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2010 Payment Rule Removes SGR Drugs, Uses New Practice Expense Data
CMS released the 2010 Medicare physician payment schedule proposed rule, including a long-awaited announcement that the Obama Administration will change the definition of physician services under the SGR to exclude physician-administered drugs. The drug costs will be removed retroactive to the 1996/97 base year of the SGR formula, which will greatly lessen the forecast SGR cuts in future years, although there is still a 21.5% cut scheduled for 2010. This action will substantially reduce the legislative cost of congressional proposals to reform physician payments makes a permanent solution to SGR disaster much more feasible.
The proposed rule is scheduled for publication in the Federal Register on July 13th but is available online at: http://www.federalregister.gov/inspection.aspx#special
CMS has also utilized data that it purchased from a new practice expense survey sponsored by the AMA and 72 specialty societies and other health care professional organizations to revise the practice expense relative values. Further information on the PPI survey and data provided to CMS is available at www.ama-assn.org/go/ppisurvey
Specialty impacts of the new proposed rule are displayed in Table 39 (below). In addition to the new practice expense data, these impacts reflect a CMS proposal to eliminate Medicare coverage for consultations and redistribute the relative values to visits, as well as changes in the methodology for professional liability insurance relative values. Other changes in the rule include revisions to the e-prescribing incentive program intended to simplify reporting requirements and addition of more measures and more measures groups for the Physician Quality Reporting Initiative (PQRI). The AMA is continuing to review the 1128-page rule and will develop a more detailed summary of the proposed changes. Comments on the rule will be due by August 31st.
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