MORE good reimbursement news (+62% increase for Physics!)

[Gfunk6]

More good news! Source: AAPM mailing list

In the 2014 Medicare Physician Fee Schedule (MPFS) final rule released on November 27th, the Centers for Medicare and Medicaid Services (CMS) agreed with the AAPM recommendation to revalue CPT 77336 Continuing medical physics consultation and has increased reimbursement by 62% effective January 1, 2014. The MPFS specifies payment rates to physicians and other providers, including freestanding radiation therapy centers.

Medicare reimbursement for CPT 77336 began declining in 2007 and the AAPM Professional Economics Committee (PEC) made this is a key focus to increase payment. This procedure code was last reviewed by the Relative Value Scale Update Committee (RUC) for the 2003 Medicare rule. AAPM supported review and revaluation of the Continuing medical physics consultation code beginning in 2012. AAPM advised CMS that, "CPT code 77336 is misvalued because changes in the technique for rendering continuing medical physics consultations have resulted in changes to the knowledge required, time, and effort expended, and complexity of technology associated with the tasks performed by the qualified medical physicist and other staff."

AAPM worked with the American Society of Radiation Oncology (ASTRO) in preparing the clinical labor and medical equipment data submitted to the RUC in 2013. PEC Chair James Goodwin and PEC member Gerald White presented the recommendations to the RUC in April and met with key CMS officials in May to reinforce the recommendations and respond to any remaining issues of concern.

In the final rule, CMS accepted all of the recommendations submitted by AAPM without revision, which included increased qualified medical physicist time and updated medical equipment. The 2014 relative value unit is 2.09 with an estimated 2014 payment of $71.11. "This is a significant increase from the current Medicare reimbursement of $43.89," said PEC Chair Goodwin. "We were able to achieve a great win professionally for the AAPM membership."

It should be noted that the reimbursement for 77336 under the other major Medicare payment system, the Hospital Outpatient Prospective Payment System (HOPPS), is determined from past hospital claims data and is projected to be $114.65 for 2014.

A summary of the 2014 MPFS final rule will be posted to the AAPM website in the next few weeks at: [URL='http://www.aapm.org/government_affairs/CMS/2014HealthPolicyUpdate.asp[/quote']http://www.aapm.org/government_affairs/CMS/2014HealthPolicyUpdate.asp[/URL]

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[medgator]

It also sounds like the Medicare Payment Advisory Committee is recommending reducing and/or eliminating the disparity between freestanding and hospital-based payments:

On December 12, the Medicare Payment Advisory Committee (MedPAC) released recommendations supporting payment parity across sites of service. The recommendations to Congress included a proposal to reduce or eliminate differences in payment rates between outpatient departments and physician offices for selected ambulatory payment classifications (APCs), including radiation therapy, IMRT, and Level I drug administration.

The MedPAC June 2013 Report assessed the possibility of site-neutral payments for the 66 APCs, but yesterday was the first time that it was formally presented as a recommendation (that the Commission will then officially vote on in January). As you may recall, MedPAC's March 2013 Report recommended also recommended that payment rates for outpatient evaluation and management (E&M) office visits provided in hospital outpatient departments should be the same regardless of site of service.

Of the 66 APCs mentioned in this new recommendation, 24 APCs were listed as "Group One" in the appendix, the policy would reduce hospital payments all the way down to the physician office payment level, while hospital payments for the 42 APCs in "Group Two" would be reduced down below current levels, but would still remain higher than Medicare PFS payments, "narrowing the difference between HOPPS and Medicare PFS". Radiation therapy, IMRT and Level I drug administration among others were included in the Group Two recommendation.

 

[oncology2020]

can someone explain what the physics consultation is and how it works? does that money go to Rad onc physician or the physicist?

 

[Gfunk6]

Physics performs important QA on plans to ensure that they will be delivered precisely as planned. This includes up-front QA as well as weekly QA.

In most situations, Physicists are salaried and their reimbursement goes directly to the hospital or the practice (if physician-owned).