Congress approaches ‘fiscal cliff’ during lame duck session
The key to progress on any resolution will be how much each of the respective sides are able to reach a compromise on policies related to several key issues, including taxes and entitlements. There is a possibility that a resolution will not be reached. However, alternatively, a temporary resolution could be put into place for further negotiations in 2013, including discussions on Medicare physician payment reform. Read more about Medicare payment reform.
Stop cuts to Medicare physician payment
CMS Physician Fee Schedule analysis: Complex repair code cuts for 2013
In the 2012 Final Medicare Physician Fee schedule rule, CMS identified 13152, eyelid, nose, ears, and/or lips, 2.6 to 7.5 cm, as potentially misvalued due to the code being Harvard-valued with annual allowed charges equal to, or greater than, $10 million. Therefore, CMS required that 13152 be surveyed, which necessitated a survey of the entire family of complex repair codes in 2012. The American Academy of Dermatology Association (AADA), the American Academy of Otolaryngology — Head and Neck Surgery, and the American Society of Plastic Surgeons presented the survey results to the AMA RUC in April 2012.
While values were roughly maintained at current payment levels for most of the codes in the complex repair code family — and some actually increased — the final 2013 fee schedule included a reduction to 13152 by 13 percent, and 13132 (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet 2.6 to 7.5 cm) by 16 percent — which are mostly due to a cut in physician work relative value units (RVU). For 13152, the physician work RVU was cut 23.08 percent; the practice expense RVU was cut 4.4 percent. For 13132, the physician work RVU was cut 27.36 percent; the practice expense RVU was cut 7.59 percent. The impact of the 2013 final rule will be greater if Congress fails to issue a freeze to the Sustainable Growth Rate. View the impact of the 2013 Physician Fee Schedule Final Rule on the complex repair codes as well as other key dermatology codes.
As previously reported, the final 2013 fee schedule included a significant reduction in reimbursement for the technical component (TC) of surgical pathology code 88305. That code’s TC will be cut by 52 percent, although the professional component (PC) will be raised by 2 percent. Overall, the global value of 88305 was reduced by 33 percent. The AADA has joined forces with other organizations, whose physicians will also be affected by these cuts, to formulate a strategy for responding to CMS to ensure the fair and accurate valuation of dermatologic services.
In addition, the final rule contains a number of refinements to policy initiatives. CMS will reduce the threshold for reporting the electronic prescribing measure (eRx) from 225 to 75, add an appeals process and two additional penalty exemptions for participating physicians, and allow group practices of 2 to 24 eligible professionals to participate in the eRx program in 2013. Read more about refinements to policy initiatives within the final Fee Schedule. For additional analysis of the final rule, check your mailbox for the December issue of Dermatology World.
Throughout the year, the AADA has actively weighed in on this rulemaking process with regard to important provisions affecting physician payments. CMS did accept the majority of the AMA RUC recommendations on almost 30 dermatology codes that were surveyed in 2012. Read the AADA’s comment letter to CMS on the proposed 2013 Medicare Physician Fee Schedule. Read the full text of the final rule.
The AADA will submit comments to CMS prior to the Dec. 31 deadline, and asks that physicians provide feedback directly to the AADA. For more information and to provide feedback, contact the AADA at 202-842-3555 or email@example.com.
AMA House of Delegates addresses workforce shortage, physician payment cuts, ICD-10
The program allows international medical graduates to waive their return-home visa requirement if they agree to complete a two-year residency in a Health Professional Shortage Area — as designated by HHS. The program is currently capped at 30 positions per state. The House of Delegates also re-affirmed the AMA’s position to oppose cuts to graduate medical education (GME) federal funding that could cause residency programs to close.
AADA delegates along with the Dermatology Section Council also worked with other organizations to successfully advocate for a resolution to oppose the Centers for Medicare and Medicaid Services’ (CMS) changes in Relative Value Units that are in excess of those recommended by the AMA/Specialty Society Relative Value Scale Update Committee (RUC).
The HOD also adopted a resolution that opposes the transition to the new patient diagnosis coding set ICD-10 and supports delaying any mandatory transition until the ICD-11 coding set — currently open for review and comment — is released. Currently, CMS is requiring that providers switch to the ICD-10 codes by October 2013.
Read more about the AMA House of Delegates interim meeting.
AADA provides practice management resources on health system reform
AADA supports Ohio truth-in-advertising bill
In the letter, the AADA stated that those who regulate and deliver medical care have an obligation to inform the public of the qualifications and limitations of the persons providing their care prior to treatment. All providers should identify or disclose their degree or field of study, board certification and licensure to each patient. Read more from the AADA’s letter of support. Get information and advocacy resources related to truth in advertising in the AADA’s State Advocacy Toolkit.
AADA offers advocacy assistance to state societies