11 December 2006

Good News, for Once

So it looks as if Congress (for better or worse) has passed the bill which would prevent the 5% cut in Medicare reimbursement to physicians. No action on fixing the SGR formula, but another band-aid. So, fine.

Where does this leave Emergency Medicine?

If you remember back a few months ago, ACEP won a major victory at the RVU Update Committee, in which the RVU values for ER docs (and many so-called 'cognitive' specialists) were increased, at the detriment of the procedure-based specialties. Of course, CMS giveth and CMS taketh away, and what with the fact that the budget neutrality clause required a 10% reduction in all RVU values and the proposed 5% medicare cut on top of that, nobody really knew what it meant. But now it's safe to say that we do. CMS did release its final rule not long ago, so we have the final RVU values for Emergency Medicine (if you follow the link, look on page 1021). Here are the updated RVU values:Let's look at a hypothetical busy practice in the Pacific Northwest. The case mix is as follows:

  • Level 1 -- 0.5%
  • Level 2 -- 5%
  • Level 3 -- 40%
  • Level 4 -- 34%
  • Level 5 -- 16%
  • Critical Care -- 4.5%
Based on the 2006 fee schedule this would yield a weighted average RVU value of 2.45 RVUs per "average patient." Based on the 2007 fee schedule this would yield an "average patient" worth 2.84 RVUs. That's a 16% increase. Since these six CPT codes account for 85-90% of EM revenue, that translates to about a 15% increase in total RVU production. If your contracts are based on the Medicare fee schedule, as all of ours are, that should result in an increase in revenue of that same 15%.

One of the tough things about Emergency Medicine, from a business perspective, is that it is not a growth industry. Your business is limited to what walks (rolls) through the front door. You can bill and code as well as you like, but you just can't really *grow* your business, and hence your revenue is pretty fixed. And you're always getting squeezed, by payors, by the government, by malpractice insurers, by the hospitals, and on and on. So to get a "raise," to get "free money," to get at least some tiny token to offset the huge burden we shoulder by seeing all society's castoffs and most vulnerable citizens, well, it's a huge pleasure. And I am going to savor it.

Don't say ACEP never does anything for you.

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