AAMC Testifies Before PPAC
on Medicare Physician Fee Schedule, SGR
February 14, 2003 - The Practicing Physicians Advisory
Council (PPAC) met Feb. 10 to review several topics of importance
related to the Medicare Physician Fee Schedule and the Sustainable
Growth Rate System (SGR). For the first time, PPAC was able
to make recommendations in advance of the Centers for Medicare
and Medicaid Services (CMS) preparing the first draft of the
upcoming year's fee schedule, scheduled to be released in
May. CMS will take PPAC's recommendations into advisement
as it develops the Calendar Year 2004 schedule.
Albert Bothe Jr., M.D., executive director, University of
Chicago Faculty Practice Plan, compliance officer and professor
of Clinical Surgery, University of Chicago Medical School,
and medical director, University of Chicago Health Plan and
the chair elect of AAMC's Group on Faculty Practice (GFP)
Steering Committee and chair of the GFP Subcommittee on Legislative
and Regulatory Issues, testified
(PDF, 7 pages - 135KB) on the physician payment update
and the SGR.
PPAC members discussed topics including the timeliness and
treatment of professional liability expense data under the
Medicare Economic Index (MEI) and SGR, the inclusion of "incident
to" drugs in Part B actual expenditure calculations
PPAC members also recommended that CMS:
- Remove drug expenditures from the definition of physician
services in the calculation of the sustainable growth rate.
- Calculate the utilization rates and cost of regulations,
subregulatory actions by the agency (e.g., quality initiatives)
and national coverage decisions that impact physician practice
costs, and use the results to increase Medicare payment
rates each year to account for these costs.
- Consult with organizations representing physicians concerning
the methodology for calculating regulation impact costs.
- Invite public comment in the proposed rule on changes
to the sustainable growth rate formula.
- Ensure that the duration of Medicare participation agreements
is consistent with the duration of the Medicare fee schedule
payment period.
- Address the refinement of the malpractice Relative Value
Units, including a more detailed description of the methodology/proposed
alternatives CMS is considering for malpractice Relative
Value Units.
- Include a statistically significant sample of all professional
liability insurance carriers when collecting liability premium
data for the Medicare economic index; and
- Eliminate the 30-day physician visit requirement for
outpatient therapy services.
Information:
Denise Dodero, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
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