New Medicare Physician Fee Schedule & Cardiologists

CMS is expected to release its final rule for the 2010 physician fee schedule on November 1, 2009. They gave us a preview of what it could look like earlier this summer. The big story is that it could result in large cuts for specialties and increase payments to primary care physicians.

Those specialties that have a strong emphasis on imaging could see the biggest cuts. In particular, cardiologists could be hit hard.

Here's a look at what the proposed rule could mean for cardiologists:

Practice Expense (PE)
CMS has proposed incorporating the AMA's Physician Practice Information Survey (PPIS) to update the practice expense component of physician fees. This could result in a 10 percent decrease in PE RVU changes (leading to a grand total of a negative 11 percent combined impact on cardiology in the 2010 physician payment fee schedule). Other specialties fare better: anesthesia, family practice and ophthalmology would see increases.

Potential Cuts to Cardiology:

- 42 percent Transthoracic Echo Proposed Cuts
- 24 percent Left Heart Catheterization Proposed Cuts
- 21 percent ECG Payment Proposed Cuts
- 40 percent Technical Component of CT, MR and IMRT Proposed Cuts
- 11 percent Proposed Increase for Office Visits (Level 4 Established Patient Office Visit - 99214)

Consultation Codes
The proposal would stop payments for consultation codes and use existing E/M service codes. CMS claims that the "savings" would be re-distributed to E/M service codes.

Equipment Utilization: 50 percent to 90 percent
CMS proposes to adopt MedPAC's recommendation regarding medical equipment that costs more than $1 million. It would be assumed that the equipment is being used 90 percent of the time that the office is open (as opposed to the current 50 percent).

Other interesting aspects include the idea of separating administered drugs from the physician fee schedule. Physicians will also face a massive cut of over 20 percent if the SGR formula is not updated.