CMS has released the 2010 Medicare Physician Fee Schedule (MPFS) proposed rule.  The proposed rule projects a 21.5 percent cut to the MPFS for 2010 which will take effect unless Congress intervenes to implement legislation with additional funding to avert the cut.  The proposed rule will be published July 13 in the Federal Register, but is available now at: http://www.federalregister.gov/OFRUpload/OFRData/2009-15835_PI.pdf.  

This significant cut will be somewhat mitigated for Emergency Physicians in the slight boost in the practice expense component of the fee schedule calculation that they received. This has contributed to an increase in the fee schedule for the Evaluation and Management (E&M) codes that are the bulk of emergency physicians’ payments. The new AMA survey to determine the practice expense portion of the Medicare fee schedule better reflects the costs for Emergency Medicine practices. Much of the credit for this improvement is due to hard work by Dr. Jeff Bettinger who worked in conjunction with ACEP and EDPMA to acquire revisions in the practice expense survey criteria as well as improving the process for obtaining and sharing the information with the AMA. Below is a chart that demonstrates some of the wins and losses from the new fee schedule.

 Using the 21.5% decrease and adjusting for the increase of 2% in the ED E&M Codes, the net result would be an approximate overall 19.5% decrease for emergency medicine. This estimate is verified by Table 40 of the proposed rule that lists several of the ED codes:

 Unless Congress acts to renew the 1.0 floor on the Geographical Practice Cost Indices (GPCI), areas like San Antonio, TX located in a designated “rural” area (rest of Texas) could have an additional decrease based on the Cost Index. Prior to the floor being implemented, the GPCI for area 99 (rest of TX) was 0.87.

The proposed rule has a 60-day comment period that will close on August 31.  Groups like the AMA, EDPMA, ACEP and other specialty societies will coordinate comments to the proposed rule. It will take time to review the contents of the complex regulation. 

There are proposals associated with health care reform that purport to fix the SGR (Sustainable Growth Rate) formula methodology by which the Medicare payments are established. While it might be advisable to watch over the next few weeks to ascertain if the physician Medicare fee schedule will be revised by Congress, it will be important to remain involved in structuring appropriate responses to the proposed rule. If Congress does not act promptly to fix the fee schedule, it will be essential that everyone be engaged in the full court press of calls, emails and Congressional visits to help prevent this pending disaster.