Monday evening, Senate Majority Leader Harry Reid (D-Nev.), Finance Committee Chairman Max Baucus (D-Mont.), Minority Leader Mitch McConnell (R-Ky.), and Finance Committee Ranking Member Charles Grassley (R-Iowa) reached a tentative consensus to stave off the proposed cuts to payments physicians receive for services provided to Medicare beneficiaries. The consensus proposal delays the payment cuts, which were produced in part by the sustainable growth rate (SGR) formula, for 12 months.
A full list of policies that will be extended by the consensus proposal has not been released yet. However, it is expected that the proposal would extend a number of expiring payment policies, such as the “floor” on geographic adjustments to the physician work component of the Medicare physician payment schedule.
The total cost of the consensus proposal is estimated to be $19.2 billion. The proposal will be paid for by making a change to a provision of the health care reform law. The proposed change recoups a greater proportion of overpayments that in some circumstances may be made to consumers who are deemed eligible for subsidies to purchase coverage in the health insurance exchange that will be established by the Affordable Care Act.
The Senate was to review the proposal Monday night, and it is expected that the 12-month delay to physician payment cuts will pass with a unanimous consent agreement later this week, possibly on Wednesday.
This action by Congress addresses only the reduction to the conversion factor. The reduction to RVUs for sleep medicine codes as published in the 2011 Physician Fee Schedule remains.
The conversion factor used to calculate the payment information in this table is $36.87, which reflects the proposed conversion factor freeze. The following is a table of payment information for sleep codes 95800-95811. This table reflects RVUs applicable starting January 1, 2011
|
Code
|
Physician Work RVU
|
Physician Work Payment
|
Practice Expense RVU
|
Practice Expense Payment
|
PLI RVU
|
PLI Payment
|
Total RVU
|
Total National Payment = (work + PE + PLI) x Conversion Factor
|
|
95800
|
1.05
|
$38.71
|
37.51
|
$1382.99
|
.05
|
$1.85
|
38.61
|
$1423.55
|
|
95801
|
1.00
|
$36.87
|
64.32
|
$2371.47
|
.05
|
$1.85
|
65.37
|
$2410.19
|
|
95803
|
.90
|
$33.18
|
3.84
|
$141.58
|
.04
|
$1.48
|
4.78
|
$176.24
|
|
95805
|
1.20
|
$44.24
|
10.84
|
$399.67
|
.08
|
$2.95
|
12.12
|
$446.86
|
|
95806
|
1.25
|
$46.09
|
4.05
|
$149.32
|
.08
|
$2.95
|
5.38
|
$198.36
|
|
95807
|
1.28
|
$47.19
|
12.45
|
$459.03
|
.15
|
$5.53
|
13.88
|
$511.75
|
|
95808
|
1.74
|
$64.15
|
17.28
|
$637.11
|
.17
|
$6.27
|
19.19
|
$707.53
|
|
95810
|
2.50
|
$92.18
|
17.80
|
$656.28
|
.21
|
$7.74
|
20.51
|
$756.20
|
|
95811
|
2.60
|
$95.86
|
19.30
|
$711.59
|
.23
|
$8.48
|
22.13
|
$815.93
|
The AASM will keep members informed as more information is available.
