Medicare final rule confirms 24.9% reimbursement cut

November 18, 2010

Urologists and other physicians who treat Medicare patients will see a total reimbursement reduction of 24.9% in 2011 under the Medicare physician fee schedule, according to the recently released Centers for Medicare & Medicaid Services? final rule for 2011.

Urologists and other physicians who treat Medicare patients will see a total reimbursement reduction of 24.9% in 2011 under the Medicare physician fee schedule, according to the recently released Centers for Medicare & Medicaid Services’ final rule for 2011.

The reductions will apply to payments for services furnished on or after Jan. 1, 2011.Under the sustainable growth rate (SGR) formula, Medicare physician fee schedule rates are currently scheduled to be reduced on Dec. 1 (23%) and again on Jan. 1, 2011 (1.9%) for a total reduction of 24.9%. Although Congress has passed temporary measures preventing previous cuts dating back to 2003, CMS said in a statement that "a long-term solution is critical."

"Broad physician participation in Medicare is essential to ensuring that beneficiaries continue to have access to care, and physician engagement is critical to our efforts to strengthen the quality of care," said CMS administrator Donald Berwick, MD. "Medicare needs to be a strong, dependable partner with physicians, and that means the SGR must be fixed. The administration supports permanently reforming the Medicare payment formula."

In its statement, CMS said the final rule continues its recent efforts to improve the accuracy of Medicare physician fee schedule payment rates by implementing Patient Protection and Affordable Care Act mandates to identify and revise payment for misvalued services. It also addresses concerns about potential physician self-referral by requiring physicians who provide computed tomography, magnetic resonance imaging, or positron emission tomography scans in their own offices to notify patients that they may receive the same services from other suppliers in the area.

The final rule will appear in the Nov. 29, 2010 Federal Register. CMS will accept comments on certain aspects of the final rule until Jan. 3, 2011.