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September 2010
Policy and Advocacy
IDSA Urges Better Payments and Coverage for ID Services

Big changes are in store for physician payments, thanks to the Patient Protection and Affordable Care Act of 2010. The Centers for Medicare and Medicaid Services (CMS) have started implementing many of the law’s provisions in Medicare’s proposed physician fee schedule for 2011. IDSA is weighing in to ensure that ID physicians are appropriately paid and that key preventive services—such as immunizations and HIV testing—are covered.

In an Aug. 24 comment letter, IDSA once again urged Medicare to reverse its previous decision to eliminate payments for consultation codes—a decision that now seems unnecessary and ironic. IDSA believes it’s unnecessary, given that the new health reform law includes provisions to increase payments for primary care physicians (which was the justification for short-changing consultations). And it’s ironic because CMS is also adding coverage of follow-up inpatient telehealth consultations. (In a September e-mail, IDSA asked members to contact their Senators and ask them to sign onto a letter urging Medicare to reinstate the consultation codes. For more on IDSA’s position on consultation codes, see this June IDSA News article.)

The Society also urged CMS to work with Congress to reform the flawed Sustainable Growth Rate (SGR) payment formula, which—if not addressed—will result in a 30 percent payment cut for all physicians in 2011. At minimum, IDSA and other medical groups say, the SGR should be replaced by a formula that accounts for the actual annual increase in medical practice costs.

In addition, IDSA asked CMS to work with Congress to cover recommended vaccines under Medicare Part B (rather than Part D), because of the access, quality, and integrity concerns related to transporting Part D-covered vaccines from retail pharmacies to physicians’ offices for administration. This would add Part B coverage of vaccines for diphtheria, pertussis, herpes zoster, and tetanus.

Finally, IDSA urged CMS to exercise caution in tying physicians' payments to their performance (see related story).

For a PDF of IDSA’s extensive comment letter to CMS, click here:
IDSA Comments on the Proposed Rule of the 2011 Medicare Physician Fee Schedule (PFS)

For more on the proposed fee schedule, see the July/August issue of IDSA News.
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