31 October 2008

But numbers are so boring!

I was browsing the Federal Register yesterday (I know, I know, don't we all?) and couldn't help but note that the 2009 Medicare Professional Fee Schedule had been formally issued.

Um, it's 1,459 pages of spine-tingling excitement!

But it kinda does matter. The most significant change this year is that CMS has changed its methodology slightly from the last couple of years. The 2007 and 2008 fee schedules were subject to a negative 10% "budget neutrality factor" adjustment due to the increase in the value of the E/M codes for cognitive services. CMS applied the BNF to the work RVUs. This year pursuant to the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS will apply the BNF to the conversion factor instead and leave the work RVUs intact. Also, remember that the MIPPA, passed so dramatically this summer, allows for a 1.1% increase in the CF come January.

So the MPFS CF for CY 2009 is (drum roll please!): $36.0666!

Some interesting numerology there, perhaps.

I you would like to know how your specialty will be impacted by this, scroll down to page 1045. I'll save you some time and effort: Emergency Medicine will see a net 4% increase in reimbursement. Internal medicine, family practice and pediatrics will see a 2% increase. Interestingly, surgery and thoracic surgery will see 3 and 2% increases, as well. Most everybody else is flat -- either not change or +/- 1%.

Emergency Medicine is particulary benefitted by this change because such a high percentage of the E/M RVUs are work RVUs, so our codes rise proportionately more than other specialties' do.

Here are the 2009 RVUs relevant to Emergency Medicine:

So only slightly changed from the prior values. If you're a wonk, there's lots more in there, including the history of the RVRBS and a detailed explanation of how codes are arrived at, how they are valued, and the recommendations from the RUC. I'll write more about this later, when I have had time to delve deeply into the document. Enjoy!


  1. I'm a second year med student and would like to know more about how reimbursements are calculated and such. Do you know of any good websites that provide intro material to the subject?


  2. Matt,

    There's a lot on this blog -- just search "reimbursement" and plenty will come up. If you are interested in a more basic level, there was a great article in Annals of EM a few years back, Volume 48, No. 4 : October 2006, pg 400-402, BILLING UNVEILED: CALCULATING THE VALUE OF EMERGENCY PHYSICIAN WORK
    Jan Green

    That's a great primer. I may write a general review article one of these days.

  3. This seems unnecessarily complex.


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