Creation/Revision Date: January 03, 2011
January 3, 2011
Donald Berwick, MD
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Mail Stop C4-26-05
7500 Security Boulevard
Baltimore, MD 21244-1850
Subject: CMS-1503-FC Medicare Program; Revisions to Payment Policies Under the Physician Payment Schedule and Other Revisions to Part B for CY 2011; Final Rule
Dear Administrator Berwick:
The Renal Physicians Association (RPA) is the professional organization of nephrologists whose goals are to ensure optimal care under the highest standards of medical practice for patients with renal disease and related disorders. RPA acts as the national representative for physicians engaged in the study and management of patients with renal disease. RPA is writing to commend CMS on its decisions on two issues specific to kidney care, and to offer comments on the relative value units (RVUs) scheduled to be assigned to inpatient dialysis services as of January 1, 2012.
As noted, RPA is encouraged by the Agency’s decisions in two areas. First, the determination to allow Medicare contractors to waive the requirement for a monthly face-to-face visit to home dialysis patients on a case-by-case basis will provide sufficient flexibility to account for geographic hardship and patient absence from scheduled visits, while promoting the delivery of an appropriate standard of care to these patients. Additionally, CMS’ decision to add the procedure codes for both individual and group kidney disease education to the list of approved services under the telehealth services list will facilitate the ability of practitioners to provide those services.
On the RVU-specific issue, Addendum C of the final rule lists Codes with Interim RVUs Open for Comment, and four inpatient dialysis codes valued by the AMA’s Relative Value Update Committee (RUC) for implementation in the 2011 Fee Schedule (CPT codes 90935, 90937, 90945, and 90947) are included on this list. RPA is providing comments on the fully implemented practice expense RVUs for these codes scheduled to be implemented for 2012 and beyond.
From our perspective one of the purposes of the RUC’s review of the inpatient dialysis codes was to restore the relativity of these codes to the inpatient evaluation and management (E&M) services that are a typical component of these dialysis codes. As an example, in 2004 the value for CPT code 90935 was roughly equivalent to a level three subsequent hospital visit (CPT code 99233). Due in part to increases in the practice expenses for E&M codes over a several year period, by 2010 the total value for 90935 was less than that of a level two subsequent hospital visit (CPT code 99232). RPA surveyed nephrologists to determine the physician work and practice expense associated with providing inpatient dialysis services, presented its findings to the RUC in October 2009, and was pleased that the RUC acknowledged the validity of our concerns and partially restored the relative relationship of the inpatient dialysis codes to the inpatient E&M codes.
However, the fee schedule indicates that in 2012 the RVUs will fall for the inpatient dialysis codes and rise for CPT code 99232, the net result of which will be that the relativity between these codes will again be lost, and the most commonly used dialysis code, CPT code 90935 will be valued less than one of its component services. RPA strongly believes that the practice expenses for the inpatient dialysis codes should not be less than that for CPT code 99232, and we urge CMS to ensure that the relativity between the inpatient dialysis codes and their component E&M services is maintained.
As always, RPA welcomes the opportunity to work collaboratively with CMS in its efforts to improve the quality of care provided to the nation’s kidney patients, and we stand ready as a resource to CMS in its future endeavors. Any questions or comments regarding this correspondence should be directed to RPA’s Director of Public Policy, Rob Blaser, at 301-468-3515, or by email at firstname.lastname@example.org.
Edward R. Jones, M.D.