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In July, the Centers for Medicare and Medicaid Services (CMS) issued two proposed regulations--one on how Medicare physician reimbursement would change in 2010 (Medicare Physicians' Fee Schedule/MPFS) and the other on hospital reimbursement changes (Hospital Outpatient Prospective Payment System/HOPPS). The most dramatic and devastating effects would result from the changes proposed to for the MPFS reimbursement, including:
- The change from a 50 percent equipment utilization standard (the benchmark utilization number for many years) to a 90 percent standard;
- Modifications to practice expense data; and
- Modifications in the conversion factor.
ACRO is deeply concerned that these changes may have devastating effects on the care of cancer patients across the country. We have been working actively in both the legislative and the regulatory arenas to fight these modifications. We encourage you to join us in contacting your members of Congress to express your concern. ACRO has developed sample letters and talking points as part of an ACRO Alert. You can find this material at www.acro.org. Obviously, personalized communications and personal relationships with members of Congress can be especially helpful.
Equipment Utilization Calculation
For equipment costing more than $1 million, CMS has proposed a 90-percent equipment utilization standard in place of the current 50 percent standard. This means that CMS reimbursement calculations would assume that your equipment is used more often over its lifetime and reimbursement per unit of use would drop dramatically. Particularly affected would be the following codes:
CPT 77014 - CT guidance, would decrease 32 percent
CPT 77413 - treatment delivery, would decrease 14 percent
CPT 77414 - treatment delivery, would decrease 16 percent
CPT 77418 - IMRT, would decrease 44 percent
CPT 77421 - stereoscopic guidance, would decrease 19 percent
The ACRO strongly believes that it is inappropriate to include radiation therapy under rules designed to address diagnostic imaging issues. Our position on this issue was clearly stated during the discussions around the Deficit Reduction Act and in other subsequent arenas. There are no data to justify modifying the utilization rate for high cost radiation therapy equipment. ACRO maintains that the current equipment utilization rate of 50 percent is appropriate for all pieces of radiation therapy equipment, regardless of cost, and we will be providing the CMS and Congress with information to support that position.
Practice Expense Methodology
We are also concerned that the modifications proposed to the practice expense methodology would have devastating effects on radiation oncology.MS is changing its calculation methodology and using new Physician Practice Information Survey Data. CMS is proposing to use the new data without sharing all the data with impacted organizations and individuals. Nor is the CMS allowing adequate time to review the full impact of the change. Of greatest concern is that CMS is not requiring all specialties to adhere to the same level of data precision requirements. We believe that the data changes do not adequately capture the resources needed to provide patient care and is contrary to CMS's own policy of using a methodology that appropriate reflects practice expenses. CMS estimates that using the new data reduces overall payments to radiation oncology by 12%. Again, the impact varies from code to code and the impact on individual practices may vary.
Conversion Factor Adjustment
Finally, the conversion factor is scheduled to be reduced as required by statute. While reprieves have been granted in years past, absent any congressional intervention, the conversion factor is expected to drop by 21 percent, from $36.06 to $28.32. This reduction would be in addition to the other cuts noted above.
The combination of an increase in the equipment utilization rate, the use of problematic data and a potentially lower conversion factor together would dramatically affect all radiation oncologists. In light of this, ACRO has launched a campaign to counteract these changes. Please review the ACRO Alert to join in our effort; it can be found at www.acro.org.
On a positive note, the CMS has proposed the removal of physician-administered drugs from the definition of "physician services" for the purpose of computing the physician update. ACRO supports this change.
The changes proposed in the HOPPS rule are less far-reaching. They include:
- Further clarification of physician supervision requirements for services provided in the hospital outpatient setting. While the current policy is not changed, CMS has provided additional examples that may assist hospitals in understanding appropriate supervision standards.
- The high-dose rate electronic brachytherapy code is being moved from a new technology level IXX code to APC 0313 (brachytherapy). The reimbursement drops as a result of this change. As before, ACRO maintains that electronic brachytherapy, like all other forms of radiation therapy, should be supervised, delivered and managed by physicians trained, authorized and experienced in radiation therapy.
ACRO remains committed to working with CMS and congressional representatives on these critical issues. We need you to join us in our efforts. Please visit our web site to find out how you can help ACRO and your own practice.
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