Practicing Physicians Advisory Council (PPAC) UpdateDate: Monday February 10, 2003 I am pleased to post my report of the Practicing Physicians Advisory Council meeting of February 10, 2003. The Practicing Physicians Advisory Council (PPAC) is a congressionally designated committee of 15 physicians to advise Health and Human Services on matters of Medicare and Medicaid. Medicare Fee Update Testimony was heard from multiple speciality societies about the physician fee update for 2003 and the proposed fee update for 2004. The AMA made excellent points about CMS's errors in calculating the Gross Domestic Product and the errors in the numbers of Medicare fee for service enrollees. These points were echoed by multiple specialty societies. Mr. Scully again stated that he would correct the errors if allowed to by Congress. He was cautiously optimistic about a fix for the 2003 4.4% fee decrease and was hopeful that there would be a positive update for 2004. The sustainable growth rate formula (SGR) was again a major topic. PPAC again requested that CMS remove drug expenditures from the definition of physician services used to calculate the SGR. The SGR is a target which when exceeded results in a decrease in physician reimbursement. We felt that physicians have very little control over the cost of drug expenditures and should not penalized for the increase in cost of pharmaceuticals. These are not prescription drugs but those pharmaceuticals and laboratory tests which are given incident to a physician visit in the office. PPAC discussed at length the flaws in the current system of calculating the costs of providing care to Medicare beneficiaries. We recommended that the impact of the regulations (e.g., HIPAA) on practice costs be calculated accurately and that Medicare payments be increased accordingly. Similarly, medical liability insurance costs are included in calculating the Medicare Economic Index but PPAC felt that the costs had been underestimated by CMS and requested that more specific data be used in calculation of these costs (including data from a statistical sample of PLI carriers). We requested that CMS consult with physician organizations to represent physician concerns about the methodology of determining the financial input of all the regulations and non-regulatory mandates and to work with these organizations to update the calculations of the actual cost, to use in calculating the Medicare Economic Index. We also felt that the SGR target should be calculated to include the utilization changes which will result from the national coverage decision so that the target is not exceeded and physicians are not penalized for behaviors we are requested to perform by CMS. Several societies, anesthesiology and family practice in particular, testified on their need for specific increases in their reimbursement. (Anesthesiology's request was because their conversion factor is a special case in the RBRVS system and family practice because there are no care coordination codes). Both of these items were deserving of a fix but ran into the budget neutrality problem. Any increase, no matter how deserving, causes a decrease in the reimbursement of other specialties and demonstrates the basic unfairness of the budget neutrality doctrine. Unfortunately, changing this doctrine would require Congress to change legislation and is therefore an unlikely event since putting us at odds with one another is an effective means of dividing the house of medicine and containing cost. We also requested that physician work be recognized in the immunization code, since for both children and adults physicians must persuade people to get immunizations and to allay their fears about the complications of immunizations. Communications With Carrier Medical Directors We requested that the Physician Regulatory Issues Team review and provide solutions for improving physician communication with carrier medical directors. We discussed the importance of physicians being able to communicate easily and inexpensively with carrier medical directors in order to comply with CMA regulations and coding guidelines. We expressed concern about the inaccuracies of the advice received and the 30% of beneficiary calls which currently go unanswered, and requested follow-up information on CMS's plans to fix this problem. G Codes G codes are often useful to allow payment while the CPT process is underway. PPAC recommended that the interested parties have input into the development of G codes and that transition to a CPT code be made as soon as possible. Physical Therapy Currently physical therapy prescriptions require a 30 day visit no matter what the physician orders. PPAC requested that a 30 day visit requirement be waived and that the physicians be able to determine the correct timing of a return visit on a physical therapy prescription. Effect of Prescription Drug Benefit Mr. Scully also stated that he welcomed input from PPAC on issues broader than specific regulations. We expressed concerns that a prescription drug benefit cost would be calculated as part of Part B physician services and therefore decrease physician reimbursement. He stated that it was currently his understanding that prescription drugs would be a separate benefit but that this would be a congressional, not a department decision. He also said that he would welcome PPAC comments on Medicaid but was concerned that the complexity of the state programs would be overwhelming. Feedback I hope this update remains helpful to you. I was able to use input from many of you to let CMS know that its comments to PPAC are being distributed to physicians all across the country. I hope this will increase the utility of PPAC. Please feel free to give me feedback on the actions that PPAC has taken or what our responses to CMS should be for future issues. Thank you for your time in reading this. Sincerely, Barbara L. McAneny, M.D., F.A.C.P.
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