2006 proposed fee schedule - American Society of Clinical Oncology
2006 proposed fee schedule - American Society of Clinical Oncology 2006 proposed fee schedule - American Society of Clinical Oncology
Allergy, Asthma, and Immunology (JCAAI), the National Coalition of Quality Diagnostic Imaging Services (NCQDIS) and a joint survey from the American Gastroenterological Association (AGA), the American Society of Gastrointestinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG) We contract with the Lewin Group to evaluate whether the supplemental survey data that are submitted meet our criteria and to make recommendations to us regarding their suitability for use in calculating PE RVUs. (The Lewin Group report on the 2005 submissions is available on the CMS web site at http://www.cms.hhs.gov/physicians/pfs/). The report indicated that, except for the survey from NCQDIS, all met our criteria and we are proposing to accept these. The survey data submitted by the NCQDIS on independent diagnostic testing facilities (IDTFs) did not meet the precision criterion of a 90 percent confidence interval with a range of plus or minus 15 percent of the mean (that is, 1.645 times the standard error of the mean, divided by the mean, is equal to or less than 15 percent of the mean). For the NCQDIS survey, the precision level was calculated at 16.3 percent of the mean PE/HR (weighted by the number of physicians in the practice). However, the Lewin Group has recommended that we accept the data from NCQDIS. The Lewin Group points out that PE data for IDTFs do not currently 50
exist, and suggests that the need for data for the specialty should be weighed against the precision requirement. We are proposing not to accept the NCQDIS data to calculate the PE RVUs for services provided by IDTFs. As just noted, the NCQDIS data do not meet our precision requirements. We established the minimum precision standards because we believe it is necessary to ensure that the data used are valid and reliable, and the consistent application of the precision criteria is the best way to accomplish that objective. Section 303(a)(1) of the MMA added section 1848(c)(2)(I) of the Act to require us to use survey data submitted by a specialty group where at least 40 percent of the specialty’s payments for Part B services are attributable to the administration of drugs in 2002 to adjust PE RVUs for drug administration services. The statute applies to surveys that include expenses for the administration of drugs and biologicals, and are received by March 1, 2005 for determining the CY 2006 PE RVUs. Section 303(a)(1) of the MMA also amended section 1848(c)(2)(B)(iv)(II) of the Act to provide an exemption from budget neutrality for any additional expenditures resulting from the use of these surveys. In the Changes to Medicare Payment for Drugs and Physician Fee Schedule Payments for Calendar Year 2004 interim final rule published 51
- Page 1 and 2: DEPARTMENT OF HEALTH AND HUMAN SERV
- Page 3 and 4: 2. By mail. You may mail written co
- Page 5 and 6: Rick Ensor (410) 786-5617 (for issu
- Page 7 and 8: service of the U.S. Government Prin
- Page 9 and 10: 4. Proposed Revisions to §413.170
- Page 11 and 12: AGA American Gastroenterological As
- Page 13 and 14: GAO General Accounting Office GPCI
- Page 15 and 16: PLI Professional liability insuranc
- Page 17 and 18: Initially, only the physician work
- Page 19 and 20: This resource-based system was base
- Page 21 and 22: effect in 1997, published on Novemb
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- Page 29 and 30: November 1, 2001 (66 FR 55246).) Th
- Page 31 and 32: The CPEPs identified specific input
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- Page 35 and 36: procedure: $27,305,408. In this exa
- Page 37 and 38: as a whole. Indirect costs include
- Page 39 and 40: ● The unscaled indirect expense a
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- Page 61 and 62: multi-specialty PEAC that were base
- Page 63 and 64: the needed survey or other data or
- Page 65 and 66: PERC/RUC recommendations for these
- Page 67 and 68: eflect the typical number of cast c
- Page 69 and 70: on comments received and additional
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- Page 87 and 88: Effective January 1, 2006, this pro
- Page 89 and 90: challenge the validity of a new loc
- Page 91 and 92: ones reconfigured). Yet we also rec
- Page 93 and 94: The issue of payment locality desig
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Allergy, Asthma, and Immunology (JCAAI), the National<br />
Coalition <strong>of</strong> Quality Diagnostic Imaging Services (NCQDIS)<br />
and a joint survey from the <strong>American</strong> Gastroenterological<br />
Association (AGA), the <strong>American</strong> <strong>Society</strong> <strong>of</strong> Gastrointestinal<br />
Endoscopy (ASGE) and the <strong>American</strong> College <strong>of</strong><br />
Gastroenterology (ACG)<br />
We contract with the Lewin Group to evaluate whether<br />
the supplemental survey data that are submitted meet our<br />
criteria and to make recommendations to us regarding their<br />
suitability for use in calculating PE RVUs. (The Lewin<br />
Group report on the 2005 submissions is available on the CMS<br />
web site at http://www.cms.hhs.gov/physicians/pfs/). The<br />
report indicated that, except for the survey from NCQDIS,<br />
all met our criteria and we are proposing to accept these.<br />
The survey data submitted by the NCQDIS on independent<br />
diagnostic testing facilities (IDTFs) did not meet the<br />
precision criterion <strong>of</strong> a 90 percent confidence interval with<br />
a range <strong>of</strong> plus or minus 15 percent <strong>of</strong> the mean (that is,<br />
1.645 times the standard error <strong>of</strong> the mean, divided by the<br />
mean, is equal to or less than 15 percent <strong>of</strong> the mean). For<br />
the NCQDIS survey, the precision level was calculated at<br />
16.3 percent <strong>of</strong> the mean PE/HR (weighted by the number <strong>of</strong><br />
physicians in the practice). However, the Lewin Group has<br />
recommended that we accept the data from NCQDIS. The Lewin<br />
Group points out that PE data for IDTFs do not currently<br />
50
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