September 2010

• Observation Stay Legislation Introduced
• AMDA, AAFP, and AGS to Present Survey Recommendations for Nursing Facility Discharge Codes in September 2010

Observation Stay Legislation Introduced

On July 29, Representative Joe Courtney (D-CT) introduced the Improving Access to Medicare Coverage Act of 2010 (H.R. 5950), which counts observation status in a hospital exceeding 24 hours toward satisfying the 3-day inpatient hospital eligibility requirement for coverage of SNF services under Medicare. The proliferation of extended time in observation status also was the subject of Center for Medicare & Medicaid Services (CMS) Listening Session.

“My legislation will fix this unfair component of Medicare law that arbitrarily differentiates between patients on inpatient versus observation status with obtaining necessary skilled care. The Improving Access to Medicare Coverage Act will count a beneficiary's time on observation towards the three-day hospital stay requirement for skilled nursing care,” said Representative Courtney during the bills introduction.

AMDA’s policy is that the time spent in observation should be counted toward the eligibility requirement. AMDA will monitor the issue as it continues to gain momentum both in Congress and CMS.  Since the bill was introduced late in the 111th Congress, the bill may die when the session closes on October 9th.

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AMDA, AAFP, and AGS to Present Survey Recommendations for Nursing Facility Discharge Codes in September 2010

The Medicare statute requires the Centers for Medicare and Medicaid Services (CMS) to review the relative value units (RVUs) for physician work for all services paid under the Medicare Physician Fee Schedule (MPFS) no less often than every 5 years.  Accordingly, following initial implementation of the fee schedule in 1992, 5-year reviews were completed in1997, 2002 and 2007.  In the final rule for 2010 that was published in the Federal Register on November 25, 2009, CMS solicited comments on services for which the currently assigned work RVUs might be inappropriate. AMDA submitted a formal request that the nursing facility discharge codes (99315, 99316) be included as part of this fourth 5-year review. 

Following acceptance of our request by CMS, the American Academy of Family Physicians (AAFP), and the American Geriatrics Society (AGS) joined AMDA in conducting a required survey of practicing physicians this summer to obtain each physician’s estimates of the amount of physician work and time required to provide these services.  This survey asked physicians to compare the work, time, complexity and intensity of the nursing facility discharge codes to “reference” services which are comparable services for which the physician work and time are considered to be valued appropriately. 

The survey has been completed and the results are under review.  The survey results will serve as the basis for recommended work RVUs that will be submitted jointly by AMDA, AAFP and AGS to the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC). The RUC is a unique multi-specialty committee dedicated to making relative value recommendations to CMS for use in updating the MPFS.

AMDA RUC Advisor Dennis Stone, MD, MBA, CMD, AMDA RUC Alternate Advisor Charles Crecelius, MD, PhD, CMD, and AMDA Past President Eric Tangalos, MD, CMD, will join AAFP and AGS Advisors in co-presenting these survey results during the September 29 to October 3, 2010 RUC meeting, allowing enough time for codes to be considered with other Five-Year Review recommendations that will be submitted to CMS.

CMS will respond to the RUC recommendations in a proposed notice that CMS intends to publish in the Federal Register in the spring of 2011. In that rule, CMS will solicit comments from the public on the proposed valuation of the codes. CMS will publish the agency’s final decisions as part of the 2012 MPFS final rule. The changes would become effective January 1, 2012.

AMDA, AAFP and AGS joined in the effort to obtain appropriate physician work values during the last Five Year Review, the results of which were implemented in 2007 and 2008. AMDA successfully achieved new and revised nursing facility codes along with an increase in physician work values for the initial (99304-6) and subsequent visit codes (99307-9) along with values for the new subsequent visit code (99310) and the new annual assessment code (99318).

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