Magazine article Clinical Psychiatry News

Proposed Pay Plan Gives 3% Increase to Psychiatrists Proposal Getting Mixed Reviews: CMS Estimates Don't Include 21.5% Cut

Magazine article Clinical Psychiatry News

Proposed Pay Plan Gives 3% Increase to Psychiatrists Proposal Getting Mixed Reviews: CMS Estimates Don't Include 21.5% Cut

Article excerpt

Psychiatrists could see a 3% increase in their Medicare payments next year--if Congress steps in to stop a projected 21.5% across-the-board payment cut.

The estimates on reimbursement were part of the 2010 Medicare Physician Fee Schedule proposed rule, from the Centers for Medicare and Medicaid Services.

The proposal also includes increased pay for primary care physicians, decreased pay for some specialists, and a potential way to get rid of the sustainable growth rate formula. A final rule is expected in November.

Physicians' organizations have sought the repeal of the sustained growth rate (SGR)--the statutory formula used to set physician payment rates under Medicare--saying that it is flawed and does not reflect the true cost of providing medical care.

One criticism is that the formula counts the price of physician-administered drugs, over which physicians have little control, as a physician service. Since the SGR is designed to cut payments when health care expenditures rise above a certain target, the inclusion of drugs has caused physicians to exceed those targets more rapidly and has contributed to pay cuts over the years.

The removal of physician-administered drugs from the SGR should reduce the number of years that physicians see pay cuts, according to the Centers for Medicare and Medicaid Services. And the American Medical Association is betting that the change will make it less expensive for Congress to repeal the SGR, which would also benefit physicians.

Even if enacted, however, the proposal would not stop the 21.5% pay cut slated to go into effect Jan 1. 2010. However, several physicians interviewed said they hoped that Congress would step in again this year to roll back the cut--whether through health reform legislation or in a separate bill.

The 21.5% cut would affect physicians across the board, but the rest of the fee schedule proposal would apply differently, depending on specialty. For example, the proposed rule includes plans to eliminate the use of consultation codes except tele-health codes starting Jan. 1. At the same time, the agency would increase the work relative value units for new and established office visits, increase the work values for initial hospital and initial nursing facility visits, and incorporate the increased use of these visits into the practice expense and malpractice relative value unit calculations.

"We believe the rationale for a different payment for a consultation service is no longer supported because documentation requirements are now similar across all E&M [evaluation and management] services," the CMS wrote in the proposed rule. …

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