2014 Medicare fee schedule expands chronic care management, keeps SGR pay cuts

December 9, 2013

High-quality care and efficiency – Those are the two points that the Centers for Medicare and Medicaid Services (CMS) emphasized with the release of its 2014 Medicare Physician Fee Schedule.

 

High-quality care and efficiency – Those are the two points that the Centers for Medicare and Medicaid Services (CMS) emphasized with the release of its 2014 Medicare Physician Fee Schedule.

Included in one of the provisions, primary care physicians will begin to see reimbursements for chronic care management services outside of face-to-face visits, beginning in 2015.

“Healthcare is changing, and part of delivery system reform is recognizing this and making sure payment systems account for these changes,” said CMS Principal Deputy Administrator Jonathan Blum in a written statement. “We believe that successful efforts to improve chronic care management for these patients could improve the quality of care while simultaneously decreasing costs, through reductions in hospitalizations, use of post-acute care services, and emergency department visits.”

The rules also allow payments for telehealth services in rural areas that qualify as health professional shortage areas. A change to the Physician Quality Reporting System (PQRS) gives eligible physicians the option to report quality measures through qualified clinical data registries.

CMS estimates that approximately $87 billion will be paid to physicians under the 2014 fee schedule.

But it also maintains the sustainable growth rate (SGR) pay cuts, which has prompted forceful pushback from physician groups, including the American Medical Association (AMA) and the American Academy of Family Physicians (AAFP).

“The AAFP is disappointed that current law continues to require CMS to issue a physician fee schedule that slashes payment by 20.1 percent next year,” said Reid Blackwelder, MD, AAFP president in a written statement. “The schedule reflects the flawed sustainable growth rate formula that dictates Medicare payment for physician services. That formula must be repealed, and the AAFP urges Congress to act quickly to do so.”

Congressional leaders have a plan that would repeal the SGR and implement a 10-year pay freeze and performance-based incentive program. But it’s unclear whether the proposal will garner enough support to pass before the looming Jan. 1 deadline.

“The clock is ticking. At stake are innovations that would make Medicare more cost effective for current and future generations of seniors,” said AMA spokesman Robert J. Mills in a written statement. “These innovations are not possible if physicians are worried about drastic cuts to Medicare rates that have remained almost flat since 2001, while the cost of caring for patients has gone up by 25 percent.”