Medicare Hits Physicians with New Regulations, Cuts
$3 Billion From Fee Schedule
Medicare actually
pays 80% of the fee schedule rate, while the beneficiary is
responsible for the remaining 20%. Nearly 95% of Medicare
physicians, however, accept the fee schedule rate as payment in
full, according to CMS.
Spending under the 2009 Physician Fee Schedule is
projected at $54 billion
June 30, 2008 While physicians caring for
Medicare patients have a 10-day reprieve from a 10 percent pay cut, they
did get hit today by new regulations proposed by Medicare, as well as,
changes in the agencys compensation structure that will reduce payments
to doctors by about $3 billion. Some question if this will encourage
doctors to push more of the bill to the senior citizen patients.
The Centers for Medicare & Medicaid Services (CMS)
says the proposed new rules are to promote access to higher quality and
more efficient health care delivered by the nations physicians to
people with Medicare under the 2009 Medicare Physician Fee Schedule (MPFS).
CMS acting administrator Kerry Weems said, We are
taking a multi-pronged approach to improve how Medicare pays for health
care services for our nations seniors. These efforts are designed to
ensure that beneficiaries continue to get the highest quality of health
care at the greatest value for beneficiaries and the Medicare program.
The MPFS was created by Congress and is updated
annually to set the Medicare payment rates for more than 980,000
physicians and nonphysician practitioners (NPPs) who bill Medicare for
the services they furnish to beneficiaries.
Under a formula in the Medicare statute, CMS is
required to reduce 2009 Physician Fee Schedule by 5.4 percent. This is
in addition to the 10.6 reduction in pay rates that was to become
effective tomorrow.
Total Medicare spending under the 2009 Physician
Fee Schedule is projected at $54 billion, down 5 percent from the $57
billion projected for 2008.
Medicare actually pays 80 percent of the fee
schedule rate, while the beneficiary is responsible for the remaining 20
percent. Nearly 95 percent of Medicare physicians, however, accept the
fee schedule rate as payment in full, according to CMS.
One of the worries about the reduction in pay and
increase in demands by CMS is that an increasing number of physicians
will discontinue treating patients covered by Medicare.
CMS has been carefully monitoring beneficiary
access to physicians services, said Weems.
To date, our studies, as well as studies by the
Medicare Payment Advisory Commission, reveal that beneficiaries in most
areas of the country are having little or no trouble in seeing their
physicians and we expect this to continue in 2009.
Through the MPFS, CMS says it is encouraging
greater efficiency in the delivery of care, while reducing treatment
errors through the use of electronic health records; and exploring new
payment models to see if there are ways to promote greater coordination
of care among providers, producing better outcomes for the health care
dollar.
CMS is proposing additional improvements to the
Physician Quality Reporting Initiative (PQRI) which allows eligible
professionals to report quality measures relating to their clinical
practice.
Proposed changes for the 2009 PQRI Program include:
● Proposing that the final set of quality
measures will be selected from 175 measures that fall into four broad
categories:
(1) 113 current 2008 PQRI measures;
(2) 17 new measures that have been endorsed by the National Quality
Forum (NQF);
(3) 20 new measures that have been adopted by the AQA Alliance (AQA);
and
(4) 25 new measures proposed for 2009 contingent on NQF endorsement
or AQA adoption by July 31, 2008;
● Increasing the number of conditions covered by
measures groups to nine, adding coronary artery disease, HIV/AIDS,
coronary artery bypass surgery, rheumatoid arthritis, care during
surgery, and back pain, to the original measures groups for diabetes,
chronic kidney disease, and preventive care. Measures groups require
reporting a set of related measures and can help assure that patients
are receiving a range of care appropriate for a given clinical condition
or clinical focus.
● Reporting options that include two new
reporting periods (January 1, 2009 to December 31, 2009, or July 1, 2009
to December 31, 2009) to provide eligible professions with additional
options for reporting PQRI data; and
● Accepting PQRI data via clinical registries
and electronic health records systems.
Launched in 2007, the PQRI was recently expanded as
a result of the Medicare, Medicaid and SCHIP Extension Act of 2007 to
include additional measures that will allow more eligible professionals
to earn incentive payments in 2008 for submitting 2008 data, and to
provide alternative, streamlined methods for reporting.
Thus, eligible professionals who are not already
participating in the PQRI this year will have the opportunity to begin
reporting in July 2008 to qualify for an incentive payment.
Those eligible professionals who have reported PQRI
data successfully for the full year can earn an incentive payment based
on their total Medicare allowed charges for services furnished in CY
2008, while those who begin reporting in July can earn an incentive
payment based on their total allowed charges from July 1 through
December 31, 2008.
CMS is also proposing to improve the quality of
diagnostic testing performed by physicians and NPPs in their offices by
requiring them to enroll as suppliers of these services and to meet
certain quality and performance standards, including applicable Federal
and State licensure, health and safety requirements that currently apply
to independent diagnostic testing facilities (IDTFs).
CMS is proposing to make the standards effective
January 1, 2009 for newly enrolling suppliers, but to allow existing
suppliers until September 30, 2009 to come into compliance.
The proposal specifically seeks public comment
about whether these standards should apply to all diagnostic services or
to a subset of services such as those that require more costly testing
and equipment, imaging services generally, or only advanced imaging
techniques.
The fee schedule proposed rule also addresses a
change to the exemption that limits the use of computer-generated faxes
to e-prescribe Part D covered drugs for Part D eligible individuals to
instances in which temporary/transient transmission failure or
communication problems preclude the sue of the adopted NCPDP SCRIPT
standard.
This change is scheduled to take effect on January
1, 2009.In the MPFS 2009 Proposed Rule, CMS is proposing to retain the
provisions that would allow for use of computer-generated faxes in
instances of temporary/transient transmission failure or communication
problems that preclude the use of the adopted NCPDP SCRIPT standard, and
add an exemption for computer-generated faxes used by dispensers to
request refills from providers that are not capable of receiving and
processing refill requests using the adopted NCPDP SCRIPT standard.
CMS will accept comments on the proposed rule until
August 29, 2008, and will respond to those comments in a final rule to
be issued by November 1, 2008. The revised policies and payment rates
will become effective January 1, 2009.
