While the relative value units (RVU) for emergency medicine codes increased slightly, the much-discussed cut to physician reimbursement mandated by the SGR formula (sustainable growth rate formula) was included in the rule and dictated a 21.2% decrease to overall physician reimbursement.

Each year since 2002, the SGR formula has yielded negative updates to Medicare’s reimbursement; and every year, Congress has stepped in to thwart the reduction. As global health care reform unfolds, stay tuned for timely updates on the ACEP Web site (www.ACEP.org) regarding the fate of physician reimbursement and other pressing reform issues.

Starting in 2010, Medicare has begun a transition to an alternate methodology for valuing the practice expense component of our payments, resulting in increased reimbursement for emergency medicine. The approximate 2% increase will be transitioned over a 4-year period and is based on the updated Physician Practice Inventory Survey (PPIS) data that ACEP helped fund.

See the accompanying table for a comparison of 2009 and 2010 Emergency Medicine RVUs.

Although emergency physicians don’t typically report consultations, it is worth noting that in 2010 CMS will no longer recognize the consultation codes. CMS is instructing providers to report those services using the office/other outpatient codes or initial hospital care codes, depending on the site of service. Emergency physicians likely won’t notice any direct impact on payment from this policy change, but it could factor into the availability of on-call specialists for ED consults.

In the area of electronic prescribing (E-Rx), bonuses that transition quickly to ongoing 2% penalties for those not performing E-Rx will continue in 2010. Because of the lack of direct physician control and the unique nature of emergency departments’ episodic and geographically varied patient population, CMS has elected to “carve out” the ED from the E-Rx program, and EDs will not be participating.

Physician Quality Reporting Initiative

CMS has currently published 153 PQRI measures, of which 9 potentially apply to the emergency department setting. The PQRI bonus for 2010 remains stable at 2%. As they become available, final specifications relating to the current year’s measures can be found on the Medicare Web site, www.cms.hhs.gov/pqri.

CMS has responded to physician concerns regarding difficulty obtaining PQRI reports. As a result, a new mechanism has been created to obtain PQRI feedback reports. Beginning in October 2009, individual physicians may call their respective Medicare carriers directly to obtain feedback reports based on their individual NPI numbers. A list of CMS contact centers can be found on the CMS Web site, www.cms.hhs.gov.