Emergency medicine will see a very small decrease in our overall RVU values

On Nov. 1, 2011, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule Final Rule, which addresses changes to the physician fee schedule, as well as other important Medicare part B payment policies. The rule is effective beginning Jan. 1, 2012, and is published in the Nov. 28, 2011, issue of the Federal Register.

The 2012 Conversion Factor

The year 2011 ended with a Medicare conversion factor (the Medicare payment per relative value unit [RVU]) of $33.9764. The dreaded Sustainable Growth Rate (SGR) formula remains on the books, and with the expiration of the latest congressional “patch” on Feb. 29, 2012 (as of press time), the 2012 Final Rule published a conversion factor of $24.6712, representing a 27.4% cut to physician payments. With a familiar chorus of physician pleading ringing in their ears, members of Congress staved off our execution each year since 2003 with a variety of short-term patches.

emergency medicine will experience a –1% update to our overall rvu values in 2012.

Emergency Department RVUs

According to the CMS specialty-specific impact analysis, emergency medicine will see a very small decrease in our overall RVU values. As published in the 2012 rule, emergency medicine will experience a –1% update to our overall RVU values in 2012. This is independent of any change to the conversion factor.

The RVUs for our major reimbursement drivers, the E/M codes, have only second decimal point adjustments, predominantly because of small changes in practice expense. Of note, the work RVUs have not changed for 2012 and remain stable at 2011 levels (Table 1).

Other services frequently provided by emergency physicians have also had their RVUs adjusted by the 2012 rule. For 2012, the Initial and Subsequent Observation Codes will see large gains (Tables 2 and 3).

Additionally, the RVUs for many emergency department procedures were impacted by the 2012 rule. CPR will see a roughly 5% increase, while the code for complex abscess drainage – a common ED procedure – will increase by almost 9%. The laceration codes were a mixed bag. Many of the superficial laceration codes were decreased slightly and a few of the intermediate codes were increased.

For a detailed analysis of the impact of the 2012 RVUs on key emergency department procedures, visit the ACEP website at www.acep.org and click on the reimbursement link.

Telehealth Expansion Includes Emergency Department Services

Telehealth services are expanding, in part because of the CMS vision of promoting greater integration of the health care delivery system, and now include the emergency department as a qualified site.