2027 PFS Proposed Rule - FREESTANDING

[TheWallnerus]

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If a frog had side pockets he'd carry a handgun...

If a rad onc practices in a freestanding center he'd get reimbursed the following amounts by Medicare in 2027...

MPFS 2027 Proposed Rule: Strong Gains for Treatment Delivery Codes Tempered by Other Cuts - What is Happening in Washington - American Society for Radiation Oncology (ASTRO)

CMS's proposed 2027 Medicare Physician Fee Schedule delivers strong gains for radiation treatment delivery codes but cuts planning, management and SBRT rates.

www.astro.org

 

[CaesarRO]

If a frog had side pockets he'd carry a handgun...

If a rad onc practices in a freestanding center he'd get reimbursed the following amounts by Medicare in 2027...

MPFS 2027 Proposed Rule: Strong Gains for Treatment Delivery Codes Tempered by Other Cuts - What is Happening in Washington - American Society for Radiation Oncology (ASTRO)

CMS's proposed 2027 Medicare Physician Fee Schedule delivers strong gains for radiation treatment delivery codes but cuts planning, management and SBRT rates.

www.astro.org

So basically huge jumps on the technical delivery codes. 2-3% cuts across the board on all the pro billing?

ETA: 2-3% reduction in RVUs: 4-6% reduction if you're a pro-billig group because of the conversion factor contribution

 

[TheWallnerus]

So basically huge jumps on the technical delivery codes. 2-3% cuts across the board on all the pro billing?

Seems right

 

[RickyScott]

Vast majority of radoncs are rvu based, typically hospital system based. Technical fees are ultimately whatever consolidating monopolistic systems can extort form employers/insurers. Despite cms, overall revenue increases every year as health care expenditures outpaces inflation. Disregard the noise and focus on supply/demand and $/rvu. Strange how Astro never mentions what actually matters.

 

[CaesarRO]

Vast majority of radoncs are rvu based, typically hospital system based.

Just further pushing consolidation and employment. There are few enough private practices left and a large chunk of what remains of private practice is PSA-based and doesn't own technical

 

[BobbyHeenan]

Further cut to wRVU on top of a big haircut (IGRT code) we just took.

Good luck trying to renegotiate that $/wRVU .

 

[Gfunk6]

I particularly enjoyed the cruel irony of our least used codes 77402 (level 1) and 77412 (level 3) got double digit percentage increases while the one that is used for 70-80% of radiation treatments 77407 (level 2) got a ~ 7% increase. With the gutting of the other planning/supervision codes, the net increase in reimbursement for the average practice will be somewhere in the ballpark of ~0.6-0.7% relative to 2026.

I wanted to congratulate ASTRO for their strong advocacy of following up a 2026 gutting of reimbursement with a 2027 < 1% increase. I also appreciate that they are still pushing the abomination of ROCR.

 

[Mandelin Rain]

I also appreciate that they are still pushing the abomination of ROCR.

 

[medgator]

I particularly enjoyed the cruel irony of our least used codes 77402 (level 1) and 77412 (level 3) got double digit percentage increases while the one that is used for 70-80% of radiation treatments 77407 (level 2) got a ~ 7% increase. With the gutting of the treatment codes, the net increase in reimbursement for the average practice will be somewhere in the ballpark of ~0.6-0.7% relative to 2026.

I wanted to congratulate ASTRO for their strong advocacy of following up a 2026 gutting of reimbursement with a 2027 < 1% increase. I also appreciate that they are still pushing the abomination of ROCR.

Protons 4 lyfe

 

[BobbyHeenan]

I haven’t looked into this to confirm, but this could have big implications on same day CT sims or flexible laryngoscope on same day as a clinic appt.

 

[metallica81788]

Screw this Luks guy for basically saying what all the boomers that have been screwing the rest of us over. Yeah you got yours but you still won't retire and let us even attempt to fix things. Just F(*O(*&*(& it all up on the way out and DGAF.

I guess he's honest, though.

 

[NotMattSpraker]

I haven’t looked into this to confirm, but this could have big implications on same day CT sims or flexible laryngoscope on same day as a clinic appt.

The rule is that they pay 100% of the highest price code then cut the lower priced -25 codes by 50%.

It does not cut the wRVUs, so should not directly affect the vast majority of RO contracts. The impact will be through administrators forcing us to slow down patient care.

This is a silly way to save money and will ultimately just slow down care. Wonder if it will survive the comment period.

 

[BobbyHeenan]

The rule is that they pay 100% of the highest price code then cut the lower priced -25 codes by 50%.

It does not cut the wRVUs, so should not directly affect the vast majority of RO contracts. The impact will be through administrators forcing us to slow down patient care.

This is a silly way to save money and will ultimately just slow down care. Wonder if it will survive the comment period.

Thank you for the context.

I’m not employed so I don’t know how closely employers/hospitals look…but if the rule stands you think most employed docs would get the wRVU credit even if on the back end Medicare isn’t reimbursing the full amount?

I would suppose then there will be admin pressure to NOT do same day of service procedures, etc (which I get - they’re not getting paid the full amount for)?

 

[HolySmokes]

I’m not employed so I don’t know how closely employers/hospitals look…but if the rule stands you think most employed docs would get the wRVU credit even if on the back end Medicare isn’t reimbursing the full amount?

No chance. I already get dinged on RVU credit for -76 modifier for BID CBCTs (-50% on second of the day), so I suspect this is will affect employed physicians comparably. You can do the right thing for the patient but your own reimbursement and the hospital reimbursement suffer, or you can delay care to get full credit.

 

[NotMattSpraker]

Thank you for the context.

I’m not employed so I don’t know how closely employers/hospitals look…but if the rule stands you think most employed docs would get the wRVU credit even if on the back end Medicare isn’t reimbursing the full amount?

I would suppose then there will be admin pressure to NOT do same day of service procedures, etc (which I get - they’re not getting paid the full amount for)?

The end result on the ground is going to vary a lot and is dependent on your administration and your contract. All I am saying is supposedly the rule cuts reimbursement not wRVUs.

I've never gotten dinged for -25 or -76 modifiers.

Id guess a fair number of Rad Oncs are on base + bonus and don't bonus. In that case, it doesn't affect them at all, unless the admin yells at them.

 

[Mandelin Rain]

Screw this Luks guy for basically saying what all the boomers that have been screwing the rest of us over. Yeah you got yours but you still won't retire and let us even attempt to fix things. Just F(*O(*&*(& it all up on the way out and DGAF.

I guess he's honest, though.

You didn't have to be screwing the system to be happy to have an exit ramp now.

I'd argue the "boomer" doctors (really Gen X at this point), were just living living the life doctors should expect. The fact that it eroded to this point has a lot to do with K-street lobbyists coupled with congressional greed, shunting health care dollars to hospitals, insurers, and pharma/med supply at the expense of physicians (and patients). Could argue that that the elder docs could've unionized or created strong lobbies themselves, but I don't see a big groundswell of such activity among the younger generations of docs either.

Inflation adjusted, I'd top-of-head-estimate rad oncs have taken about 75% salary reduction in the past 25 years. That's not all because these guys sold their practice on their way out the door (as everyone always did).

I'm not some boomer apologist, but I do think doctors need to stop quarreling with other doctors over the scraps. The fight is much larger than that.

 

[Mandelin Rain]

We stopped same day sim (except emergent) this year in preparation for this.

It's terrible, inconvenient care for all involved. But the lights do need to stay on.

 

[medgator]

We stopped same day sim (except emergent) this year in preparation for this.

It's terrible, inconvenient care for all involved. But the lights do need to stay on.

If you're freestanding you have to literally do it all. The cuts are so bad this year

 

[WildRivers]

The rule is that they pay 100% of the highest price code then cut the lower priced -25 codes by 50%.

It does not cut the wRVUs, so should not directly affect the vast majority of RO contracts. The impact will be through administrators forcing us to slow down patient care.

This is a silly way to save money and will ultimately just slow down care. Wonder if it will survive the comment period.

this depends if they change the value of the code when it's modified. if it gets pushed out as 0.5x then it will affect. if the RVU for the code remains the same, should be okay.

 

[cmw021]

RVU credit for -76 modifier for BID CBCTs (-50% on second of the day)

THIS IS A THING??? Had no idea.

 

[medgator]

THIS IS A THING??? Had no idea.

Great way to cut cost. One code a day fully paid for. Doing the right thing for the pt will cost you. No good deed goes unpunished, CMS policy consistent with that. Same goes for treating more than one site at the same time (one benefit to 77412 this year was getting paid more for 2 concurrent sites/isos)

 

[CaesarRO]

Have they ever bothered to give a rationale? What are they preventing by preventing same-day procedures? Otherwise it just seems like an unbridled cut

 

[NotMattSpraker]

Have they ever bothered to give a rationale? What are they preventing by preventing same-day procedures? Otherwise it just seems like an unbridled cut

Probably Dave Adler told someone it was important.