On February 1, the House of Representatives narrowly passed legislation (S. 1932) to freeze Medicare physician payments at 2005 levels. The legislation averted a scheduled 4.4 percent cut to physician Medicare payments in 2006. At the request of ASH and other medical societies, the Centers for Medicare and Medicaid Services (CMS) has agreed to retroactively adjust claims submitted after January 1, 2006. This will keep physicians from having to resubmit claims. CMS has also agreed to reopen the 45-day period in which physicians may change their 2006 Medicare participation status. Changes will be retroactive to January 1, and claims will be adjusted to reflect the change in status.
Unfortunately, cuts are still expected in 2007 and subsequent years unless Congress takes additional action this year. The Sustainable Growth Rate (SGR) formula ties Medicare reimbursement to economic performance. However, as physicians know, medical needs of beneficiaries do not decrease when the economy slows. Clearly, the SGR does not keep pace with the economy. ASH and other medical societies will continue to work together to permanently repair the flawed SGR formula.
"While this is a small improvement in the reimbursement situation for physicians who are providing care to the Medicare population, it is only a stopgap for Medicare to realize the need to reimburse adequately for evaluation and management (E/M) codes," said Dr. Thomas Bensinger, one of the practicing physicians advising the ASH Subcommittee on Reimbursement. "Medicare must also recognize the flaws in the SGR calculations so that physicians are not fighting a holding action just to keep last year's reimbursement at a time when there should actually be an increase in the payments for the E/M codes. If Medicare reimbursements fall much further, there could be real erosion in the number of Medicare recipients able to find physicians who will be able to take care of patients with complex hematological problems. Unfortunately, then the real loser will be the Medicare beneficiaries."
In addition to legislation affecting Medicare reimbursement, E/M services are valued periodically by the Relative Value Update Committee (RUC), which is facilitated by the American Medical Association. The RUC is currently meeting to review E/M codes related to physician work and will submit recommendations to the CMS regarding E/M services. The RUC process has recently come under the scrutiny of the Medicare Payment Advisory Commission (MedPAC) and other agencies as the physician community questions its ability to render fair and unbiased decisions. Balanced deliberations and processes at the RUC are crucial to appropriately valuing E/M services in terms of complexity and intensity of physician work. In turn, correctly valued services and adequate Medicare fee schedule amounts provide appropriate reimbursement to practicing physicians. ASH continues to participate in the E/M review, with Dr. Samuel Silver representing ASH at the RUC. If CMS accepts the recommendations, changes will be implemented January 1, 2007.
