CMS update calls for cuts in physician payments, expansion of glaucoma screening coverage

WASHINGTON — Medicare payments to physicians will be cut by 4.3% in 2006 if a proposed rule released this month by the Centers for Medicare & Medicaid Services goes into effect.

The rule also calls for expanded Medicare coverage for glaucoma screening in Hispanic people, according to a press release from the CMS.

The proposed reduction in payment rates for physicians’ services is required because of “substantial growth in overall Medicare spending in 2004,” the CMS release said. The CMS will pay about $56.5 billion to some 875,000 physicians during 2006, according to the release.

The American Academy of Ophthalmology and other physician groups have repeatedly called for reform of the sustainable growth rate formula, or SGR, that is used by the CMS in calculating physician payment updates.

CMS Administrator Mark B. McClellan, MD, PhD, said in the release that his agency is working with Congress, physician organizations and other health care interests to improve physician payment without adding to overall Medicare costs.

The proposed rule provides for expanding the glaucoma-screening benefit to include Hispanic people at least 65 years old. Hispanics have been identified as a group at high risk for the development of glaucoma. Currently, the screening benefit is limited to people with diabetes, those with a family history of glaucoma and African-Americans over the age of 50.

Other provisions in the proposed rule include expanding the list of Medicare tele-health services to include certain medical nutrition therapy services; revising the methodology used to account for the costs of running a physician’s practice; refinements to the payment adjustments for the malpractice costs associated with specific services; and revising the list of health services to which physicians are prohibited from self-referring their patients.