Q: Did Medicare increase or decrease the 2007 payment rates for wound management procedures performed by physicians?
A: When the 2007 Resource-Based Relative Value Scale (RBRVS) was first released, it included a 5% conversion factor decrease that was due to take effect on January 1, 2007. After enormous pressure from physicians and their professional societies, Congress passed the Tax Relief & Health Care Act of 2006 on December 9, 2006. President Bush signed the act into law on December 20, 2006, thus erasing the pending 5% physician pay cut. The new law addresses 2 components of the RBRVS payment formula:
* Conversion factor: The 2007 RBRVS fee schedule conversion factor is frozen at the 2006 level of $37.8975
* Geographic Practice Cost Index (GPCI): All work GPCIs that would have fallen below 1.0 are frozen at 1.0.
Q: Will the 2007 physician RBRVS rates be the same as they were in 2006?
A: The RBRVS payment formula is complex. It includes relative value units (RVUs) for work, practice expenses, and malpractice. The formula then applies the conversion factor, which turns the RVUs into dollars.
Despite the freezes on 2 of the items in the payment formula, the 2007 physician fees will differ from the 2006 fees. To keep the Medicare Part B spending within a legally defined budget, Congress did not eliminate the 10.1% reduction in all work RVUs. In addition, the Centers for Medical and Medicaid Services (CMS) selectively adjusted the work and practice RVUs for some codes, such as 99213. Table 1 provides an overview of the major wound management RBRVS Physician Fee Schedule Rates.
Q: Did CMS introduce payment in return for physician reporting of quality measures?
A: Yes. Physicians can earn an additional 1.5% of their total allowed charges if they report quality measures for at least 80% of the services they offer for which measures are available. In 2007, there are 66 quality measures. These have 460 measurement codes, which have a payment status of "M" and correspond to the quality measures. None of the typical wound management codes are designated as quality measurement codes for 2007.
Q: Medicare arbitrarily reduced the work RVUs to keep the Medicare Part B budget within legally defined limits. How does this affect the private payer fees based on the full work RVUs?
A: Medicare is the only payer that applies the work RVU adjuster. However, the work RVU adjuster will also apply if a private payer bases its payment on the RBRVS Physician Fee Schedule. Other private payers will use the full work RVU. Therefore, physicians will need to maintain 2 sets of work RVUs: the full work RVUs for private payers and the 10.1% reduced work RVUs for Medicare and private payers that base payment on the RBRVS fee schedule.