CMS Proposes Changes to Physician Fee Schedule

CMS Proposes Changes to Physician Fee Schedule, from ACEP / EM Today

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rule making that concerns changes to the Medicare Physician Fee Schedule for 2007, including a revision of physician work Relative Value Units (RVUs) that could mean an increase in emergency physician reimbursement for providing Evaluation and Management (E/M) services.

Although the values published in the proposed rule will not be final until the comment period ends and the final rule for the 2007 Medicare Fee Schedule is published in late fall, work RVUs for emergency department E/M codes should have significant increases. The actual financial impact for each member will depend on several factors such as patient volume, payer mix, service mix, and frequency distribution. The combination of these factors can have a significant impact on the total annual Medicare payment in the ED.

Family Presence in ED Resuscitations Video

Hospitals are allowing loved ones into the ER, even when the going gets rough. CNN’s Tom Foreman reports.

Doctors’ Average Pay Fell 7% in 8 Years, Report Says

From the NY Times, via Symtym:

The Dr. Smiths are having trouble keeping up with the Mr. Joneses.

A report planned for release today indicates that the average physician’s net income declined 7 percent from 1995 to 2003, after adjusting for inflation, while incomes of lawyers and other professionals rose by 7 percent during the period.

The researchers who prepared the report say the decline in doctors’ inflation-adjusted incomes appears to be affecting the types of medicine they choose to practice and the way they practice it — resulting in fewer primary care doctors and a tendency to order more revenue-generating diagnostic tests and procedures.

Primary care doctors, who are already among the lowest-paid physicians, had the steepest decline in their inflation-adjusted earnings — a 10 percent drop — according to the report by the Center for Studying Health System Change, a nonprofit research group in Washington.

The average reported net income for a primary care physician in 2003 was $146,405, according to the study, after expenses like malpractice insurance but before taxes. The highest-paid doctors were surgeons who specialize in areas like orthopedics, who had an average net income of $271,652, nearly double what the primary care doctors said they earned.

The report was based on a national telephone survey of roughly 6,600 physicians in 2004 and 2005 and earlier surveys by the research center. “These are large enough changes that physicians are responding,” said Paul B. Ginsburg, the center’s president and a health economist.

Doctors, he said, are reacting to the financial incentives under the current payment system by choosing to specialize and work in fields where they can increase their income by providing more services, like diagnostic tests or procedures, he said.

Dr. Cecil B. Wilson, the chairman of the board of the American Medical Association, said that for practicing physicians the survey “confirms what they already know from their own practices: payments are not keeping up with inflation.

Physicians barred from using cursive to write prescriptions

From the Seattle Post-Intelligencer, via Symtym:

Physicians, heal thy handwriting.

On June 7, a new law went into effect that could paralyze the penmanship-impaired. It says that if a prescription isn’t hand-printed, typed or electronically generated, it can’t be filled, Jeff Smith of the state Health Department explained.

Cursive is illegal.

Dr. Richard Goss, medical director of quality improvement at Harborview Medical Center, said he is in favor of the bill because his own handwriting is hard to read.

“One of the comic strips on my office wall is a physician’s guide to the alphabet,” he said. “Each letter is illegible.”

Goss said his handwriting probably was readable when he was in junior high, but it went downhill from there. Years of fast handwriting and note-taking took their toll.

As a result, he’s been forced to slow down when he writes prescriptions, print carefully, read them over and make sure someone else can read them. He also double-checks figures.

If physicians, veterinarians and other prescription writers want to assign blame for this bill, Dr. William Robertson of the Washington Poison Center is willing to accept it.

Robertson said it’s taken him 27 years to make scrawled prescriptions illegal. Lots of doctors are opposed to this, but it will save drug errors, he said.

Increased CMS Payments for Emergency Medicine

From ACEP:

American College of Emergency Physicians is proud to announce that the Centers for Medicare and Medicaid Services will increase payments for emergency medicine Evaluation and Management codes beginning in January 2007.

According to a proposed notice released by CMS this week, the Relative Value Units for emergency medicine E/M codes will increase from 8.1% to 60%, or about 25% across the board. The actual financial impact for each ACEP member will depend on several factors, including patient volume, payer mix, and frequency distribution.

You can calculate the impact these increases will have on your payments by going to We have created an interactive calculator that will allow you to see what you can expect to be reimbursed in 2007.

US hospitals sued in class action over nurse pay

From Reuters:

Nurses backed by the biggest U.S. health-care union on Tuesday filed four class-action lawsuits against some of the biggest U.S. hospitals, including No. 1 chain HCA Inc., claiming they conspired to depress wages for nurses amid a national shortage.

The lawsuits, which also target the biggest U.S. Catholic hospital system, Ascension Health, charge the hospitals regularly discussed nurses’ wages in meetings, over the telephone and in written surveys, in an effort to coordinate and suppress pay.

The suits, filed in federal courts in Chicago; Memphis, Tennessee; Albany, New York; and San Antonio, Texas, seek back compensation and legal costs totaling “hundreds of millions of dollars” under federal antitrust laws.

Reasons for Being Admitted to the Hospital through the Emergency Department, 2003

More HCUP Highlights, from Statistical Briefing #2

Circulatory disorders (diseases of the heart and blood vessels) were the most frequent reason for admission to the hospital through the ED, accounting for 26.3 percent of all such admissions; injuries accounted for 11.4 percent.

The top 20 specific conditions accounted for more than half of all hospital admissions through the ED, with pneumonia as the single most common specific condition at nearly one million (5.7 percent) of all such admissions.

Complications of procedures, devices, implants, and grafts ranked as the ninth most common reason for admission through the ED and included postoperative infections, malfunction of orthopedic devices, and infection of arteriovenous fistulas used for dialysis.

The top 20 specific conditions admitted through the ED included several chronic conditions: chronic obstructive lung disease, asthma, diabetes, and mood disorders. Also included were fluid and electrolyte disorders; urinary, skin, and blood infections; gall bladder disease, gastrointestinal bleeding, and appendicitis; and hip fracture.

While up to 82 percent of the most frequent acute conditions were admitted through the ED, a large percentage of chronic conditions were also admitted through the ED; for example, 72 percent of cases with conestive heart failure, chronic obstructive lung disease, and asthma were such admissions.