!

Last week, CMS released its final rule regarding the 2012 Medicare Physician Fee for Service schedule.  As we all know, effective January 1, 2012 there is a schedule physician fee service cut of 27.4%.  


What does this mean?  Well basically, we've been down this road before.  Each calendar year since 2008, Congress has chosen via legislation to avert and repeal the mandated SGR (Sustainable Growth Rate) cuts enacted in the 2003 Medicare Modernizaton Act.  As a result, because each previous cut needs to be recalculated into the SGR formula for the following year, we as physicians in the Medicare system are in line for a dramatic cut of 27.4%.  This is actually a decrease from the proposed 29.1% that the SGR was supposed to initiate on January 1.


Why did it drop from 29.1% to 27.4%?  In the recent health care legislation, there was language that a modest increase in primary care payments would not be affected, so the CBO and CMS agreed in part to increase the conversion factor 1.0018 to the 2012 level of $24.6712.  In 2011, the conversion factor is $33.9764.  In 2010, the second half of the year we enjoyed a conversion factor of $36.8729.  The reduction in the factor was also played in part by the third Five-Year review and the elimination of the work adjustment RVU.


So how does it affect podiatrists?


Here is a an Excel format showing the comparison from 2011 to 2012.  Now I am not trying to be an alarmist, but I know FOR A FACT, THAT THE APMA HAS NOT RELEASED THIS INFORMATION TO THE GENERAL PODIATRY MEMBERSHIP AND NOT A WORD IS OUT IN THE NEWS MEDIA.


http://presentelearning.com/upload/files/2012_PFS_Compare-2011.xls


Yes, my friends and colleagues, this is real.  Unless Congress acts (which we know will happen since its a major election year), these cuts will be in effect on January 1, 2012.  It is disturbing to review the numbers (I have included the new skin replacement codes with the 2012 reimbursements -- see my post on CPT Replacement Skin Subsitute Coding Changes) and that MANY podiatrists will probably be out of business by June 2012 if the cuts are not averted.


Get on the eAdvocacy website via APMA.  Call your local congressman's office.  Call your state senators.  Do what must be done.  There is no more time to sit on the sidelines, and hope that things fix themselves.  I know I can't survive on this fee schedule.  I hope this drums up enough replies that people see this for what it is.  Call your local news stations and see if they can report this story.  Just don't sit back and think this is going to be fixed by itself!


Eric J. Lullove, DPM


Excel table provided by AAWC Regulatory Committee



  • Comments (23)
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  • Ok everyone, President Obama will have signed the 60-day extension for the Medicare "doc fix" before he leaves for Hawaii. Basically, and most likely, the offset of the 26.4% Medicare fee cut will most likely come from the hospital outpatient reimbursement schedule. As I previously posted, HOPD visits will be cut roughly 70-80% and this will most likely affect physicians who practice in hospital-owned medical clinics, wound centers and private offices owned by hospitals. Basically, any POS of "22 -- outpatient hospital" will be cut as above unless Congress figures out a different way to pay for the SGR reversal and payroll tax reduction.Have a Happy Holiday Season,Eric
  • Any references to dates and deadlines has to do with currently planned recess/adjournment dates for the holidays.  You don't think they want to stay in session for a minute longer than necessary, do you?  It has been enough of a don-nothign Congress as it is.  In the end, they won't cut fees by 27% any more than they'll cut Social Security benefits--they're going to risk pissing off the senior vote in an election year?  It would be political suicide.


    Unpopular legislation gets passed early a term, counting on the electorate to forget by the time reelection is in the works.  I admit to being a bit cynical, but in this case I believe it to be a political reality.  It is partof why I believe ther should be term limits on Congressmen and Senators.

  • Quote:

    A last-minute plan is shaping up in Congress to postpone a massive reduction in Medicare reimbursement to physicians for 2 years, and freeze rates in the meantime. The political will to avoid a 27.4% pay cut scheduled for January 1 seems to be there on both sides of the aisle. Last week, House Majority Leader Eric Cantor (R-VA) said that Congress would pass legislation by December 16 to avert what physicians consider a catastrophic blow to their practice finances and seniors' access to care.

    The question is how Republicans and Democrats will strike an agreement while they are fighting tooth and nail over other end-of-year matters, such as extending a payroll tax cut for workers, and unemployment benefits for the jobless.

    Source: Robert Lowes, Medscape News [12/6/11]

      


    Brandon,

    Thanks for putting this post up.  However, I will answer your last question with another one....

     

    Why do you think Congress will act by December 16?  Is it even possible?  The one thing I have learned about Congresspeople -- when the Camera is ON, they say anything to win votes....its what said behind closed doors and the camera isn't on that the American People need to hear.


    This is crap.  I really am worried this time.  As a solo practitioner in a HEAVY medicare-based state (Florida), I can only imagine what the commercial payers are frothing at the mouth to pay me at 80% of Medicare rates for office visits....should be nice to see a BCBS patient for an office visit, get paid around $21.00 (83% of MFFS for 2012) and have to refund $9.00 to the patient out of their $30.00 copay...this should be fun.


    Oh and lest I forget, BCBS will still collect premiums and never have to write a check or send me an EFT for services....



  • Any chance Michelle has painful bunions?
  • Well, Jeff--I hadn't yet gotten to the point of losing sleep over it, but I was going to a one day seminar with information reagrding Medicare's plans for 2012.  There were plenty of people there who would be in the know, so I asked around.  One person had heard "something", then this little article turned up.  I did receive information that APMA folks are always up "on the hill" in Washington and have been putting in their two cents' worth--and being heard.   To me, APMA can't get things like this done by themselves but are doing what they can.  Major political endeavors like this take a lot of sustained pressure from a variety of interested parties.

     

    Interestingly enough, I heard a story that back in the 1960s, podiatrists weren't going to be included in Medicare, but Lady Bird Johnson's podiatrist put in the word to her, she lobbied LBJ, and the rest is history.

  • Brandon - What happened to the "nerves of steel"? Weren't you one of the those who assumed a "bail out" would come?
    I read the same blog this morning and for the first time in 2011 actually breathed a sigh of relief.

    I agree with you that the fallout from such a cut could potentially be disasterous for our politicians. Could you imagine first a "tech bubble" then a "bank bailout", then a "mortgage crisis" to be topped off with a "Medicare crisis" - I don't think Congress wants to add another something to their "to do list". 
    And by them "freezing the wages" for two years, in a way it's a win for them as inflation is not factored in. 

     

  • I was actually starting to get a bit worried this time because there hasn't yet been the typical information that has come out by now regarding pending action in Congress to deal with the doc-fix and pending payment cuts.  So this morning, I ran across the following, copied from PM News:

     

    -----------------

    A last-minute plan is shaping up in Congress to postpone a massive reduction in Medicare reimbursement to physicians for 2 years, and freeze rates in the meantime. The political will to avoid a 27.4% pay cut scheduled for January 1 seems to be there on both sides of the aisle. Last week, House Majority Leader Eric Cantor (R-VA) said that Congress would pass legislation by December 16 to avert what physicians consider a catastrophic blow to their practice finances and seniors' access to care.

    The question is how Republicans and Democrats will strike an agreement while they are fighting tooth and nail over other end-of-year matters, such as extending a payroll tax cut for workers, and unemployment benefits for the jobless.

    Source: Robert Lowes, Medscape News [12/6/11]

     


    ------------------

     

    Fact is that this is a budget--political issue.  I would imagine the politicians are more afraid of the grief they'd hear from the senior citizen organizations such as AARP and the senior vote itself than they are of the lobbying efforts from APMA and AMA combined.


    Stay tuned for more details as they arise.

     


    Brandon Macy

  • Eddie - All the points you make in this post are taken to heart by me. I would encourage you to make these issues more public. What makes these public forums such as here and PM NEWS great is that they afford us as a profession a way of communicating with and to each other.
    The same way I am asking what is the APMA doing with regards to MEDICARE fee schedule.
    Our voices need to be heard.

    To participate or not to participate that is the question - this is a story for another day.

  • Jeff:

    I would encourage all to take a look at the AAPS:  http://www.aapsonline.org/
    Podiatrists are currently in the "associate" member category but that could change if there was sufficient interest.  If you look at the philosophy of AAPS it will be obvious that I do not approve of a number of  actions of the APMA.  AAPS encourages physicians to leave Medicare and the third party payment system as much as possible.  Yes, I am still a Medicare provider but am weighing all options.  There need be a "critical mass" of non-third party participants that effectively network before we will see real change.

    We do need a specific organization that represents our interests to payors and government.  Reimbursements are being reduced via a number of mechanisms: 1) replacing CPT codes with lessor paying codes, 2) not allowing providers to use certain codes, 3) RBRVS devaluations and the like. 

    Some examples:   1) The code for diagnostic ultrasound exam 76880, was replaced with 76882 and 76881.  It is suggested that podiatrists should use primarily the absurdly low valued 76882.  This change was made with APMA in attendance.  I had made numerous appeals to APMA on this issue with no response.  2) We have "directives" from our Medicare rep in Texas that podiatrists should not bill code 11755 and almost never, the higher level codes such as 99214.

  • Eddie - so tell me where is "going with the flow" going to land us as of Jan 1st? Let's all place our bets now. We will then be back in less than 30 days and will know who the "podiatric prophets" are.....I say going with the flow is the wrong move.

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