WASHINGTON – A new report issued Monday by the General Accountability Office says Medicare reimbursement to physicians should be trimmed to account for efficiencies that occur when a physician treats the same beneficiary on the same day for multiple services.
The GAO said the Centers for Medicare and Medicaid Services should take steps to ensure that physician fees reflect efficiencies occurring when services are commonly furnished together. For example, some resources required for the services may not need to be duplicated.
The GAO also said Congress should consider exempting any resulting savings from federal budget neutrality so that savings accrue to Medicare.
To create this report, GAO officials examined relevant policies, laws and regulations, interviewed CMS officials and others and analyzed claims data to identify opportunities for further savings.
Officials at the Department of Health and Human Services agreed with the GAO, saying the HHS plans to review physician Medicare services performed together. They also requested that the GAO include an appendix to the report listing specific services that would receive cuts.
The Obama administration and Congress are currently discussing proposals to change how physicians are paid under Medicare to ensure that they don't drop out of the program, leaving Medicare beneficiaries with fewer providers. The debate includes concerns over the costs of a revamping healthcare in America and looks for ways to cut costs from the Medicare program.
The American Medical Association has disagreed with the GAO's recommendation.
Under the budget neutrality requirement, savings from reductions in fees are redistributed by increasing fees for all other services. If Congress exempted the potential savings from the budget neutrality requirement, AMA officials said, physicians would see a pay cut. Physicians already face an estimated 21 percent pay cut in January, according to the AMA.
The CMS already has implemented a multiple procedure payment reduction (MPPR) policy for certain imaging and surgical services when two or more related services are furnished together, which resulted in a $96 million savings in 2006 for imaging services.
The GAO said the CMS program is limited because it doesn't apply to nonsurgical and nonimaging services commonly furnished together, nor does it take into account the physician work component. The new GAO report said the CMS could save an additional $175 million annually by expanding its MPPR policy.
