CMS to Use ACR Practice Expense Data: Proposed Rule Changes Mixed Bag for Radiology
The Centers for Medicare and Medicaid Services (CMS) has announced proposed rule changes in the Medicare Physician Fee Schedule as a result of the third five-year review and an attempt to make practice expense relative values resource-based for 2007.
In order to pay for a 37% increase in evaluation and management work relative values for family and general practitioners, Medicare is proposing to apply a minus 10% work adjustment to all physician work RVUs as a budget-neutral adjustment.
Medicare is proposing to use a special method that does not change the RVUs in the Medicare physician fee schedule but changes the dollar payments calculated for the payers. Medicare must apply the cuts to the physician work RVUs because project impacts in utilization growth, which will cause the 4.6% cut in the conversion factor, has maxed out what already can legally be applied to the conversion factor for 2007.
In the practice expense area, Medicare announced that it has come up with a bottom-up methodology where they use the actual dollar values of clinical time, supplies, and equipment for direct costs and would then use ACR data to calculate the added indirect costs. The rule proposes to phase in the implementation of the practice expense impacts over the next four years.
Below are the total allowed charge impacts of the proposed changes on radiology and various other specialties if/when fully implemented (2010):
- Radiology (minus) –3%
- Radiation Oncology (gain) 2%
- Interventional Radiology (minus) –8%
- Cardiology (minus) –4%
- Pathology (minus) –7%
- Vascular Surgery (gain) 1%
ACR staff continue to analyze the effects of these proposed rule changes and will inform members of any new developments. The College will provide comment to CMS regarding these proposed changes within the formal 60-day comment period.
Please visit the ACR Web site (www.acr.org) often for any important updates regarding these proposed changes.
Click Here to read statement on CMS Web site.
To read the Five Year Review Proposed Rule, click here.
