Endocrine Insider
July 9. 2009
On the eve of the July 4th holiday, the Centers for Medicare and Medicaid Services (CMS) released its 2010 proposal for Medicare physician payment policies, including some significant changes to the way in which reimbursement for physician services are determined. The CMS proposal alters the sustainable growth rate (SGR) by excluding physician-administered drugs from the definition of physician services. The elimination of these drugs from the SGR payment formula will help to reduce forecasted SGR cuts in future years and reduce costs associated with fixing the physician payment formula through health care reform. Even so, physicians still face a 21.5 percent cut to payments in 2010 due to cuts accumulated from previous years.
In addition to changes to the SGR, CMS proposes to eliminate the use of consultative billing codes by specialists, instead requiring them to use office codes for these consultations. In return, CMS would provide an increase in relative value to office codes, resulting in a higher payment for these visits. Based on CMS analysis provided in the proposal, endocrinologists are expected to receive a payment increase of approximately 3 percent in 2010, which includes the changes to consultation codes. However, this increase will not be realized unless Congress steps in to reduce or eliminate the looming 21.5 percent overall cut to physician payments.
Staff of The Endocrine Society continue to analyze the CMS proposal, and will provide written comments to the agency in the next few weeks on these very important issues.
