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CMS-1403-FC
● Develop a refinement method to be used during the
transition.
● Consider, in the course of notice and comment
rulemaking, impact projections that compare new proposed
payment amounts to data on actual physician PE.
In CY 1999, we began the 4-year transition to
resource-based PE RVUs utilizing a “top-down” methodology
whereby we allocated aggregate specialty-specific practice
costs to individual procedures. The specialty-specific PEs
were derived from the American Medical Association’s (AMA’s)
Socioeconomic Monitoring Survey (SMS). In addition, under
section 212 of the BBRA, we established a process extending
through March 2005 to supplement the SMS data with data
submitted by a specialty. The aggregate PEs for a given
specialty were then allocated to the services furnished by
that specialty on the basis of the direct input data (that
is, the staff time, equipment, and supplies) and work RVUs
assigned to each CPT code.
For CY 2007, we implemented a new methodology for
calculating PE RVUs. Under this new methodology, we use the
same data sources for calculating PE, but instead of using
the “top-down” approach to calculate the direct PE RVUs,
under which the aggregate direct and indirect costs for each
specialty are allocated to each individual service, we now
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