CMS calls for hike in Medicare reimbursements to family physicians, internists

July 9, 2012
Daniel R. Verdon
Daniel R. Verdon

Family physicians will get a 7% increase in Medicare reimbursements, and internists will see a 5% increase, if a proposed rule is finalized from the Centers for Medicare and Medicaid Services.

Family physicians will get a 7% increase in Medicare reimbursements, and internists will see a 5% increase, if a proposed rule is finalized from the Centers for Medicare and Medicaid Services (CMS). Other practitioners providing primary care services could see increases between 3% to 5%.

Cardiologists and some other specialists would see decreases.

Slated for publication in the Federal Register on July 30, payment increases are intended to promote high-quality, patient-centered care, CMS says. This ruling would update payment policies and rates under the Medicare Physician Fee Schedule (MPFS) for 2013.

For the first time, CMS is proposing to pay for the care required to help a patient transition back to the community following discharge from a hospital or nursing facility. The proposal would call for CMS to make a separate payment to a patient’s community physician or practitioner to coordinate the patient’s care.

Although the proposal offers guidance on the sustainable growth rate (SGR) methodology, it will delve into data collection on patient function and other areas.

“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,” CMS reports. The comment period is open until September 4.

CMS projects a significant reduction in MPFS payment rates under the SGR methodology due to the expiration of the adjustment made for 2012 in the statute, CMS says in a prepared statement. For 2013, CMS projects a reduction of 27% 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,” CMS adds.

The proposed rule would continue the 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, CMS says.

The agency also states:

“The law allows CMS to phase in the Value Modifier over three years from 2015 to 2017. For the 2015 physician payment rates, the proposed rule would apply the Value Modifier to all groups of physicians 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 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 2015 Value Modifier was established as 2013 in the MPFS Final Rule for 2012.

“The proposed rule calls for changes to two quality reporting programs that are associated with the MPFS – the PQRS and the E-prescribing Incentive Program and 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 would also 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.”

A final rule will be issued by November 1, CMS says.

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