The Centers for Medicare and Medicaid services released its proposed Medicare Physician Fee Schedule for 2010. The press release and the entire 1,200 fee schedule are attached. CMS is projecting a 21.5% physician fee schedule decrease based upon the application of the sustainable growth rate (SGR) formula. Of course, Congress has intervened in each of the last five or six years to override the automatic fee schedule revision based upon SGR, which has been uniformly negative for the last six years. No one expects a 21.5% decrease! 

CMS highlights several key areas in the press release:

1.         Elimination of consultation services;

2.         CMS proposes to eliminate consult payments to specialists and replace them with the application E&M Code to reduce payments.

3.         Initial Preventative Physician Exam (IPPE):

            CMS proposes to increase the payment for the "Welcome to Medicare" visit to be more in line with payment rates for higher complexity services.

4.         Chronic disease:

            The new fee schedule proposes to implement new Medicare benefit categories for cardiac and pulmonary rehabilitation services, and chronic kidney disease education.

5.         Imaging accredation in physician office: CMS has resuscitated the proposal that imaging services and physician offices must be subject to the same quality or standards or accredation applicable to independent diagnostic testing facilities. The accreditation requirement would be effective as of January 1, 2012 and would apply to mobile units, physician offices, and independent diagnostic testing facilities, but would only apply to the technical component aspect and not to the physician who interprets them. The general accounting office (GAO) has stated "Spending on advanced imaging services, such as computed tomography (CT), magnetic residents imaging (MRI) and positron emissions tomography (PET) is growing almost twice as fast as the spending on other types of imaging services, and is a significant contributor to the rapid growth in health care pending in recent years, but there is little administrative oversight to ensure the quality of care." I wonder how much CT, MRI and PET is actually being provided in physician offices.