Changes

• CMS announced proposed Medicare Part B physician reimbursements changes for the 2010 calendar year. The principal change is that physician administered drug costs will be pulled out of the RBRVS reimbursement (I'm not sure how those expenses will be reimbursed). According to the Hill, While legislation is needed to prevent a [Medicare] cut [in Part B physician reimbursement] in next year’s rates, "the Medicare agency notes that excluding the cost of drugs from the payment formula would 'reduce the number of years in which physicians are projected to experience a negative rate.'" Primary care physicians will be paid six to eight percent more but specialists will be paid less. Medicare also would pay less for imaging services provided in a doctor's office. The battle lines have been drawn. The Wall Street Journal reports that

  Ted Epperly, president of the American Academy of Family Physicians, said the Medicare proposal would help reduce the income gap among doctors -- specialists make two to five times as much as primary-care physicians -- and attract more medical students to primary care. He called the change "long overdue."
  
  Groups representing cardiologists, radiologists and other specialists said they will lobby lawmakers to stop the cuts. Dr. Bove warned that "cutting back like this certainly threatens the successes we have had over the years with reducing heart disease."

• CMS also proposed 2010 changes to its hospital outpatient care prospective payment system and to its Physician Quality Improvement Program and e-prescribing initiative. CMS is accepting public comment on all of these proposed changes until August 31, 2009, and it intends to publish final rules by November 30, 2009.

• In May, the American Medical Association expressed concern about the creation of a public option. Today, its new president, J. James Rohack, according to CNN, "suggested Wednesday that the Federal Employee Health Benefit Program available to Congress members and other federal employees could be expanded as a public option. That would avoid having to create a new program from scratch, he said." However, the FEHBP is not a public program like Medicaid; it's a well managed employee benefit program for federal and postal employees and annuitants. The FEHBP certainly could be a model for a health insurance exchange but opening the FEHBP to all comers would be harmful to the Program and the people it serves.