The Top Five Physician Stories of 2009 (Other Than Reform)

HealthLeaders Media Staff, December 17, 2009

The healthcare reform debate has made 2009 both exciting and frustrating for anyone involved with the healthcare industry. There were a lot of major changes, beginning with the American Recovery and Reinvestment Act early in the year, and we'll close out 2009 still waiting for a resolution.

The problem with such a massive story as healthcare reform is that it tends to have a wide gravitational field that draws attention away from other news and events that would be top-of-mind in any other year.

So before the Senate votes and healthcare reform returns to center stage, here are some of the top non-reform stories of 2009 that were of interest to physicians:

1. Shifts from specialists to primary care. Although there are some reimbursement bonuses for primary care doctors in reform legislation, the major realignment began with the Medicare Physician Fee Schedule released this year. There were two major components to the shift. First, CMS promised reimbursement increases to primary care as high as 8%, paid for with savings in imaging payments. The agency recalculated the imaging utilization rate, which could cut some specialists' reimbursement for imaging practice expenses by double digits.

The second change was the elimination of consultation codes, which CMS says were subject to high levels of miscoding and possible fraud. Many specialists rely heavily on consults and will now need to bill for existing or new patients. These codes generally pay less, even after CMS increased them to offset the elimination of consults.

2. Rifts in physician representation. One of HealthLeaders' most-viewed stories this year concerned a dispute between Sermo and the American Medical Association over CPT codes. According to Daniel Palestrant, MD, founder of Sermo, the AMA's proprietary ownership of the CPT codes makes transparency difficult because people can't do side-by-side comparisons of goods and services.

The dispute may be indicative of the AMA's waning influence—there are simply more groups representing doctors these days, including Sermo—which the reform debate further exposed. Many physicians were upset at the AMA's initial stance on the public option and other reform components, for various reasons, and some state medical associations wrote letters to Congress contradicting the AMA position this fall.

3. RACs. Medicare's Recovery Audit Contractor has consistently been one of the most popular topics on this year. Audits suggest CMS overpays millions because of incorrect coding, and they are cracking down. Physician practices have to be prepared for the contractors—which means ensuring coding is accurate and well-documented beforehand—and also must make sure they understand the RAC appeals process in case they get dinged.

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