The following information has been received by ANCO.
As you know, the Centers for Medicare & Medicaid Services (CMS) has released the 2009 Physician Fee Schedule (PFS). This new fee schedule implements the 1.1% increase in physician services reimbursement that Congress mandated in the Improvement for Patients and Providers Act of 2008 Medicare bill, also known as MIPPA. On the surface, this was a short-term positive because it averted a 10.6% cut in services reimbursement, and replaced it with a slated increase of 1.1%. However, the devil is in the details at CMS. That is why we are providing a tool that will help you estimate the impact of the Medicare changes for 2009.
Go to the Community Oncology Alliance (COA) website at http://www.communityoncology.org and log into the Administrators’ Network temporary area. You can download the tool, which was developed and tested by actual community oncology practices as part of the COA Administrators’ Network in development. The tool will show you the impact on E&M and drug administration revenue, as well as the impact of bonus payments if you participate in the PQRI and/or e-prescribing programs.
In order to actually increase services payments by 1.1%, the Medicare PFS conversion factor decreases from $38.09 in 2008 to $36.07 in 2009, while the physician work value units increase by approximately 12%. The net is that E&M revenues will increase; however, oncology-specific drug administration codes will go down.
The PQRI bonus has been increased to 2% of services in 2009 and the new e-prescribing bonus is an additional 2% beginning in 2009.
The fact that drug administration fees will decrease in 2009 is simply ludicrous. This is the problem with blindly supporting increases to the Medicare PFS that can adversely impact community oncology.
As a result, COA has launched the most comprehensive study ever undertaken to identify and quantify the clinical and operational components of delivering cancer care. A committee drawn from the ranks of medical oncologists, mid-level providers, nurses, pharmacists, and administrators is advising one of the top healthcare policy and research firms in the country, which has been commissioned by COA. Community oncology practices from across the country will be asked to participate in this landmark study for community oncology. The data gathered will be instrumental in supporting a massive outreach program to the new Administration and Congress being developed by COA. More information on this study will be provided shortly.
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