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Fam Pract Manag. 2007;14(1):12-15

CMS bumps pay for point-of-care A1C tests

The payment physicians will receive from the Centers for Medicare & Medicaid Services (CMS) for administering point-of-care A1C testing will increase this year, thanks in part to a push from the AAFP.

The payment for the test increased to a national average of $21.06 on Jan. 1. Previously, more than half of Medicare's 56 carriers paid $13.56 for the test. The CPT code for the test is “83037 Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use.”

In a 2006 letter to CMS, then-AAFP Board Chair Mary Frank, MD, cited the existing $13.56 payment and wrote, “We have concerns with this payment level.”

Current AAFP Board Chair Larry Fields, MD, told AAFP News Now on Dec. 7 that he expects the payment increase will improve patient care by encouraging more physicians to perform A1C tests at the point of care, rather than sending patients for off-site testing.

Congress halts Medicare cuts at last hour, establishes bonus for data reporting

In what has become an end-of-the-year tradition, Congress has acted at the last hour to avert a 5-percent cut in physicians' Medicare payments. The action occurred during a late-night congressional session on Dec. 9, and while it may sound like good news, it translates into a payment freeze for physicians in 2007.

The narrowly avoided cut was the result of the flawed Medicare physician payment formula, which if not fixed permanently will result in continued cuts over the coming years and may push more doctors to leave the program.

“The time is long overdue to devise a sound financing system for the Medicare program so we can avoid this annual struggle to preserve seniors' access to care,” said AMA Board Chair Cecil Wilson, MD.

Key measures in the bill

The legislation established a 1.5-percent bonus for physicians who choose to participate in the Physician Voluntary Reporting Program that begins July 2007. Under the program, physicians will be eligible for the bonus if they submit quality of care data to Medicare; at this stage, they do not have to meet performance targets. The exact measures have not been announced.

Some doctors believe the small bonus isn't worth the hassle of collecting and submitting performance data. “Medicare has a good idea here but has not put much money behind it. The 1.5-percent bonus does not justify the extra effort required to do the quality reporting that the government wants,” said Stephen C. Albrecht, MD, a family physician in Olympia, Wash., in the Dec. 12 New York Times.

The bill also calls on the Centers for Medicare & Medicaid Services to carry out a three-year demonstration project to examine the effectiveness of the “medical home.” The concept has been championed by the AAFP and the American College of Physicians, which believe that if individuals have a personal medical home through which they receive acute, chronic and preventive medical services, they “can be assured of care that is not only accessible but also accountable, comprehensive, integrated, patient-centered, safe, scientifically valid and satisfying to both patients and their physicians,” said AAFP President Rick Kellerman, MD.

“Investing in a primary-care based health care system means a healthier, more productive society,” Kellerman said. “This bill includes a step in that direction and is helpful for our patients.”

Rising overhead hurts FP profits

Family practices faced a 6.3-percent increase in operating costs in 2005 and reported a 3.5-percent decline in total revenue after operating costs, according to the Medical Group Management Association (MGMA) Cost Survey: 2006 Reports Based on 2005 Data.

In comparison, obstetrics/gynecology practices reported a 2-percent decline in total revenue after operating costs, while anesthesiology groups experienced a 3.9-percent increase. When looking at multispecialty groups only, the survey found that operating costs increased 7.6 percent; profits rose 7.3 percent thanks to increased production.

Retail clinics continue to make news

Two recent announcements by national retail health clinic chains are of interest to family physicians. Take Care Health Systems announced that its Pittsburgh-area clinics, which are located inside Eckerd stores, now accept Highmark Blue Cross Blue Shield insurance. With that development, the company estimates that about 70 percent of Pittsburgh-area residents are insured by carriers that are accepted at Take Care clinics.

Other insurance companies that currently cover a visit to Take Care in the Pittsburgh area include HealthAmerica, UnitedHealthcare, HealthAssurance, Humana, First Health/CCN and Medicare.

If the Take Care announcement makes you wish you could run your own retail health clinic, you might want to consider the franchise offer from Now Medical Centers. The company, based in Minnetonka, Minn., announced that it had reached an agreement with Supervalu Corporation to install retail health clinics in its grocery stores nationwide. The twist from other retail chains is that these clinics will be owned and operated by local physician groups on a franchise basis.

The start-up cost of a Now Medical Centers franchise ranges from $117,500 to $215,750. For more information, visit

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Copyright © 2007 by the American Academy of Family Physicians.

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