rule include:

• Removal of Physician-Administered Drugs for Purposes of Computing Update –  CMS is finalizing its proposal to remove physician-administered drugs from the definition of “physician services” for purposes of computing the Medicare physician fee schedule update.  While the proposal will not change the projected update for services during CY 2010, CMS projects that it would reduce the number of years in which physicians are projected to experience a negative update.

• Physician Payment Refinements to Practice Expense – In its final rule with comment period, CMS adopted several refinements to Medicare payments to physicians, which are expected to increase payment rates for primary care services.  For 2010, for purposes of establishing the practice expense (PE) relative value units (RVUs), CMS had proposed to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association (AMA).  While CMS is finalizing the proposal, it will phase it in over a 4-year period. 

The impact to the PE relative value units for anesthesiologists and pain medicine physicians, as estimated by CMS is as follows:

	Previous Indirect PE/HR	Final Rule Indirect PE/HR	Previous Indirect %	Final Rule Indirect %
Anesthesiology	$19.76	$29.36	56%	82%
Interventional Pain Medicine	$59.04	$156.79	67%	70%
Pain Medicine	$59.04	$122.42	67%	70%

• Physician Quality Reporting Initiative (PQRI) – CMS finalized the incorporation of the new Perioperative Temperature Management measure in PQRI.  Technical specifications for the measure can be expected in December 2009.

• Physician Payment Update – Under the final rule, and consistent with current law, CMS will move forward in implementing the slated rate reduction of -21.2% for CY 2010 (rather than the 21.5% projected in the proposed rule – the difference attributed to the most recent data available to CMS).   Since 2003, however, Congress has acted to avert significant reductions in Medicare physician payments, with the latest of these interventions occurring last July via the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).  MIPPA provided physicians with a 0.5% update for the remainder of 2008 followed by a 1.1% update through December 31, 2009, thereby preventing what was at the time a projected 10.6% Medicare payment reduction.  ASA is committed to continuing its work with Congress to support SGR reform legislation.

ASA will continue to analyze the final rule.  In the meantime, please use the following links for additional information:

Copy of final rule for 2010 Physician Fee Schedule
CMS press release
CMS fact sheet