Endocrine Insider
November 12, 2009

(See Full Issue)

Spurred by the Centers for Medicare and Medicaid Services’ (CMS) decision to eliminate billing for consultation codes, the American Medical Association’s (AMA) House of Delegates approved this week a resolution calling for the AMA to oppose all public and private efforts to eliminate payments for inpatient and outpatient/office consultation codes and to support legislation to overturn CMS’ action to eliminate the codes. The Endocrine Society and other specialty medical societies co-sponsored the resolution.

CMS has finalized its decision to eliminate billing for inpatient and outpatient/office consultation codes and instead to require physicians to bill for either new or established office visits or for initial hospital stays. The Endocrine Society and other physician groups have worked extensively throughout the past few months to oppose these changes, but CMS decided to advance its proposal as planned. The agency will increase payments for initial hospital stays by 2 percent and outpatient/office visits by 6 percent in order to offset losses from the elimination of these codes. Even so, many endocrinologists expect to see a significant reduction in reimbursement as a result of this new policy.

Other Provisions in the Final Rule
Scheduled to go into effect on January 1, 2010, the final rule also contains details about CMS’ proposal to retroactively remove physician administered drugs from the sustainable growth rate formula (SGR). This policy change will make a significant contribution to decreasing the rate at which SGR targets are met and exceeded in 2011 and beyond. However, the decision does not affect the looming 21.2 percent reduction to physician payment that is scheduled to go into effect in January. The U.S. House of Representatives has recently introduced legislation to eliminate these cuts for 2010 and to alter the SGR system in the process. More detailed information on this issue can be found here. Though CMS estimates endocrinologists will see an approximate 2 percent increase in payment in 2010 as a result of positive changes to practice expense costs, this increase does not take into account the scheduled 21.2 percent pay cut.

Other important changes in the final rule include expanding the number of measures and measure groups available for reporting in the Physician Quality Reporting Initiative (PQRI). Successful 2010 PQRI participants may earn an incentive payment of 2 percent of their total Part B allowed charges. In addition, the Medicare Resource Use Measurement and Reporting Program, which produces confidential reports on resource use data, will expand in 2010 to include data on diabetes care and eight other high-cost, high-volume conditions. Endocrinologists have not been designated as a physician group to receive these confidential reports, though they may be included in future years of the program.

The Endocrine Society will continue to work on the issue of consultation codes in the coming weeks and months and will keep its members informed on all issues of importance related to the 2010 fee schedule and physician reimbursement. Questions about any of these issues may be directed to Holly Whelan, Associate Director of Health Policy, at hwhelan@endo-society.org.