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Physician Fee Proposal Generates Calls for Changes

Margaret Dick Tocknell, for HealthLeaders Media, September 10, 2012

Multiple procedure payment reductions (MPPR)

When outpatient or surgical services are furnished to the same patient on the same day, Medicare reduces payment for the second procedure to account for efficiencies. That process is in place for CT scans, MRIs, and some ultrasound and nuclear medicine studies. CMS wants to expand MPPR to include the technical component of additional cardiovascular and ophthalmology diagnostic procedures.

MedPac supports this step but wants CMS to also include the professional component of the services. "When multiple tests are performed together, certain physician activities…such as reviewing records…are likely to occur only once."

SNMMI opposes the expansion. It contends that the proposed policy is based on flawed assumptions regarding potential efficiencies. The group also said the CMS line item methodology to support payment reductions was not published in the proposed rule and is "necessary for complete public comment."

Concern about the negative impact on free-standing radiation oncology centers led the Rochester, MN-based Mayo Clinic to also oppose the change. "Before CMS makes significant reductions in the practice expense, CMS should be certain that it is using the most comprehensive and accurate information to value the full practice expense relative value weight."

Telehealth services

CMS proposes to expand telehealth services to include alcohol and substance abuse assessment and intervention services. This is especially important for rural areas where specialist may not be available onsite to see patients.

It comes as no surprise that the American Psychiatric Association, representing more than 36,000 psychiatric physicians, supports allowing services such as annual depression screenings and behavioral counseling for obesity to be delivered via telehealth. The group noted that the "prevalence of psychiatric disorders in primary care is well-documented" and contends that providing PCPs with the opportunity to bill for these preventive services will "facilitate timely referral to specialists."

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