Something
positive actually happened at the Department of Health and Human Services for cardiologists on Friday!
The
Centers for Medicare and Medicaid Services (CMS) on Friday released a technical
correction to the 2010 Medicare Physician Fee Schedule, which
results in significant payment increases for myocardial perfusion imaging (MPI)
codes, cardiac CT codes, and cardiac catheterization codes, retroactive to Jan.
1, 2010. The correction notice also includes a minor increase in the Medicare
conversion factor (from 36.066 to 36.0791) effective June through December
2010. Our colleagues at ASNC deserve
major credit here for their technical work, persistence, and serving as the
lead agency in pressuring CMS to correct their RUC-related errors on the
nuclear codes.
However, this is not the BIG FIX needed to protect private
practice, but it is a positive step for sure. The danger here is we don’t want Congress to think this
will fix the problem. This will NOT
stabilize private practice, and does nothing at all for ECHO, consults, or most
practice expense cuts. Half of cardiology private practices have already sold
their practices to employment and are now employees -- this positive step in the
right direction is too late for them. But those still considering selling their
practices to survive may see this partial step as a good sign.
All
in all, this
definitely helps.
The
corrections the Secretary approved to MPI and CT codes address errors
made in incorporating RUC recommendations on direct practice expenses (e.g.,
medical supplies, equipment time) for these services. The
errors included incorrect practice expense values for CPT codes 75571-75574 and
78451-78454. For example, the corrected national average payment for 78452
(SPECT MPI, multiple) is $439, compared to the $379 published in the November
Final Rule.
The
correction notice also includes changes to malpractice RVUs for cardiac catheterization
services. CMS agreed with ACC, SCAI, and the AMA that
cardiac cath services should be assigned malpractice RVUs based on the higher
surgical risk factor. However, the published RVUs and payment rates did not
correctly reflect that policy change. With this notice, CMS has corrected its
error. The payment changes -- for example, an increase from $235 to $253 for
93510-26 (Left heart catheterization, professional component) -- reflect the
higher risk associated with invasive procedures.
The ACC has prepared a chart outlining the specific corrections (.xls).
The ACC continues to apply pressure to CMS to
address the other imaging cuts included in the 2010 Medicare rule. Most
importantly, we continue to press for a phase-in of the bundled nuclear codes
and an approach to restoring echo and other services through adherence to appropriate use criteria -- we are working closely
in repeated visits with members of Congress and CMS to help them understand the
extent of the cuts, their impacts on practices and the need for a formal policy
that phases in cuts of a certain magnitude over time. In the meantime, stay
tuned for more information as it relates to notifying private insurance
companies of these new corrections, since they typically track Medicare
payments.
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