If you are having trouble sleeping, the CMS rule relating to physician and other provider payment changes for 2010 and beyond should help. Covering 1669 pages, the rule reveals the arcana of physican fee schedule calculations. (CMS Rule) The rule actually provides great background information on several important initiatives, including the physician quality reporting initiative, the physician resource use demonstrations, the e-prescribing initiative and others.
The final rule spreads out the reductions in specialist reimbursement over four years to make those cuts more palatable. Those reductions are supposed to pay for increases in primary care reimbursement. The final rule does not limit payments for oncology radiation therapy, but does reduce payments for imaging. The sustainable growth rate cuts are there and unless Congress does something, which it almost certainly will, those cuts will go into effect at the start of 2010. This is difficult timing for reform proponents because of the potential effect of deferring or eliminating the cuts on reform bill scoring and the deficit. For those who believe that more government involvement in health care is a good thing, the sheer size and complexity of this rule, and the mishmash Medicare has created in reimbursing various providers, with no meaningful cost control or improvement in quality, should give pause. Policymakers should look at this system very carefully and see if they can’t figure out a better way to handle cost and reimbursement.