It's not too soon to look ahead to 2009 to see what's in store for pediatricians as a result of the CMS machinations. I've ignored, as you can see, the drama over the last few weeks related to the scheduled Medicare fee cuts - there are plenty of places you can find that news. However, I have the opportunity to share some notes to the AAP's Coding and Nomenclature Committee about what they are seeing. I've edited or reduced the information and highlighted some important (to me) points, so please blame just me for any miscommunication, etc.

• "...CMS is proposing to exclude the clinical staff times when calculating the 2009 PE RVUs for the immunization administration codes...the potential increase in PE RVUs that we had been expecting will be negligible, if anything."The clinical staff time in question includes time spent entering data into an immunization registry, logging temps, etc. Given that this time demand has exploded for some offices, it's pathetic that CMS doesn't understand what these practices are going through.
• CPT 99174 (Ocular Photoscreening) should get PE and PLI RVUs.
• There is a scheduled 5.4% fee cut. My bet is that is sticks - things are going to get worse before they get better.
• The 1.000 GPCI floor will be removed. It's been threatened before, but I also think it will stick. This is a big deal that will add up to an additional 5-10% cut, iirc, for some places.
• "Per CPT copyright release restrictions, new codes are not able to be included in the proposed rule (since its publication pre-dates the AMA's release of new codes via its CPT manual). Therefore, we will not know how CMS proposes to value the new expanded age PICU codes or the ESRD codes until the final rule comes out in November."I want to see if I have this right: because the AMA wants to protect its ridiculous CPT copyright (including the non-copyrightable RVU values), its own members - and the affected public - cannot actually learn what our government is going to do with some federally mandated codes until the AMA has time to publish its book. I can't believe that this was in the spirit of the copyright law when it was written and I have a hard time believing it's actually in the letter of the law, either. Someone lend my the $500K+ it would take to fight that lawsuit and I'll get right on it. The money the AMA receives from their licenses ($70m/annually, when they last told me) is worth more to them than doing the right thing.

Enough of my ranting. I have to go prep for CCHIT. What can a lowly pediatrician do? Make sure your contracts are locked into a specific year of the RVUs. I prefer 2005->2007, myself.