Posts tagged with gpci

First, I have to be clear: my knowledge of the arcane RBRVS system, the RUC committees, CMS, etc., is all driven by my work for pediatricians. Thus, I have a very skewed view of how it works. Almost all of the changes to the CMS budget affect my clients indirectly and I have very little understanding of the big picture/politics of it all. Often, when I read through the RVU content, I gloss over big sections of important-looking information because it doesn't seem to apply to pediatrics. I don't know why I'm offering this caveat today, perhaps it's the GI bug I picked up from my kids speaking.

Anyway, the interesting news.

• There is language on the table to remove the scheduled 10.1% reduction and replace it with a .5% increase. However, there may be a related relationship to an expansion of the physician quality reporting system. No idea yet.
• There will be an extension of the 1.0 floor to the work geographic adjustment (the effects of the loss of which were heroically outlined par moi).
• Both of these changes last only until June, 2008, at which point the original proposals will be enacted. I think. We don't know, yet.

You can seem some other reactions to this news in obvious places, such as the WSJ. One thing I find interesting is that it looks like the language to make the changes above may be knowingly vetoed by GWB, but there are enough votes to override the veto. [This is a good example of what I talked about above.]

As the world turns!

All the RVU drama makes it hard for me to get to other things, but here is the latest from my generous and favorite inside source (instead of using an inappropriate 70s adult film nickname, we'll use "Siouxsie"):

1) The new CF for 1/1/08 through 6/30/08 will be $38.0870 [= 0.5% increase from the current CF of $37.8975; what happens after that point is anyone's guess] 2) The work GPCI floor (1.000) will be maintained through 6/30/08 [again, what happens after that point is unknown] 3) The bill did NOT include provisions to "alter or supplant the role" of the RUC

Attached with this cogent explanation was a memo straight from Michael Maves, the E-VP and CEO of the AMA. Now, let's all be tense for six months. Ready? Go! [I can actually update the RVU calculators, now.] Wow, Siouxsie kicks butt and sends me this important AMA Memo about the changes 2 minutes after I post this.

Wow, some shockers.  Anyone here live in Alaska?

Just like last year, I’ve gone through the entire GPCI catalog and have calculated the impact of the geographical adjustment changes for RBRVS in 2009.  While folks focus 99% of the attention on the impact of individual codes or the new annual multiplier, not enough attention is paid to the GPCI impacts.  For some of you, the impact is greater than any change.

Some highlights from the table below:

• Whoa, Alaska!  What has happened there that has called for a 22% increase in Medicare rates?
• OK, New Orleans I understand.  They probably have a problem with doc volume right now and will for a bit.  But why is Ventura, CA enjoying a 3.7% increase over the last two years while Santa Clara, SF, Oakland, etc., are getting killed?  Why is LA “doing well?”
• I’m sure it’s out there somewhere, but does someone have a good resource for explaining the creation and adjustment of this table?  I still scratch my head at having distinct pricing for places like…Brazoria, TX or Beaumont, TX but there’s nothing distinct for San Antonio.  Or even here in VT, where practicing in Chittenden County is not at all like practicing in the Northeast Kingdom (though some could argue that anyone providing medical service up in the Kingdom should get a bonus).  I have plenty of clients who either benefit or are zapped - usually the latter - by this piece of the calculation.

Location	Difference (’08-’09)	Difference (’07-’09)
Alaska	22.24%	21.43%
New Orleans, LA	2.13%	4.31%
Ventura, CA	1.84%	3.70%
Rhode Island	1.55%	3.21%
Miami, FL	1.33%	2.75%
Los Angeles, CA	1.31%	2.69%
Fort Lauderdale, FL	1.22%	2.47%
Hawaii/Guam	0.92%	1.72%
Rest of Pennsylvania	0.85%	1.67%
Rest of Louisiana	0.61%	1.23%
Rest of Missouri*	0.61%	1.22%
Rest of Florida	0.58%	1.12%
Anaheim/Santa Ana, CA	0.52%	1.09%
Idaho	0.46%	0.93%
Mississippi	0.47%	0.89%
Indiana	0.48%	0.87%
Beaumont, TX	0.43%	0.81%
Delaware	0.42%	0.79%
Arkansas	0.38%	0.77%
Connecticut	0.34%	0.74%
South Carolina	0.42%	0.74%
Vermont	0.33%	0.61%
New Mexico	0.33%	0.56%
Rest of Texas	0.30%	0.55%
Northern NJ	0.26%	0.49%
Rest of New Jersey	0.23%	0.47%
Rest of Illinois	0.20%	0.40%
Tennessee	0.24%	0.38%
Rest of Maryland	0.17%	0.30%
Nebraska	0.20%	0.29%
Southern Maine	0.11%	0.26%
Oklahoma	0.11%	0.23%
Ohio	0.13%	0.21%
Rest of Georgia	0.13%	0.20%
Virginia	0.14%	0.18%
North Carolina	0.10%	0.16%
Galveston, TX	0.09%	0.13%
Rest of Oregon	0.09%	0.08%
Metropolitan Philadelphia, PA	0.01%	0.07%
Rest of Maine	0.06%	0.02%
West Virginia	0.03%	-0.00%
Rest of Massachusetts	-0.04%	-0.04%
Rest of California*	-0.07%	-0.15%
Kentucky	-0.06%	-0.19%
Alabama	-0.11%	-0.22%
Kansas	-0.11%	-0.22%
Iowa	-0.10%	-0.26%
Puerto Rico	-0.12%	-0.30%
Montana	-0.18%	-0.36%
Rest of New York	-0.15%	-0.40%
Queens, NY	-0.23%	-0.43%
New Hampshire	-0.22%	-0.44%
Rest of Washington	-0.21%	-0.52%
South Dakota	-0.25%	-0.54%
Poughkpsie/N NYC Suburbs, NY	-0.31%	-0.58%
NYC Suburbs/Long I., NY	-0.32%	-0.68%
Wisconsin	-0.33%	-0.72%
Wyoming	-0.34%	-0.74%
Baltimore/Surr. Cntys, MD	-0.41%	-0.76%
Utah	-0.36%	-0.77%
Rest of Michigan	-0.37%	-0.80%
Nevada	-0.44%	-0.87%
East St. Louis, IL	-0.42%	-0.88%
Manhattan, NY	-0.44%	-0.92%
Metropolitan St. Louis, MO	-0.44%	-0.92%
Metropolitan Kansas City, MO	-0.47%	-1.03%
DC + MD/VA Suburbs	-0.61%	-1.26%
Houston, TX	-0.64%	-1.27%
North Dakota	-0.64%	-1.33%
Colorado	-0.73%	-1.40%
Minnesota	-0.70%	-1.43%
Fort Worth, TX	-0.81%	-1.70%
Virgin Islands	-0.84%	-1.72%
Metropolitan Boston	-0.87%	-1.76%
Chicago, IL	-0.97%	-1.92%
Portland, OR	-1.01%	-2.00%
Brazoria, TX	-1.03%	-2.13%
Suburban Chicago, IL	-1.12%	-2.22%
Detroit, MI	-1.10%	-2.23%
Arizona	-1.11%	-2.24%
Seattle (King Cnty), WA	-1.19%	-2.35%
Dallas, TX	-1.44%	-2.79%
Austin, TX	-1.53%	-3.01%
Marin/Napa/Solano, CA	-1.80%	-3.54%
Atlanta, GA	-1.93%	-3.79%
Oakland/Berkley, CA	-1.98%	-3.88%
San Francisco, CA	-2.20%	-4.31%
San Mateo, CA	-2.20%	-4.35%
Santa Clara, CA	-5.04%	-9.57%

Yesterday, I asked if anyone knows how the awkward RBRVS GPCI system is developed.  Siouxsie, of course, had the answer.  In fact, more than answer.  Those of you who are dinged by the GPCI breakdown should head Reed Tinsley’s quick review of it and then check out CMS’s PDF…and get in touch with CMS! Remember, it worked with the imms admin for 2009, why not for GPCIs as well?