Reductions in Medicare reimbursement slated for 2008

Dermatologists once again find themselves at the mercy of the politicians in Washington, facing significant reductions in Medicare reimbursement for 2008, unless Congress once again comes to the rescue - and President Bush signs whatever legislation is passed.

For many dermatologists, though, the issue goes beyond the average 10.1 percent fee schedule cut confronting all physicians unless a solution is found, because the rule published by the Centers for Medicare & Medicaid (CMS) containing the cut also removes the long-standing Multiple Procedure Reduction Rule exemption for Mohs surgical procedures.

At press time, lobbyists for physicians, including dermatologists, were negotiating with members of the Senate Finance Committee attempting to secure a deal similar to legislation approved in the House of Representatives that would rescind that huge cut and replace it with positive 0.5 percent updates in 2008 and 2009.

According to comments filed with CMS in August objecting to the decision to remove the specific exemption accorded to the Mohs micrographic surgery codes in 1992, the action "will unduly impact not only those Medicare beneficiaries who have or will be diagnosed with skin cancer, but also those surgical dermatologists who provide these services."

The letter, signed by all four organizations in the Mohs Coalition, states the agency failed to articulate adequate justification for its action and says CMS "has long recognized that there are no efficiencies inherent in these procedures when performed together."

The coalition says the factors cited by CMS as the reason for removal of the exemption are the same factors it previously used to justify the exemption.

"We believe this proposal will negatively impact Medicare beneficiaries' access to timely and quality care, and application of the Multiple Procedure Reduction Rule will not likely generate significant cost savings and may paradoxically increase the cost of providing care to these patients," the letter says.

The issue of dealing with the overall fee schedule issue was one involving politics, time and money. The House rollback was contained in H.R. 3162, the Children's Health and Medicare Protection Act of 2007 (CHAMP), but many senators were reluctant to couple a Medicare physicians' fee fix with children's health legislation, and President Bush already vetoed an earlier version of the children's health insurance bill.

Legislative issues

Congress was swamped with legislative issues that needed to be resolved before adjournment for the year, and those House-passed changes would cost $1.4 billion over the next five years. Congressional rules require that those losses must be made up.

All of that combined to create a sizable stumbling block, which made finding a workable and politically feasible solution for the fee schedule cut difficult.

In past years, Medicare reimbursement cuts have been ordered by the Centers for Medicare & Medicaid (CMS) as required by law, only to have Congress step in later and reverse its action. In 2007, CMS had to establish a mechanism to restore reimbursement to physicians who lost money from cuts ordered last year that were rescinded by Congress early this year.

AADA is part of a coalition of specialty societies, the Alliance for Specialty Medicine, which has been working with the American Medical Association (AMA) and other groups to work out a deal with the Senate Finance Committee. An Alliance source tells Dermatology Times that she is still "hopeful" a solution can be worked out.

Not only were they trying to reverse the 10.1 percent cut ordered by CMS and replace it with a modest increase, the physicians' groups were also asking Congress to dedicate new funding to the update "rather than the same old funding gimmicks" that they say only make the problem worse as the years go on.