reimbursement,demystified-americancollegeofradiology.ppt

The Third 5 Year Review Enter the Budget Neutrality Adjustment… Professional Component (PC) Payment (RVUxGPCI) +(RVUxGPCI) + (RVU+GPCI) * CF (RVUxGPCIx.8816) +(RVUxGPCI) + (RVU+GPCI) * CF CMS has finalized its 32% increase for anesthesiology physician work values as part of the third 5 year review.? The physician work adjustor will cause the 10.1% cut in physician work values for 2007 (with a work adjustor of .89896) to be increased to a 11.94% cut (changing the work adjustor to .8816) to all physician work values in the physician fee schedule for 2008. Conversion Factor Calculated each year based on a statutory formula that centers around the Sustainable Growth Rate - a.k.a. SGR SGR components Medical economic index - a.k.a. MEI Volume of services in prior years Target volume of services based on the Medicare population Gross domestic product SGR now demanding decreases in the conversion to achieve the target rates Five years of fixes leaves a large amount to repay to the system We are at the cliff and if the SGR formula is not changed double digit reductions in the CF will occur Decreases 10.1% for 2008 to $34.0682 ACR Policy Priorities Co-founder of Access to Medical Imaging Coalition (AMIC), ACR will urge AMIC to support Accreditation as a means to address rapid growth in utilization / ACR will support participation in Accreditation programs BY ANY PHYSICIAN SPECIALTY who commits to quality and appropriate use of imaging studies and further, the ACR will support Medicare development of Accreditation requirements/Appropriateness criteria based on private sector/physician specialty societies programs AMA and medical community pushing for comprehensive legislation to fix or replace the SGR focusing on those changes not adversely affecting radiology Because the increase in imaging utilization by ~14% is seen as a driver of SGR spending, radiology remains in the crosshairs Extensive congressional lobbying with bipartisan co-s