Coalition Launches New Drive To Ensure Fair Physician Practice Expense Payments

Main Category: Public Health
Article Date: 11 Dec 2009 - 0:00 PDT

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A coalition of 19 major medical and health care organizations announced a new grassroots and advertising campaign to ensure that the Center for Medicare and Medicaid Services (CMS) can begin its careful and reasoned implementation of up-to-date practice expense rates into its Medicare physician payments without unnecessary intervention by Congress. The Practice Expense Equity Coalition supports the new practice expense rates recently issued by CMS, which use accurate data from a rigorous survey supported by more than 70 medical and health care professional groups and recognize that overhead costs differ among physician and health care specialties. The rates rely upon data that was independently corroborated by a respected third-party survey firm.

"The CMS decision is the right one because it levels the playing field by using sound data gathered from all parts of medicine and health care at the same time," said David W. Parke II, MD, CEO of the American Academy of Ophthalmology, which is a member of the coalition. "The new rates are based upon strong, scientifically valid evidence to determine fair and accurate physician practice expense rates."

"Previously, CMS had been using practice cost data for most physicians and health care professionals that was at least a decade old and failed to capture the relative costs faced by different practices today," said Helene Fearon, PT, spokesperson for the American Physical Therapy Association. "If any changes were to be made to the new 2010 rates, it would favor a few groups at the expense of many other physicians and health care professionals. We are hopeful that Congress will realize that rates based on robust, independently corroborated data should not be second-guessed at this stage of the process."

The latest practice expense data is based on a new Physician Practice Information Survey (PPIS) conducted in 2008 under strict methodology as outlined by CMS. The results were validated by The Lewin Group, an independent survey firm. CMS will phase in the new practice expense data over a four-year period. In their own words from the rule, CMS calls PPIS "the most comprehensive, multispecialty, contemporaneous, consistently collected PE data source available." The data does not by itself result in more payments to physicians, but an equitable redistribution of the payment pool based in part on the practice expense data.

The survey design and methodology had the wide support of medicine and other health care professional groups, including funding from CMS and the AMA. Medical and health care groups were not alone in calling for new practice expense data. The Medicare Payment Advisory Commission and the Government Accounting Office had called for CMS to update data for all specialties.

The coalition members are:

- American Academy of Dermatology Association
- American Academy of Family Physicians
- American Academy of Neurology Professional Association
- American Academy of Ophthalmology
- American Academy of Otolaryngology - Head and Neck Surgery
- American Association of Neurological Surgeons
- American Association of Orthopaedic Surgeons
- American College of Emergency Physicians
- American College of Obstetricians and Gynecologists
- American College of Surgeons
- American Occupational Therapy Association
- American Optometric Association
- American Physical Therapy Association
- American Psychiatric Association
- American Society of Anesthesiologists
- American Society of Cataract and Refractive Surgery
- American Society of Plastic Surgeons
- Congress of Neurological Surgeons
- Infectious Diseases Society of America

Source
American Academy of Ophthalmology

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