Fee Schedule Would Cut Audiology Rates: ASHA Leads Fight Against Proposed Reductions and Return of Medicare Caps

Abstract

You have accessThe ASHA LeaderBottom Line1 Sep 2005Fee Schedule Would Cut Audiology Rates: ASHA Leads Fight Against Proposed Reductions and Return of Medicare Caps Steven White, and Marat Moore Steven White Google Scholar More articles by this author and Marat Moore Google Scholar More articles by this author https://doi.org/10.1044/leader.BML2.10122005.1 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Audiology reimbursement could be cut by as much as 21% for certain procedures by 2009 if proposed changes in the 2006 Medicare Fee Schedule are approved. The Centers for Medicare and Medicaid Services (CMS) published the 2006 proposed rates in the Federal Register on Aug. 8, with an overall cut in 2006 payments of 4.3%. ASHA has intensified its efforts to come to agreement with CMS on a new reimbursement methodology that fairly values the professional expertise and judgment of audiologists and speech-language pathologists in its determination of levels of relative value payments. Public comments are due by Sept. 30, and ASHA will submit its objections in detailed comments. Opposition is also building in Congress, where several bills supported by ASHA already have been introduced to repeal the statutory formula used to determine the payment cut. It came as no surprise that CMS proposed ending the “non-physician work pool” (NPWP) in the reimbursement formula. CMS created the NPWP to protect the technical component services (including audiology and speech-language pathology) from “substantial decreases” until “further refinement” could take place. Without the NPWP, most audiology and speech-language pathology services would be relegated to the practice expense methodology used for all other procedures and would be vulnerable to payment cuts. Anticipating this change, three years ago ASHA’s Health Care Economics Committee began to research and present alternatives to CMS-focused on relocating the practice expense labor to the professional component (i.e., “physician work”) that would recognize the professional expertise and judgment of audiologists and SLPs. ASHA has proposed using survey data that ASHA can present to the American Medical Association’s Health Care Professional Advisory Committee (AMA HCPAC) to strengthen the case for the move to the “physician work” category. Under the current CMS proposal, however, the NPWP will be phased out over the next four years without a new reimbursement methodology to take its place-which means rates will not be protected against decreases that could hurt audiology in particular. According to Robert Fifer, an audiology member of the Health Care Economics Committee (HCEC), CMS has responded positively to ASHA’s request to work together to ensure that audiology and speech-language pathology as professional disciplines are not devastated by elimination of the NPWP. Fifer serves as ASHA’s advisor to the AMA HCPAC. Last December, Fifer and other committee members and ASHA staff met with CMS representatives to discuss what could happen if the NPWP were abolished without a reasonable reimbursement formula to take its place. CMS informed ASHA that rates would be negatively affected, “but would not tell us the extent of the payment cuts,” said Fifer, adding, “Now we know how serious the impact may be-a potential 21% cut by 2009 for audiology rates.” “Knowing the timetable and magnitude of the reimbursement impact, the HCEC will work very closely with both CMS and the AMA to find a reimbursement methodology that will alleviate, as much as possible, any long term negative effects of NPWP elimination,” he said. Proposed Rates CMS provided proposed relative value units for all procedures. The following are speech-language pathology and audiology procedures that have the most notable changes for 2006: Speech-language pathology: speech-language evaluation (+2 1/2%) swallowing treatment (+5%) clinical swallowing evaluation (-13%) motion fluoroscopic swallowing evaluation (-10%) Audiology: comprehensive audiometry (-5%) evoked otoacoustic emissions- limited (-13%) evoked otoacoustic emission-comprehensive (-9%). Medicare Caps The proposed rule also makes clear that without congressional intervention, the annual (per beneficiary) combined therapy cap for physical therapy and speech-language pathology services, and a separate occupational therapy cap will again be in effect at the beginning of 2006. CMS estimates that the value of the caps for 2006 will be $1,750. ASHA is actively working with Congress and other rehabilitation groups to repeal or modify the reintroduction of the caps. To access proposed rates, see the August 8, 2005 Federal Register. Author Notes Steven White, director of health care economics and advocacy, can be reached at [email protected]. Marat Moore, managing editor of The ASHA Leader, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 10Issue 12September 2005 Get Permissions Add to your Mendeley library History Published in print: Sep 1, 2005 Metrics Current downloads: 52 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2005 American Speech-Language-Hearing AssociationLoading ...