The International Society for the Advancement of Spine Surgery, represented by President Luis Pimenta, MD, PhD, and Chair of Coding and Reimbursement Morgan O. Lorio, MD, recently wrote a letter to CMS Administrator Marilyn B. Tavenner commenting on the proposed changes to the Medicare Physician Fee Schedule for 2014.
The letter raises concern that the payment cap rates of more than 200 physician services at outpatient prospective payment system or ambulatory surgery center rates will adversely affect patient care.
ISASS details concerns including:
• 82 percent of the codes have direct expenses that exceed the proposed payment rate.
• Proposed reductions could reduce payment for some services by more than 50 percent, driving the services completely out of the physician office setting.
• At OPPS rates, 78 of the 211 services proposed for reduced payment will actually cost Medicare and patients more than the current MPFS rates.
• CMS automatically assumes OPPS rates are accurate, rather than implementing a data-driven process to determine payment caps.
• Physician reimbursement for kyphoplasty and vertebroplasty subject to the OPPS/ASC payment caps would experience 27 to 54 percent cuts.
• Such dramatic payments cuts would severely limit patient access to spine care.
ISASS calls for CMS to individually review MPFS values against OPPS rates and to make revisions based on code-specific data, rather than summarily capping rates.
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