Highlights of the Final Rule for 2010-Medicare Physician Fee Schedule

• Pay Cut:  The Senate’s separate SGR bill failed, and House has introduced one as well. (H.R. 3961)  Unless Congress acts before the end of the year, a -21.2% cut will be imposed across the board on January 1, 2010.  The new conversion factor is $28.40, down from $36.06 in 2009.
• SGR:  CMS will take drugs out of the SGR pool retroactive to 1996/97 which will decrease the cost of replacing the formula with another way to update physician payment.
• Practice expense:  Results of the AMA-coordinated practice expense survey (PCPI) have been incorporated by CMS and will be phased in over a 4-year period.  Emergency medicine will realize a slight (2%) increase in practice expenses with a small increase in levels 4 and 5 and larger increases in levels 1-3.  The American College of Cardiology, who had reductions to PE is planning to take its fight to Congress to have the survey discarded.  ACEP strongly supported the survey.
• Consults:  CMS eliminated physician consultative fees and replaced them with initial hospital visit or office visit codes.  Savings from consult codes have been redistributed to E/M office and hospital visits, something that the Administration supports as it will increase payment for primary care physician services as well as consulting specialists. 
• Imaging:  CMS has increased amount of time that complex diagnostic imaging machines (> $1m) are used in practices from 50% of the time to 90%.  This will affect the technical component only but will significantly reduce practice expenses for many physicians who perform complex imaging services in their offices.  Policy will be phased in over 4 years.
• PQRI:  The PQRI program will continue to provide a 2% bonus to successfully participating physicians through 2010.  Legislation is required to continue bonus payments beyond 2010.
• Physician groups of 200 or more are permitted to submit data on selected quality measures if all the physicians reassigned benefits to the group.
• Rules for reporting are much the same as 2009, but the rule contains much more discussion of reporting using registries and EHRs as well as claims-based reporting.
• Measures must be NQF-endorsed by July 1, 2009 in order to be considered for inclusion in the 2010 PQRI quality measure set and there are 168 possible measures.
• CMS will publicize the names of eligible professionals and group practices that satisfactorily submit quality data for the 2010 PQRI.
• Several individual measures applicable to emergency medicine are included, and the pneumonia measures have been included as a measures group, providing an additional reporting method for emergency physicians to report.

Proposed 2010 PQRI Measures Applicable to EM: Individual Measure Reporting

• 28 Aspirin at Arrival for Acute Myocardial Infarction (AMI)
• 31 Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage
• 54 12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain
• 55 12-Lead Electrocardiogram (ECG) Performed for Syncope
• 56 Community-Acquired Pneumonia (CAP):  Vital Signs
• 57 Community-Acquired Pneumonia (CAP):  Assessment of Oxygen Saturation
• 58 Community-Acquired Pneumonia (CAP):  Assessment of Mental Status
• 59 Community-Acquired Pneumonia (CAP):  Empiric Antibiotic

Proposed 2010 PQRI Measures Applicable to EM: Measure Group Reporting

Measures for 2010 Community-Acquired Pneumonia Measure Group

• 56 Community-Acquired Pneumonia (CAP): Vital Signs
• 57 Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation
• 58 Community-Acquired Pneumonia (CAP): Assessment of Mental Status
• 59 Community-Acquired Pneumonia (CAP): Empiric Antibiotic

These lists remain tentative, as measure specifications are not yet available; CMS expects to publish final specifications on or before December 31, 2009.

The reporting period for both individual and group measures applicable to emergency physicians is from January through December 2010. 

Notes:

• CMS retired and replaced measure 34 Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA) Considered, as it was "analytically challenging."
• Measure Group Reporting Criteria: Report at least 1 measure group, and report for at least 30 Medicare Part B FFS patients (patients do not have to be consecutive; a change from 2009).

  

Code	Description	2009   Work RVUs	2010   Work RVUs	2010 Facility PE RVUs	2010 Facility** PERVUs	2009 Total RVUs	2010 Total RVUs	2010 payment CF =$28.40
99281	.ED Visit	0.45	0.45	0.09	0.10	0.56	0.58	$16.47
99282	ED Visit	0.88	0.88	0.17	0.19	1.09	1.12	$31.80
99283	ED Visit	1.34	1.34	0.27	0.29	1.7	1.71	$48.56
99284	ED Visit	2.56	2.56	0.47	0.50	3.17	3.21	$91.17
99285	ED Visit	3.80	3.8	0.69	0.72	4.72	4.74	$134.64
99291	Crit care 1st hr	4.50	4.50	1.17	1.24	5.88	5.99	$170.12
G0396	SBIR		.65		.18	.82	.86	$24.42
G0397	SBRI		1.30		.39		1.76	$49.98

**2010 Facility-based Practice expense value is year 1 of a 4-year phase in to data from PPIS survey.

Medical Liability component is approximately .03 and included when configuring total amounts.

SBIR=alcohol/substance abuse screening and brief intervention.

Conversion Factor = $28.40