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MPPR and imaging equipment utilization policies, and the impact of changes due to new, revised, and potentially misvalued codes. Column F (Impact of MEI Rebasing): This column shows the estimated CY 2011 impact on total allowed charges of the CY 2011 rescaling of the RVUs so that the proportions of total payments based on the work, PE, and malpractice RVUs match the proportions in the final revised and rebased MEI for CY 2011. Column G (Combined Impact - Full): This column shows the estimated CY 2011 combined impact on total allowed charges of all the changes in the previous columns if there were no remaining transition to the new PE RVUs using the PPIS data. Column H (Combined Impact - Tran): This column shows the estimated CY 2011 combined impact on total allowed charges of all the changes in the previous columns under the second year of the 4-year transition to the new PE RVUs using the PPIS data. TABLE 101: CY 2011 PFS Final Rule Total Allowed Charge Estimated Impact for RVU, MPPR, and MEI Rebasing Changes*

(A) (B) (C) (D) (E) (F) (G) (H)

Specialty

Allowed Charges (mil)

$81,980 $181 $1,793 $382 $6,951 $138 $240 $2,749 $2,600 $395 $5,512 $1,800

Impact of Work and MP RVU Changes

0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0%

Impact of PE RVU and MPPR Changes Full

0% 0% 4% -1% -5% 4% 3% 2% 2% 4% 4% 3%

Tran

0% 1% 2% 0% -2% 2% 2% 2% 1% 2% 2% 1%

Impact of MEI Rebasing

0% 4% -3% 0% 1% 0% -2% 3% -3% 0% 0% -1%

Combined Impact Full

0% 4% 2% -1% -5% 5% 1% 5% -2% 4% 4% 2%

Tran

0% 5% -1% 0% -2% 3% 0% 4% -3% 2% 2% 1%

TOTAL ALLERGY/IMMUNOLOGY ANESTHESIOLOGY CARDIAC SURGERY CARDIOLOGY COLON AND RECTAL SURGERY CRITICAL CARE DERMATOLOGY EMERGENCY MEDICINE ENDOCRINOLOGY FAMILY PRACTICE GASTROENTEROLOGY

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(H)

Specialty

Allowed Charges (mil)

$728 $2,286 $188 $103 $1,912 $584 $10,696 $390 $224 $46 $1,946 $1,457 $642 $59 $670 $5,287 $3,432 $941 $1,069 $68 $895 $317 $1,149 $1,786 $1,939 $5,052 $511 $398 $1,950 $708 $54 $756 $577 $390 $909 $1,039 $726 $1,212 $970

Impact of Work and MP RVU Changes

0% 0% 0% 0% 0% 0% 0% -1% -2% 0% 1% 0% -2% 0% 0% -1% 0% 0% -1% 0% 0% 0% 1% -1% -2% -2% 0% 0% -1% -1% 0% 0% 0% 0% 0% -1% 0% 0% 0%

Impact of PE RVU and MPPR Changes Full

3% 3% 5% 4% -4% 4% 3% 3% -8% -7% 1% 5% 1% -7% 1% 4% 3% 3% -1% 2% 4% 4% 2% 2% -9% -12% 1% -1% -6% -3% -6% 4% -6% -5% -27% -7% 4% 4% 4%

Tran

1% 1% 2% 2% -2% 2% 2% 1% -4% -5% 1% 2% 0% -4% 1% 0% 1% 2% 0% 1% 2% 2% 1% 1% -3% -7% 0% 0% -3% -2% -1% 2% -2% -2% -16% -3% 2% 2% 1%

Impact of MEI Rebasing

0% 0% -2% 2% 2% -2% -1% 1% 0% 1% -1% 0% 1% 0% 1% 1% 1% 1% 0% 0% -1% 1% -3% -1% 4% -1% 2% 0% 1% 0% 2% -2% -4% -4% 2% 5% -4% -1% 1%

Combined Impact Full

3% 3% 4% 6% -2% 3% 3% 2% -9% -5% 1% 5% 0% -6% 2% 4% 4% 5% -2% 2% 4% 5% 0% 1% -7% -14% 2% -1% -7% -4% -5% 2% -10% -9% -23% -4% 1% 4% 6%

Tran

1% 1% 1% 4% 0% 0% 1% 0% -5% -4% 1% 2% -1% -4% 2% 0% 3% 3% -1% 1% 1% 3% -1% -1% -1% -10% 2% 0% -3% -2% 0% 0% -6% -5% -15% 1% -1% 1% 2%

GENERAL PRACTICE GENERAL SURGERY GERIATRICS HAND SURGERY HEMATOLOGY/ONCOLOGY INFECTIOUS DISEASE INTERNAL MEDICINE INTERVENTIONAL PAIN MGMT INTERVENTIONAL RADIOLOGY MULTISPECIALTY CLINIC/OTHER NEPHROLOGY NEUROLOGY NEUROSURGERY NUCLEAR MEDICINE OBSTETRICS/GYNECOLOGY OPHTHALMOLOGY ORTHOPEDIC SURGERY OTOLARNGOLOGY PATHOLOGY PEDIATRICS PHYSICAL MEDICINE PLASTIC SURGERY PSYCHIATRY PULMONARY DISEASE RADIATION ONCOLOGY RADIOLOGY RHEUMATOLOGY THORACIC SURGERY UROLOGY VASCULAR SURGERY AUDIOLOGIST CHIROPRACTOR CLINICAL PSYCHOLOGIST CLINICAL SOCIAL WORKER DIAGNOSTIC TESTING FACILITY INDEPENDENT LABORATORY NURSE ANES / ANES ASST NURSE PRACTITIONER OPTOMETRY

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(H)

Specialty

Allowed Charges (mil)

$40 $2,204 $893 $1,801 $94 $71 $69

Impact of Work and MP RVU Changes

0% 0% 0% 0% 0% 0% 2%

Impact of PE RVU and MPPR Changes Full

5% 0% 3% 6% 2% -13% 3%

Tran

3% -3% 2% 3% 0% -5% 1%

Impact of MEI Rebasing

2% -2% 0% 1% 6% 8% 0%

Combined Impact Full

7% -1% 3% 7% 7% -6% 5%

Tran

5% -5% 1% 4% 6% 3% 3%

ORAL/MAXILLOFACIAL SURGERY PHYSICAL/OCCUPATIONAL THERAPY PHYSICIAN ASSISTANT PODIATRY PORTABLE X-RAY RADIATION THERAPY CENTERS OTHER

* Table 101 shows only the payment impact on PFS services. We note that these impacts do not include the effects of the

December 2010 and January 2011 conversion factor changes under current law.

2. CY 2011 PFS Impact Discussion a. Changes in RVUs The most widespread specialty impacts of the RVU changes are generally related to several factors. First, as discussed in section II.A.2. of this final rule with comment period, we are currently implementing the second year of the 4-year transition to new PE RVUs using the new PPIS data that were adopted in the CY 2010 PFS final rule with comment period (74 FR 61751). The impacts of using the new PPIS data are generally consistent with the impacts discussed in the CY 2010 PFS final rule with comment period (74 FR 61983 through 61984). The second general factor contributing to the CY 2011 impacts shown in Table 101 is the CY 2011 rescaling of the RVUs so that in the aggregate they match the work, PE, and malpractice proportions in the revised and rebased MEI for CY 2011. That is, as discussed in section II.E.5. of this final rule with comment period, the revised and rebased MEI has a greater proportion attributable to malpractice and PE and, correspondingly, a lesser proportion attributable to work. Specialties that have a high

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