HCR: Physicians Get Geographic Pay Raises
Physicians in 42 states and territories stand to benefit from revisions to the geographic adjustments made in calculating payments for their services over the next two years, according to the American Medical Association (AMA). The revisions are a provision in the Patient Protection and Affordable Care Act (health reform bill), enacted March 23.
For 2010, the law reinstates a floor of 1.00 on the work geographic practice cost indices (GPCI) that expired Dec. 31, 2009. In 2010 and 2011, Medicare will increase the practice expense (PE) GPCI in all payment localities that have a PE GPCI below 1.00. Beginning in 2011, the PE GPCI will increase to 1.00 in five states: Montana, North Dakota, South Dakota, Utah, and Wyoming.
The impact of the revised geographic adjustments on individual physicians will vary by state and by service, but the AMA estimates the following increases for two services provided by physicians in Alabama (assuming no change in the fee schedule conversion factor) is an indication of what to expect nationwide:
- Payment for a mid-level established patient office visit (CPT® 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 3 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity) will increase by 4.6 percent, from $59.89 to $62.66.
- Payment for a laparoscopic inguinal hernia repair (CPT® 49650 Laparoscopy, surgical; repair initial inguinal hernia) will increase by 3.9 percent, from $355.03 to $368.93.
The AMA created a table estimating how much average payment rates will increase in each locality.