Cardiovascular Business - July/August 2008 - (Page 33)

or sign-up for our weekly newsletter @ Subs.CardiovascularBusiness.com Get a daily dose of Cardiovascular Business News, visit CardiovascularBusiness.com, á Non-hospital outpatient cath labs brace for payment cuts tice expense relative value units (RVUs). The original proposed practice expense RVUs would have cut payment by 67 percent when the new RVUs were fully implemented in 2010. The cardiology community, including the American College of Cardiology (ACC), the Society for Cardiovascular Angiography and Interventions (SCAI) and the Cardiovascular Outpatient Center Alliance (COCA), persuaded CMS to allow local Medicare carriers to set prices in 2007 while cardiology stakeholders re-evaluated the data used to calculate the proposed values. In April 2007, the RVU Update Committee (RUC) approved the new practice expense data generated by the cardiology community “with very few modifications,” according to Steve Blades, president of COCA, which represents more than a 1,000 cardiologists that own and operate non-hospital outpatient cath labs. CMS took the new data into consideration, but the revised RVUs for nonhospital cardiac cath services still amounted to an 18 percent cut in 2008 and a 29 percent reduction by 2010 (see table), independent of any decrease in the Medicare conversion factor (originally set to begin July 1 at 10.6 percent). “CMS under values both direct and indirect costs for us,” Blades told Cardiovascular Business. In written and face-to-face communications with CMS, Blades has explained that the new RVU determination methodology is essentially flawed. The RUC definitions and templates are designed for services and procedures performed in physician offices, while nonhospital outpatient cath labs require “much more intensive infrastructure, equipment, staffing and supplies.” Blades also took issue with the RUC’s definition of outpatient cath lab staff as a mix of radiology technicians, registered nurses, cardiovascular technicians, licensed practical nurses, and medical assistants. He said that the RUC template is based on a “hospital staffing model where a variety of staff can be utilized in the cath lab for short periods of time and then rotated elsewhere within the hospital.” In the non-hospital outpatient cath lab, “the staff is dedicated to that facility and cannot be shifted to other areas because the lab is a contained unit, unlike a hospital or physician office setting.” CMS will accept comments on the changes until Aug. 29. By C.P. KAiSeR he cardiology community is once again girding itself to stop proposed reimbursement cuts, this time aimed at catheterization procedures performed in non-hospital outpatient cath labs. Under proposed changes to the Medicare physician fee schedule, reimbursement for procedures performed in this setting could be reduced 40 percent by 2010. The reductions are partly the result of a new methodology by the Centers for Medicare & Medicaid Services (CMS) to determine the practice expense portion of Medicare physician payments—that is, the prac- T Impact of New Practice Expense RVUs for Non-Hospital Cardiac Cath Services CPT CODE/SERVICE 93510 TC* Lef t hear t cath 93543 Injection, lef t hear t 93546 Injection, coronaries 93555 TC Imaging S&I for lef t hear t 93556 TC Imaging S&I for coronaries Total RVUs Payment** % Change from 2006 2006 PE RVUs 37.06 0.11 0.16 6.63 9.92 53.88 $2,042 Proposed 2010 PE RVUs (2006) 16.55 0.16 0.18 0.66 0.49 18.04 $684 -67% 2010 PE RVUs (2007 Final Rule) 28.12 2.62 5.86 0.59 0.88 38.07 $1,443 -29% 2008 PE RVUs 31.39 1.37 3.01 3.22 5.16 44.15 $1,673 -18% Armed with new practice expense (PE) data from the cardiology community, CMS updated its calculations for non-hospital outpatient cath lab services, going from a 67 percent reduction in payment by 2010 to a 29 percent reduction. Stakeholders say the lesser decrease still does not reflect reality. Source: ACC *TC=Technical Component **Payment calculated using 2006 Medicare conversion factor CardiovascularBusiness.com Cardiovascular Business 33 http://Subs.CardiovascularBusiness.com http://CardiovascularBusiness.com

Table of Contents Feed for the Digital Edition of Cardiovascular Business - July/August 2008

Cardiovascular Business - July/August 2008 Table of Contents First Word Cover Story: Planning for the Ideal Cath Lab Requires the Multidisciplinary Approach Clinical Study Digest: Cell Phone Technology Speeds Ecgs As Real-Time 3d Echo Matures, It Finds a Clinical Niche Ecg Image Management Brings Increased Productivity and Confidence Overcoming Barriers to Cath Lab Inventory Control Maximizing Reimbursement, Minimizing Penalties News & Views Calendar Reader Resources The Back Page

Cardiovascular Business - July/August 2008

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