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Medicare News

Medicare Wants Pay Hike for Primary Care Providers; Pay to Return Patients Home

Proposal includes more Medicare-covered preventive services that can be provided by interactive telecommunications system

July 9, 2012 – Family physicians are getting a pay increase of almost 7 percent from Medicare in January and other practitioners providing primary care services will get between 3 and 5 percent. More than a million physicians and non-physician practitioners are covered under the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2013.

The Centers for Medicare & Medicaid Services (CMS) said in the news release issued Friday that it is also proposing for the first time to explicitly pay for the care required to help a patient transition back to the community following a discharge from a hospital or nursing facility.

The proposals calls for CMS to make a separate payment to a patient’s community physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay.

Another Congressional battle over doc pay expected


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 “As has been the case every year since CY 2002, CMS projects a significant reduction in MPFS payment rates under the Sustainable Growth Rate (SGR) methodology due to the expiration of the adjustment made for CY 2012 in the statute,” according to the news release issued by CMS.

“For CY 2013, CMS projects a reduction of 27 percent and is required by law to include this reduction in these calculations. However, Congress has acted to avert the cuts every year since 2003.

“The Administration is committed to fixing the SGR formula in a fiscally responsible way.”

The SGR formula is a sensitive issue with physicians, who have had to battle with congress for years to offset these automatic pay cuts generated by the SGR.

“Helping primary care doctors will help improve patient care and lower health care costs long term,” said CMS Acting Administrator, Marilyn B. Tavenner.

“The 7 percent increase for family physicians comes from a proposal that continues the Administration’s policies to promote high quality, patient-centered care,” according to the announcement by CMS.

The proposed rule also includes:

   ● 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 also asks for public comment on how Medicare can better recognize the range of services community physicians and practitioners provide as part of treating patients either through face-to-face services in the office or coordinating care outside the office when the patient does not see the physician.

What Others Report...

Proposed Medicare Fee Schedule Includes Pay Increase For Primary Care, Family Docs

The proposed rule also would provide payment for care that helps patients make the transition back into the community following a discharge from a hospital or nursing facility.

Medscape: CMS Proposes Primary Care Raises Funded With Specialist Cuts
Medicare would reduce reimbursement for many types of specialists to fund sizable raises for primary care physicians in 2013, according to a proposed fee schedule that the Centers for Medicare and Medicaid Services (CMS) released today. These reductions and raises are apart from the huge pay cut — now put at 27% — set for January 1, 2013, that is triggered by Medicare's sustainable growth rate formula, and likely to be postponed by Congress (Lowes, 7/6).

Modern Healthcare: CMS Proposes 7% Pay Hike For Family Docs
In a proposed rule released late Friday, the CMS included a slew of potential changes to the physician-fee schedule for 2013, including a 7% payment increase for family physicians and smaller increases for other primary-care doctors. The proposed pay hike for family physicians comes from a plan to reimburse such providers separately for providing successful follow-up care after a patient's hospital or nursing-home stay, the CMS said (McKinney, 7/6).

Medpage Today: CMS Proposes Primary Care Pay Raise For 2013
The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would give family physicians a 7 percent pay boost in 2013. The proposal released Friday also would increase Medicare payments to other primary care practitioners by between 3 percent and 5 percent. "Helping primary care doctors will help improve patient care and lower healthcare costs long term," CMS Acting Administrator Marilyn Tavenner said in a press release (Walker, 7/6).

In related news -

The Wall Street Journal: Medicare Tries To Cut The Cost Of Its Most Complex Patients
Medicare is trying new tactics to cut costs for complex patients and keep them healthier, although some health-policy observers say they don't go far enough (Adamy, 7/6).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, KHN's staff of reporters and correspondents file original stories each day, which you can find on your home page.

CMS also noted that the proposed rule will also continue the “careful implementation” of the physician value-based payment modifier (Value Modifier) that was included in the Affordable Care Act by providing choices to physicians regarding how to participate.

The Value Modifier adjusts payments to individual physicians or groups of physicians 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 CY 2015 to CY 2017.

For the CY 2015 physician payment rates, the proposed rule would apply the Value Modifier to all groups of physician with 25 or more eligible professionals. The proposed rule also 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 CY 2015 Value Modifier was established as CY 2013 in the MPFS Final Rule for CY 2012.

CMS added that the proposed rule continues efforts by CMS to align quality reporting across programs to reduce burden and complexity.

The proposed rule 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. The proposed rule also 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.

The proposed rule will appear in the July 30, 2012 Federal Register. CMS will accept comments on the proposed rule until Sep. 04, 2012, and will respond to them in a final rule with comment period to be issued by Nov. 1, 2012.

>> For more information.


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