The Centers for Medicare and Medicaid Services (CMS) issued the Medicare Physician Fee Schedule Final Rule on Nov. 2, 2010, which implements aspects of the Patient Protection and Affordable Care Act of 2010, as well as the Health Care and Education Reconciliation Act.

Additionally, the 2011 Medicare Physician Fee Schedule Final Rule updates payment rates for physician services beginning with dates of service from Jan. 1, 2011, and contains a significant decrease in physician rates with a Medicare conversion factor (Medicare’s reimbursement per relative-value unit [RVU]) of $25.5217, representing a 30% cut to current rates.

Emergency physicians entered 2010 facing a 21.6% decrease to the conversion factor. What followed were a series of small congressional “patches” that forestalled the severe cuts for only several months at a time, creating great physician uncertainty. On Dec. 19, 2009, Congress passed, via the Department of Defense Appropriations Act, a 2-month freeze to the Medicare Physician Fee Schedule effective from Jan. 1, 2010, through Feb. 28, 2010, thus preserving physician reimbursement at current levels and saving us from the 21% cut.

Two additional patches (including the March 2 Temporary Extension Act of 2010 and the April 15 2010 Continuing Extension Act) extended relief from the impending significant reduction through May 31, 2010. Emergency physicians then received a small increase through the June 25 Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act, which provided for a 2.2% increase to the conversion factor effective for dates of service from June 1, 2010, through Nov. 30, 2010; the conversion factor for services furnished during this time period was $36.8729.

On Dec. 15, President Obama signed a 1-year pay fix into law. The law will eliminate the scheduled deep fee-schedule cut and instead keep Medicare physician fees at their current rate throughout 2011. The American Medical Association praised Congress and the President for averting the Medicare cuts and giving the program some stability by passing a 1-year fix, as opposed to the short-term approach Congress took throughout 2010.

Several other factors will impact emergency physician reimbursement for 2011. Adjustments to the Medicare Economic Index (MEI) related to changing the base year from 2000 to 2006 have been updated to reflect changes in prices of goods and services physicians purchase to run their practices and will have a negative impact on emergency medicine of roughly 3%. Practice expense values for 2011 represent year 2 of a 4-year transition to the new practice expense survey data, which will contribute a 0.5% increase to emergency department reimbursement.