CMS Releases CY 2006 Physician Proposed Rule; Proposes Reduction in Payments for Physicians’ Services
On August 1, 2005, the Centers for Medicare and Medicaid Services (CMS) put on display its Notice of Proposed Rulemaking (NPRM) for the 2006 Physician Fee Schedule. The NPRM proposes several important changes to its payment policies that directly affect physicians.
- Conversion factor for physician payment rate per service is reduced by 4.3 percent.
- Transmittal adjustment for drug administration services that was 32% in 2004 and 3% in 2005 will be phased out in 2006.
- CMS seeks comments on what services appropriately fall within the scope of a dispensing fee for inhalation drugs and suggests that this fee will be lower than the current $57 per month.
- The proposed rule changes the supplying fee for certain oral Medicare Part B drugs to a rate consisting of $24 for the first prescription supplied during a month and $8 per prescription for any prescription, after the first one, supplied to a beneficiary during the same month by the same supplier.
- The proposed rule does not discuss the possibility of continuing the Demonstration of Improved Quality of Cancer Care for Cancer Patients Undergoing Chemotherapy other than including a 15 percent decrease in payments for hematology/oncology in the analysis of the impact on payments “as this demonstration project ends.” However, CMS’ press release indicates a desire to continue exploring ways to better capture data on the clinical care of patients with cancer, and also provide support for improvement in the provision of that care.
- Payments are reduced for certain diagnostic imaging procedures to reflect their limited additional costs when they are performed on contiguous body parts in the same session with the patient.
- CMS makes general statements in support of payment reforms that promote higher quality and avoid “unnecessary costs.”
The Association of Community Cancer Centers is currently conducting a complete analysis of the NPRM for the 2006 Physician Fee Schedule. The proposed rule will be published in the August 8, 2005 Federal Register. CMS will be accepting comments on the NPRM until September 30, 2005, and will publish a final rule later this year.
Don Jewler, Communications Director
