Medicare physician payment rules for 2011: a primer for the neurointerventionalist
- 1Pain Management Center of Paducah, Paducah, Kentucky, USA
- 2Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA
- 3Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- 4Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Correspondence to Dr L Manchikanti, Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, KY 42003, USA;
- Received 2 February 2011
- Accepted 3 February 2011
- Published Online First 22 March 2011
Physicians generally have been affected by significant changes in the patterns of medical practice evolving over the past several decades. The Patient Protection and Affordable Care Act of 2010, also called ACA for short, impacts physician professional practice dramatically. Physicians are paid in the USA for their personal services. The payment system is highly variable in the private insurance market; however, governmental systems have a formula based payment, mostly based on the Medicare payment system. Physician services are billed under part B. The Neurointerventional practice is typically performed in a hospital setting. The VA system is a frequently cited successful implementation of a government supported health care program. Availability of neurointerventional services at many VA medical centers is limited. Since the inception of the Medicare program in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. Initially, the payment systems compensated physicians on the basis of their charges. In 1975, just over 10 years after the inception of the Medicare program, payments changed so as not to exceed the increase in medical economic index. The involvement of medical economic index failed to curb increases in costs, leading to the determination of a yearly change in fees by legislation from 1984 to 1991. In 1992, the fee schedule essentially replaced the prior payment system that was based on the physician's charges, which also failed to curb the growth in spending. Thus, in 1998, the sustainable growth rate system was introduced. In 2009, multiple unsuccessful attempts were made by Congress to repeal the formula. The mechanism of the sustainable growth rate includes three components that are incorporated into a statutory formula: expenditure targets, growth rate period and annual adjustments of payment rates for physician services.
The manuscript is a brief version of Medicare Physician Payment Systems: Impact of 2011 Schedule on Interventional Pain Management published in Pain Physician 2011;14:E5–33. This version is published with the consent of all of the authors and the permission of the journal Pain Physician.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.