Reimbursement Cuts for Procedures Back on the Table Again

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Senior Member
15+ Year Member
Oct 18, 2004
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Copy of an e-mail I got from ASIPP today.

Things look pretty bleak and this is making me think long and hard about how new guys like me should structure their practice. Didn't we just send letters/e-mails/make calls a few months ago?

Is there any hope left?

It is a never-ending saga. Just when we thought we prevented 5% cuts for 2007, we are now faced with a more issues. With the new Congress and their "pay as you go" rule, it appears that we may not be able to resolve the issue. We may be looking at cuts of almost 10% next year unless we do something very radical. On top of this, we also have impending cuts for procedures performing in ASCs. These cuts will be substantial.

You may be wondering "why should I be interested in ASCs? I don't own an ASC." It is not an issue of whether you are an ASC owner or not, it is an issue of access and trends. Once the procedures are reimbursed at a lower rate in hospitals, this will spread to ASCs and then to office settings. So whether you are a surgery center owner or not YOU will eventually be affected.

Despite the fact that interventional pain management procedures represent only 15% of all ASC procedures and only 7% of payments, under the proposed rule, 10 of the top 11 procedures performed in an ASC will face a permanent reduction of 27% starting in 2009 (a total of 135% over a 5-year period). Even during the phase-in period of 2008, cuts will be approximately 12%.

While the proposed rule must be budget neutral and therefore adjust ASC payments in such a way that certain procedures will see an increase while others will be decreased, no other specialty will see across the board reductions as severe as those proposed for interventional pain management surgery centers. These cuts are not limited only to interventional pain physicians but also to centers that perform interventional pain procedures without any ownership of interventional pain physicians. This in turn could drive individuals who are seeking treatment for chronic pain to a more expensive and less convenient setting.

Once again we are at a crossroad. To resolve this issue, Honorable Frank Pallone and Honorable Ed Whitfield, both from the Energy and Commerce Committee have agreed to send a letter to CMS. We need this letter to be co-signed by many representatives. To achieve this goal, we need to mobilize at a grassroots level. Not only do we need you to send letters to your Representatives, but also it is imperative that you ask your colleagues, staff, friends, and patients to do the same.

We have made this easy for you. The following link will take you to the Capwiz site where you can effortlessly e-mail your representatives with this important message. If you prefer, you can send the letter on your personal or business letterhead. I urge you to do this as soon as possible and to encourage your colleagues to join in the effort.

Physician letter:

Patient letter:

Staff, family and friend letter:

In the Capwiz letter, we are asking your representative to sign onto this letter. At this time, it is only budget neutral, however, if this fails, we may be looking towards the introduction of a bill. It is essential that you act as soon as possible. In a few days, we will also be sending letters to the Senate. Right now, it is limited to only the House of Representatives.

Once this issue is resolved, our next issue is to work on physician payment cuts and resolve the issue once and for all. We have provided the letter which is proposed by Representatives Pallone and Whitfield for your information (see below).

Thank you again for all your help. If you have any questions, please feel free to contact me at 2831 Lone Oak Road , Paducah , KY 42003 , phone: 270-554-8373 ext. 101, fax: 270-554-8987, or e-mail: [email protected] .

Proposed Pallone-Whitfield Letter to CMS

Ms. Leslie Norwalk

Acting Administrator

U.S. Department of Health and Human Services

Centers for Medicare and Medicaid Services

200 Independence Avenue

Washington , D.C. 20201

Dear Ms. Norwalk:

We are writing to express our concern over proposed changes to the Ambulatory Surgical Center (ASC) payment system currently under review by your agency.

As you know, the Medicare Prescription Drug Improvement and Modernization Act of 2003 directed the Centers for Medicare and Medicaid Services (CMS) to implement a new ASC payment system to take effect no later than January 2008. It also directed the GAO to compare ASC and Hospital Outpatient Department (HOPD) payments. While we do not disagree with GAO's conclusion that ASC payments should reflect the lower cost of performing certain procedures in that setting as compared to an HOPD, we are concerned that the proposed rule will have a disproportionate effect on procedures used frequently by physicians practicing interventional pain management (IPM) procedures.

Despite the fact that IPM represents only 15% of all ASC procedures and even less for payments (7%), it is our understanding that under the proposed rule 10 of the top 11 procedures performed in an ASC will face a permanent reduction of approximately 27% starting in 2009 (135% over 5 years). Even during the phase-in period of 2008, cuts will be approximately 12%. While the proposed rule must be budget neutral and therefore adjusts ASC payments such that certain procedures will see an increase, while others will be decreased, other specialties will not see the type of severe across the board reductions.

Further, we are concerned that these reductions will have the effect of driving individuals who are seeking treatment for chronic pain to an HOPD which over the long term will drive up utilization in the that setting thereby increasing overall costs in the Medicare program. The rule could also have the effect of these procedures being performed in a physician office which is not properly certified or equipped to perform IPM.

As you work to complete the final rule, we ask that you re-evaluate the proposed rule's payment formula to ensure that Medicare beneficiaries suffering from pain will continue to receive high quality treatment in the ASC setting. Thank you for your consideration of our views and we look forward to hearing what steps CMS is taking on this issue.


Frank Pallone Ed Whitfield

Member of Congress Member of Congress