Editor's note: This article by Tony Mira, president and CEO of Anesthesia Business Consultants, an anesthesia & pain management billing and practice management services company, originally appeared in Anesthesia Business Consultants eAlerts, a free electronic newsletter. Sign-up to receive this newsletter by clicking here.
Congress agreed last week to freeze Medicare physician payments at current levels through Dec. 31, 2011. On Dec. 8, the Senate voted unanimously to stop the projected 25 percent SGR-based cut from going into effect on Jan. 1, 2011. The House of Representatives followed suit on Thursday morning. President Obama is expected to have signed the bill into law by the time you read this.
Next year's conversion factors (CFs), therefore, remain at these levels:
|
Anesthesia (national average CF): |
$21.57 |
|
Other services including pain management and visits: |
$36.87 |
Had it not been for the passage of the Medicare and Medicaid Extenders Act of 2010, the two CFs would have seen major decreases:
|
The Train Wreck That Didn't Happen |
||
|
|
With SGR cut |
% change with SGR cut |
|
Anesthesia |
$15.8085 |
-26.70% |
|
Other Services |
$25.5217 |
-30.78% |
The main reason for the larger percentage decrease that would have affected other services is CMS' rebasing of the Medicare Economic Index (MEI), i.e., the inflation factor used for Medicare payment. There is not enough detail in the Final Rule on the 2011 Physician Fee Schedule (pdf) to explain why the MEI calculation was different for anesthesia, said Stanley W. Stead, MD, during ASA's excellent webinar "What's on the Horizon for Anesthesiology in 2011? – Updates on Coding and Medicare Policies and Programs" held on Dec. 7. (The recording of the ASA webinar is still available at www.asahq.org.)
The Medicare and Medicaid Extenders Act will be financed by increasing the amount that individuals and families receiving health insurance subsidies will have to repay if their income turns out to be higher than the amount on which their subsidies were based.
The legislation finally provides the $200 million needed for CMS to reprocess claims for services performed during the first six months of the year. The Patient Protection and Affordable Care Act enacted into law on March 23rd reversed reductions in the geographic practice cost indices and required retroactive adjustment of claims to Jan. 1, 2010. Thus millions of claims were in effect underpaid. Previous attempts to pass bills that would fund the reprocessing had failed in one or the other Chamber. There is no information yet on how or when the reprocessing will take place.
Including the latest legislation, Congress has approved five bills this year postponing the formula-driven SGR cuts that are clearly unpalatable to all. Those cuts have been postponed, however, and that is all. The new year is going to start another cycle of efforts to fix the SGR problem itself. We hope that those efforts will be much less exhausting and much more productive. The outcome will, once again, depend on the citizen-lobbying efforts of the entire profession, and not just of your Washington representatives.
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