The elimination of consultation codes by the Centers for Medicare and Medicaid Services included in the final physician fee schedule for 2010 will burden endocrinologists even more than the looming 21% overall reduction in Medicare reimbursement.
That 21% rate cut, based on the Sustainable Growth Rate (SGR formula), scheduled for Jan. 1, was postponed for 2 months in a bill that was passed by the Senate and signed into law by President Obama in the week before Christmas. While that news is encouraging for all physicians, for several specialties, other cuts could be even deeper, thanks to a revamping of the relative values assigned to each specialty and to reductions in medical imaging payments.
Endocrinologists fared a little better than did other specialists, but the elimination of the consultation code by the CMS is likely to have a much bigger impact than the pay cuts, in particular on community-based physicians, according to Dr. Jeffrey R. Garber, president of the American Association of Clinical Endocrinologists.
The CMS has scheduled endocrinology for a 3%-6% increase in fees. And like all physicians, endocrinologists will also be eligible for a 2% bonus payment for participating in e-prescribing and another 2% if they take part in the Physician Quality Reporting Initiative (PQRI).
But the heart and soul of endocrinology is consultation, Dr. Garber said in an interview.
In a letter sent to all members of Congress protesting the changes in the fee schedule, Dr. Garber wrote, “Comprehensive focused reviews, the essence of a consultation, typically require extensive history taking and detailed physical examinations.”
Thus, when payment for that work is taken away—that is, when the consultation fee is eliminated—endocrinologists will likely allot less time to new patient referrals and also might not communicate with the referring physician, he said.
The AACE conducted a survey shortly after the fee schedule was announced and found that 53% of the 1,000 or so respondents said they would curtail or eliminate in-hospital Medicare patient consultations if the consultation code was dropped. Half said they would curtail their in-office availability for new Medicare consults, and 23% said they would stop seeing those new Medicare consults.
Dr. Garber also said that coordination of care would be harmed if physicians are no longer compensated for the time and effort involved in the in-hospital or office-based consultations.
The CMS has not explained why it decided to eliminate the consultation code, he said. It also affects other specialties, including cardiology, which was hit with an 11% reduction in fees. Cardiologists' income will also be affected by cuts in office-based procedures such as stress testing and echocardiograms and reductions in payment for imaging technologies. The American College of Cardiology, thwarted in its attempts to reverse the cuts by legislative means, has taken the unusual step of filing a complaint against the Department of Health and Human Services Secretary Kathleen Sebelius in U.S. District Court in Florida. The specialty society claims that Secretary Sebelius unlawfully adopted the payment rates for cardiology services.
Internists, general practitioners, family physicians, and geriatric specialists will see pay increases of 5%-8%, a reflection the administration's promise to enhance pay for primary care specialties.
Even so, they, like endocrinologists and other physicians, still live under the threat of the overall reduction mandated by the SGR formula, which calculates physician payments based in part on the gross domestic product. Over the past several years, Congress has stepped in to eliminate scheduled pay cuts under the formula. However, since the SGR formula has not been altered, over time physicians will face even more significant pay cuts unless Congress acts to change or replace the SGR.
This year, the rate cut was averted when Congress on Dec. 19 enacted a Defense Department spending bill that included a 2-month delay in the scheduled 21%.
Physician groups have not given up on securing a permanent overhaul to the Sustainable Growth Rate (SGR) formula, which governs the Medicare payment rate.
In a statement, Dr. J. James Rohack, president of the American Medical Association, said that the group agreed with Senate Majority Leader Harry Reid (D-Nev.) who removed a 1-year fix from his health reform package with an aim of separately winning a permanent overhaul.
“As we call for a permanent solution, the AMA acknowledges the House and Senate votes to stop the cuts for 2 months so that access to care for Medicare and TRICARE patients is not disrupted while the Senate works on solving the problem once and for all,” said Dr. Rohack in the statement.
The House of Representatives voted for a permanent fix in a standalone bill, but the Senate later rejected it. Neither the House nor the Senate has included a permanent fix in their respective health reform bills.
Lawmakers had few legislative vehicles left to avert that Jan. 1 cut, and thus attached the delay to the Defense spending bill, knowing that, with American military in Iraq and Afghanistan, it was a must-pass proposal.
The $636 billion Defense appropriations bill had passed the House. The package includes almost $14 billion in non-Defense spending, including an extension of unemployment benefits and subsidies to help pay for COBRA benefits.
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