Psychiatric News August 20, 2004
Volume 39 Number 16
© 2004 American Psychiatric Association
p. 2
CMS Proposes 1.5 Percent Increase For 2005 Medicare Physician Fees
Mark Moran
Depending on specialty, some physicians may see a decrease in Medicare
fees. How the proposed fee schedule will affect psychiatrists is now being
analyzed by two APA offices.
A new physician fee schedule implementing an across-the-board increase of
1.5 percent in 2005 for physicians participating in the Medicare program has
been proposed by the Centers for Medicare and Medicaid Services (CMS).
The fee schedule was issued as part of a proposed rule implementing
provisions of the Medicare Modernization Act of 2003. It was published in the
August 5 Federal Register. Comments will be accepted until September
24. CMS plans to publish the final rule by November 1, with an effective date
of January 1, 2005.
The proposed 1.5 percent increase replaces a decrease of 3.7 percent that
had been previously projected. The AMA, along with APA and other groups,
vigorously opposed the projected decrease and lobbied for an increase.
However, the 1.5 increase represents the average across all specialties.
Some specialties may experience an even higher increase, while some may
experience a lower increase or even a decrease in payments. At press time,
analysis of how the proposed fee schedule could affect psychiatry was under
way by APA's Department of Government Relations and Office of Healthcare
Systems and Financing; details will appear in Psychiatric News as
soon as they become available.
Chester Schmidt, M.D., chair of APA's Committee on RBRVS, Codes, and
Reimbursement, noted that despite the across-the-board increase for 2005,
decreases are projected by CMS beginning in 2006.
"We hope that psychiatrists will benefit from the 1.5 percent
across-the-board increase and are waiting for an analysis of how the fee
schedule will affect the profession," said Schmidt. "But along
with the rest of medicine, we remain very concerned about projected cuts in
coming years."
Edward Gordon, M.D., chair of APA's Medicare Advisory Committee, noted that
in a "zero sum" budget, any increase in services means that money
will have to be taken from somewhere else.
And overriding payment issues for psychiatry is the discriminatory 50
percent copayment for outpatient mental health services. "A lot of
psychiatrists simply won't treat Medicare patients on an outpatient
basis," he said.
The AMA hailed the proposed increase while continuing to argue that the
entire formula by which physician payments are calculated should be
scrapped.
"This rule puts in place the 1.5 percent increase in Medicare
physician payments from the [new] Medicare law," said J. James Rohack,
M.D., chair of the AMA's board of trustees. "Efforts by Congress and the
Bush administration prevented an access-to-care crisis for patients this year
and next by halting a 4.5 percent cut in Medicare payments this year and a 3.7
percent cut in 2005.
"The narrowly averted 2004 and 2005 cuts—and the upcoming cuts
forecast for 2006 through 2012—are an alarm bell for America's Medicare
patients and their physicians that the flawed payment formula must be
replaced," said Rohack. "There is much work to be done to ensure
that all our Medicare patients have access to care in the future. The AMA will
continue its work with Congress and the administration to reform the flawed
Medicare payment formula."
Total Medicare spending for more than 875,000 physicians and other health
care professionals will increase by more than 4 percent, from a projected
$52.7 billion in 2004 to a projected $55 billion in 2005, according to
CMS.
The CMS's proposed rule also includes these provisions:
- New incentive payments to doctors practicing in physician-scarcity areas.
These payments of 5 percent would be made to both primary care and specialty
physicians furnishing services to beneficiaries in the areas with the lowest
20 percent of physician-to-beneficiary ratios.
- Authorization of psychologists to receive payment for both administering
diagnostic psychological tests and for supervising the administration of these
tests.
- New coverage for a one-time evaluation and counseling from a physician
employed by a hospice to determine appropriate end-of-life services for
terminally ill beneficiaries.
The proposed fee schedule is posted at
<http://a257.g.akamaitech.net/7/257/2422/06jun20041800/edocket.access.gpo.gov/2004/04-17312.htm>.
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