CMS Announces Payment Reductions of 21.2% in 2010

October 30, 2009—The Centers for Medicare & Medicaid Services (CMS) announced final changes to policies and payment rates for services to be furnished during calendar year 2010 (CY 2010) by more than 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS), which sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings.

According to the agency, the final rule will reduce the conversion factor by 21.2% for services on or after January 1, 2010, in the absence of Congressional action for the CY 2010 physician update. The current law requires CMS to adjust the MPFS payment rates annually based on an update formula that requires application of the sustainable growth rate (SGR), which was adopted in the Balanced Budget Act of 1997. The complete statement outlining the final rule with comment period is available on the CMS Web site, www.cms.hhs.gov. The entire final rule is available online ahead of publication in the November 25, 2009, edition of the Federal Register, www.federalregister.gov.

In response to the CMS announcement, the Society for Cardiovascular Angiography and Interventions (SCAI) stated that these cuts will profoundly affect the entire cardiovascular community. SCAI noted that the SGR formula for calculating physician payments is not controlled by CMS; only legislative intercession can prevent this across-the-board reduction in payments under the MPFS.

The American College of Cardiology’s Jack Lewin, MD, commented, “[T]hese cuts will cripple the nation’s ability to treat cardiovascular disease.”

The American Medical Association’s President J. James Rohack, MD, stated that this is the largest payment cut since Congress adopted the “fatally flawed” Medicare physician payment formula.