CMS Rule Would Increase FP Payments Seven Percent

CMS issued a proposed rule, July 6,  that would increase payments to family physicians by approximately seven percent and other practitioners providing primary care services between 3 and 5 percent.

The increase is part of the proposed rule that would update payment policies and rates under the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2013. For the first time, CMS is proposing to pay community physicians (or practionners) a separate payment for care coordination for 30 days following a discharge from a hospital or a skilled nursing facility.

The proposed rule asks for public comment on how Medicare can better recognize the range of services provided by community physicians and practitioners either through face-to-face services in the office or coordinating care outside the office when the patient does not see the physician.

CMS projects a 27 percent reduction in physician fees as a result of the Sustainable Grown Rate (SGR) metholodogy.  Congress has acted every year since 2003 to prevent decreases and the Obama Administration has committed to fixing the flawed SGR formula in a fiscally responsible manner.

The proposed rule  provides choices to physicians on how they participate  in Medicare by continuing implementation of the physician value-based payment modifier (Value Modifier), which was a provision included in the Accountable Care Act (ACA). The Value Modifier adjusts payments to individual physicians or physician based on the quality of care furnished to Medicare beneficiaries compared to costs.  The law allows CMS to phase in the Value Modifier over three years from CY2015 to CY2017.

For physician payment rates in CY2015, the proposed rule would apply the Value Modifier to all groups of physician with 25 or more eligible professionals.  The proposed rule provides an option for these groups to choose how the Value Modifier would be calculated based on whether they participate in the Physician Quality Reporting System (PQRS).

For groups of 25 or more that do not participate in the PQRS, CMS is proposing to set their Value Modifier at a 1.0 percent payment reduction. For groups that wish to have their payment adjusted according to their performance on the value modifier, the rule proposes a system whereby groups with higher quality and lower costs would be paid more, and groups with lower quality and higher costs would be paid less. The performance period for the CY2015 Value Modifier was established as CY2013 in the MPFS Final Rule for CY2012. 

The rule also proposes changes to two quality reporting programs that are associated with the MPFS – the PQRS and the Electronic Prescribing (eRx) Incentive Program – as well as the Medicare Electronic Health Records (EHR) Incentive Pilot Program which promotes the use of health information technology.

The PQRS proposal includes simplified, lower burden options for reporting and the proposed rule aligns quality reporting across the various programs in support of the National Quality Strategy. Furthermore, the proposed rule addresses the next phase in a plan to enhance the Physician Compare Website to foster transparency and public reporting of certain information to give beneficiaries more information for purposes of choosing a physician.

 Other provisions in the proposed rule include: 

  • A proposal to include additional Medicare-covered preventive services on the list of services that can be provided via an interactive telecommunications system;
  • A proposal to implement a durable medical equipment (DME) face-to-face requirement as a condition of payment for certain high-cost Medicare DME items;
  • A proposal to apply a multiple procedure payment reduction (MPPR) policy to the technical component of the second and subsequent cardiovascular and ophthalmology diagnostic services furnished by the same doctor to the same patient on the same day;
  • A proposal to collect data on patient function to improve how Medicare pays for physical and occupational therapy, and speech language pathology services;
  • A request for public comments on payment for advanced diagnostic molecular pathology services;
  • A proposal to revise a regulation that only allows Medicare to pay for portable x-rays ordered by an MD or DO.  The revised regulations would allow Medicare to pay for portable x-ray services ordered physicians and non-physician practitioners acting within the scope of their Medicare benefit and state law;
  • A proposal to clarify when Medicare will pay for interventional pain management services provided by Certified Registered Nurse Anesthetists (CRNAs) when permitted by State law.  This proposal will foster access to pain management services in areas where states have determined that CRNAs may provide these services.

The proposed rule will appear in the July 30, 2012 Federal Register. CMS will accept comments on the proposed rule until September 4, 2012, and will respond to them in a final rule with comment period to be issued by November 1, 2012.

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