On Oct. 30, CMS released its final physician rule for 2010. An e-mail alert was sent to AGA members announcing a 21.2 percent cut in Medicare physician payments effective on Jan. 1, 2010, absent Congressional intervention. Taking into account overall changes in the fee schedule, GI payments see an extra decrease of 1 percent, so gastroenterology would be impacted by a 22.2 percent cut if the sustainable growth rate (SGR) formula is not addressed for 2010.

For years, the AGA has aggressively advocated that Congress fix the flawed SGR formula as part of long-term health-care reform. Fortunately, there is a growing understanding in Congress that the SGR needs to be repealed. Take action — contact your lawmakers to urge them to repeal the SGR formula and prevent the 22.2 percent cut from being implemented in January 2010. AGA, along with our partners in the Alliance for Specialty Medicine, continue to fight these devastating cuts that will occur next year if Congress fails to repeal the SGR formula or specifically address the 2010 cut.

Issues in the physician final rule summary include:

• Medicare payment update — 21.2 percent decrease absent Congressional intervention.
• Physician Practice Information Survey — CMS decided to implement new practice expense data with a four-year phase-in for all specialties except oncology.
• Consultation codes — despite significant opposition by AGA and many specialties, CMS will eliminate consultation codes starting in 2010.
• Imaging issues — CMS will increase the utilization assumption of equipment priced more than $1 million with a four-year phase-in; this will positively impact GI payments.
• Physician Quality Reporting Initiative — CMS finalized new measures and improvements to encourage participation by MDs and group practices.
• E-prescribing — CMS increased its reporting mechanisms of e-prescribing measures to increase adoption.
• Physician Resource Use Measurement and Reporting Program — CMS accepted feedback to improve the format of these confidential reports.
• Physician value-based purchasing — CMS provided an update on this issue; report due to Congress in spring 2010.
• MedPAC recommendations — after opposition from organized medicine, including AGA, to the creation of an advisory body separate from the AMA/Specialty Society Relative Value Update Committee, CMS did not finalize this issue and will continue to explore options.
• Competitive Acquisition Program — CMS finalized numerous improvements to this program.
• Geographic practice cost indices — CMS is still evaluating potential changes to Medicare locality configurations.
• Malpractice relative value units (RVUs) — CMS will implement its proposed methodology with suggested changes.
• Initial preventive physical exam — CMS increased payment rates for 2010 as supported by GI.
• Fourth five-year review of work RVUs — CMS outlined its process for the next five-year review; a separate rule will be published in spring 2011.

The final rule will be published in the Nov. 25 Federal Register. Files may be accessed at: http://federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf.

AGA also announced that on Oct. 29, 2009, the House leadership introduced H.R. 3961, the Medicare Physician Payment Reform Act, which revamps the current SGR formula by preventing the 22.2 percent cut in payments in January 2010. The legislation transitions physicians to a new payment system that creates two new targets for physicians: one for evaluation and management services, which would include preventive services, and another target for all other services. The legislation also eliminates the debt accumulated by the broken SGR system. The House leadership plans to debate this legislation after they address H.R. 3962, America’s Affordable Health Choices Act. The House will begin debate on health-care reform this weekend and hopes to complete its work by Veteran’s Day.

The AGA also continues to advocate that comprehensive payment reform for physicians that provides fair, equitable reimbursement and ensures access to specialty care for patients must be part of health-care reform. We will continue to fight for fair reimbursement for gastroenterologists and access to specialty care for patients.