November 9, 2010

CMS Issues Medicare Physician Payment Rule for 2011

This week, the Centers for Medicare and Medicaid Service (CMS) issued the Medicare physician final payment rule for 2011, which included a number of provisions of interest to ATS members.

First, the rule clarified that unless Congress acts, Medicare physician payments will be cut by 24.9% by January 1, 2011. These cuts are a result of the Medicare sustainable growth rate factor - the flawed formula Congress created to calculate annual Medicare payment updates. The ATS and the entire physician community will pressure Congress to address the SGR fix in the upcoming lame duck session of Congress.

Second, CMS is changing how it calculates and reimburses the practice expenses across the entire family of CPT codes. Many pulmonary and sleep codes will see practice expense reductions phased in over the next four years.

Third, the Medicare rule will bring a number of changes to the sleep medicine community. The relative physician work values for attended sleep studies (CPT codes 95808, 95810, 95811) are cut. Providers who read sleep study interpretations (95808-26, 95810-26, 95811-26) will see 20%-25% reductions in Medicare reimbursement in 2011. On the positive side, providers will be able to use two new codes for unattended sleep studies (95800, 95801) starting in 2011 However, due to technical errors Medicare practice expense component of these two new unattended sleep studies codes, it is not yet clear with the Medicare reimbursement will be. We expect a clarification from CMS shortly and will share the information as soon as it is available.

Fourth, in the area of pulmonary rehabilitation, the final rule increases the clinical staff time and physician work value for pulmonary rehabilitation (G0424). The ATS is pleased that CMS listened to our concerns about the valuation of the G0424 code and made these corrections, which will result in an approximate 25% payment increase.

Finally, starting 2011, the pulmonary community will have additional Medicare Physician Quality Reporting Initiative measures to report on including two new asthma: tobacco screening and intervention and preventative care: tobacco screening and intervention. These new measures are addition to the existing measures of COPD (51,52), asthma (53, 64), community acquired pneumonia (56-59), and catheter related blood stream infection prevention (76). Also available are the community acquired pneumonia measure group and the asthma measure group.

Detailed information on all these topics will be covered in the December issue of the ATS Coding and Billing Quarterly.

ENVIRONMENT

ATS Urges EPA to Issue Final Ozone Rule

This week, ATS President Dean E. Schraufnagel, MD sent a letter to the Environmental Protection Agency (EPA) Administrator Lisa Jackson urging EPA to issue final rules for ozone air pollution.

Earlier this year, EPA had issued a proposed ruling that would have revised the existing standard for ozone of75 ppb/8-hours to a stricter standard between 60 and 70 ppb. A final rule was expected in August. However EPA has not yet issued the final rule. Due to the business community's strong opposition to a stricter ozone rule, most observers believe that EPA intentionally delayed issuing a stricter final rule until after the November elections.

In the letter, Dr. Schraufnagel reminded Administrator Jackson that ozone pollution is a serious health threat responsible for preventable asthma attacks, missed school days, hospitalizations and death. Delay on this important rule will only compromise America's public health.

RESEARCH

ATS Calls for $1 Billion Funding Increase for NIH in 2011

This week, the ATS sent a letter to Congress urging passage of a $1 billion increase in funding for the National Institutes of Health (NIH) in 2011. The letter was sent to members of the House and Senate Labor-Health and Human Services (Labor-HHS) Appropriations subcommittees, whose members will be reconciling the final Labor-HHS spending bill. In it, the ATS also urges passage of a 2.3% funding increase for the CDC, prevention of a $1.4 million cut to CDC's domestic tuberculosis control program and the highest funding level for the National Institute of Occupational Safety and Health (NIOSH), also at CDC. Congress will be returning to Washington on November 15 to finish work on 2011 spending bills. It is possible that Congress will pass another temporary spending measure to fund government programs, called a continuing resolution (CR), and delay final passage of FY2011 spending bills until the new 112th Congress convenes in January.

In the letter, ATS President, Dean Schraufnagel, MD, urges swift action, saying, "It is essential that the reinvestment in biomedical research made through the ARRA (spell out) be reinforced through annual budget increases that include at least inflationary adjustments. The $1 billion funding increase provided in the FY2011 House and Senate bills will ensure that the NIH's research efforts to advance public health will not be curtailed."

The Washington Letter is written by the American Thoracic Society government relations office and emailed to all ATS members living in the United States. The letter keeps clinicians, scientists, and patients abreast of legislative, judicial, and regulatory issues in pulmonary, critical care, and sleep medicine. Each week's edition is archived on the ATS Web site, www.thoracic.org. If you have any questions or one more information about becoming involved in advocacy, please contact the ATS Washington office at 202-296-9770.