[Federal Register: January 27, 2006 (Volume 71, Number 18)]
[Notices]
[Page 4590-4591]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27ja06-59]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[CMS-1328-N]
Medicare Program; February 15, 2006 Town Hall Meeting on the
Practice Expense Methodology Including the Proposal From the Physician
Fee Schedule Proposed Rule for Calendar Year 2006
AGENCY: Centers for Medicare and Medicaid Services (CMS), HHS.
ACTION: Notice of meeting.
-----------------------------------------------------------------------
SUMMARY: This notice announces a Town Hall meeting on our methodology
for establishing practice expense (PE) values for services paid under
the physician fee schedule (PFS). The purpose of this meeting is to:
(1) Clarify our proposed revisions to the PE methodology contained in
the PFS calendar year (CY) 2006 proposed rule; and (2) receive comments
and opinions from individuals of the medical community regarding ideas
for the CY 2007 PFS proposed rule. This meeting is open to the public,
but attendance is limited to space available.
DATES: The Town Hall meeting is scheduled for Tuesday, February 15,
2006 from 1:30 p.m. to 4:30 p.m. e.s.t.
ADDRESSES: The Town Hall meeting will be held at the Centers for
Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore, MD
21244-1850 in the auditorium in the central building.
Meeting Registration: Persons wishing to attend this meeting must
register by contacting Debbie Cooley at Centers for Medicare & Medicaid
Services, 7500 Security Boulevard, Mail stop C4-03-06, Baltimore, MD
21244-1850, or, by FAX at 410-786-4490 to the attention of Debbie
Cooley. Please include the name of the attendee and the organization he
or she represents, if applicable. This information must be received by
5 p.m., e.s.t, on Friday, February 10, 2006.
This meeting will be held in a Federal Government building, the
Centers for Medicare and Medicaid Services; therefore, persons
attending this meeting will be required to show a government-issued
photo identification and a copy of their confirmation of registration
for the meeting. Access may be denied to persons without proper
identification. In planning your arrival time, we recommend allowing
additional time to clear security.
Security measures include: Inspection of vehicles, inside and out,
at the entrance to the grounds; passing through a metal detector; and,
the inspection of all items brought into the building. Laptops and
other computer equipment must be registered with the security desk upon
entry. Please note that CMS headquarters is a smoke-free complex.
FOR FURTHER INFORMATION CONTACT: Debbie Cooley, (410)786-0007 or
Dorothy Shannon, (410)786-3396.
SUPPLEMENTARY INFORMATION:
I. Background
Since January 1, 1992, Medicare has paid for services of physicians
and other practitioners under a physician fee schedule. This schedule
sets payment rates for 7,000 services based on the resources used to
provide those services and is updated annually. To construct the fee
schedule, we assign values called relative value units (RVUs) to each
service. The total RVUs for a service are the sum of the work RVUs
(which include the physician's time and effort); the practice expense
RVUs (which cover expenses such as overhead, staff, and supplies); and
the malpractice expense RVUs (which cover malpractice premiums).
In the CY 2006 PFS proposed rule (70 FR 45764), we outlined our
plans to revise the practice expense (PE) methodology. There were three
major parts to our proposal:
1. Changing from a ``top-down'' methodology for calculating direct
PE to a ``bottom-up'' approach. Currently, on a specialty-specific
basis, we derive a PE per physician hour from aggregate survey data,
create a cost pool using Medicare utilization data, and then allocate
the pool to all the services performed by the specialty. This
methodology is complex, often not intuitive, and produces some PE
values that can change significantly from year-to-year. The proposed
bottom-up approach would use the sum of the typical resource costs for
clinical staff, supplies, and equipment required for each service.
These typical costs for each service would be determined based
primarily on recommendations we reviewed and accepted from the American
Medical Association's Relative Value Update Committee (RUC). We would
then convert these costs into direct cost PE RVUs. We believe this
methodology is easier to understand and more intuitive than the current
top-down approach, and should also improve the stability of the PE RVUs
over time. In addition, because most of the inputs that would be used
in the bottom-up calculation have been approved by the multi-specialty
RUC, the medical community has already agreed to their accuracy.
2. Accepting the supplementary PE surveys from seven specialties--
allergy, dermatology, urology, gastrointestinal, cardiology, radiology,
and radiation oncology--and using these in the calculation of indirect
PE.
3. Calculating, on a code-specific basis, the higher of the current
portion of the PE RVU for indirect costs (the indirect PE RVU) or the
indirect PE RVU resulting from acceptance of the supplementary surveys.
This proposal was to have the effect of mitigating the
redistributive effects of accepting the seven supplementary surveys by
ensuring that, before application of PE budget neutrality, the indirect
PE RVUs for each service were
[[Page 4591]]
no lower than the current indirect PE RVUs.
In comments on the CY 2006 PFS proposed rule, commenters indicated
that they did not understand the mechanics of our proposals and that
there was not enough information for specialties to analyze them. Many
commenters requested a 1-year delay in implementation of our proposals
to allow time for CMS to provide further information and to give other
specialties an additional opportunity to submit their own supplementary
survey.
After reviewing the CY 2006 PFS proposed rule comments, we
determined that the proposal for revising the indirect PE was confusing
to the public because the published PE values and impacts were
incorrect. Therefore, in the CY 2006 PFS final rule (70 FR 70116), we
withdrew the proposed PE revision for 2006 and used the 2005 PE RVUs
for most services. The only exceptions were to price the codes that
were new in 2006 and, as required by the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA) (Pub. L 108-173), to
use the new urology PE data in the calculation of the drug
administration codes used by their specialty.
As we indicated when we issued the CY 2006 PFS final rule (70 FR
70116), we intend to work with the medical community to ensure that any
future proposals to change the PE methodology are understandable and
informed by input from the medical community. As the initial step in
this process, we are holding this Town Hall meeting to provide this
opportunity.
II. Meeting Format
This meeting will begin with an overview of the objectives of the
meeting along with an introduction of the topics to be discussed during
the meeting which include:
Clarifying our efforts to revise the PE methodology in the
CY 2006 PFS proposed rule which include:
+ The change from a ``top-down'' methodology for calculating direct
PE to a ``bottom-up'' approach utilizing the direct cost inputs;
+ The use of the accepted supplementary PE surveys from the seven
specialties in the calculation of indirect PE;
+ The intended method of obtaining the indirect PE values; and
+ The elimination of the nonphysician workpool and the related
impacts.
A question and answer session that offers the meeting
attendees an opportunity to clarify further the topics discussed.
Soliciting input from individual attendees on each facet
of our methodology: direct PE, indirect PE, supplementary surveys, and
nonphysician workpool. The comments provided during this meeting will
assist us in the preparation of the physician fee schedule proposed
rule for CY 2007.
To provide a basis of understanding before the meeting we will be
posting information concerning the PE methodology on our Web site at
http://www.cms.hhs.gov/PhysicianFeeSched/. This information will
include current PE values, examples for deriving PE values using the
bottom-up methodology, and projected impacts of these revisions. We
encourage individuals to familiarize themselves with this material
before the meeting. Copies of this information will be available on the
day of the meeting.
Authority
(Catalog of Federal Domestic Assistance Program No. 93.774,
Medicare--Supplementary Medical Insurance Program).
Dated: January 19, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 06-747 Filed 1-26-06; 8:45 am]
BILLING CODE 4120-01-P