While the Centers for Medicare and Medicaid Services has pushed back the proposed 10.6 percent Medicare payment cuts to physicians until mid July, the agency has proposed new efforts to promote access to higher-quality and more efficient healthcare for Medicare beneficiaries under the 2009 Medicare Physician Fee Schedule.
"We are taking a multi-pronged approach to improve how Medicare pays for healthcare services for our nation's seniors," said CMS Acting Administrator Kerry Weems. "These efforts are designed to ensure that beneficiaries continue to get the highest quality of healthcare 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 non-physician practitioners (NPPs) who bill Medicare for the services they furnish to beneficiaries.
According to officials, under a formula in the Medicare statute, CMS is required to reduce the 2009 MPFS by 5.4 percent. Total Medicare spending under the 2009 MPFS is projected at $54 billion, down 5 percent from the $57 billion projected for 2008.
It is reported that nearly 95 percent of physicians enrolled in Medicare accept the fee schedule rate as payment in full. Medicare pays 80 percent of the fee schedule rate, while the beneficiary is responsible for the remaining 20 percent.
"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 healthcare 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 be selected from 175 measures that fall into four categories - 113 current 2008 PQRI measures, 17 new measures that have been endorsed by the National Quality Forum (NQF), 20 new measures that have been adopted by the AQA Alliance (AQA) and 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 (Jan. 1, 2009 to Dec. 31, 2009 or July 1, 2009 to Dec. 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.
A proposal has also been made 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. They would then have 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 proposes that these standards become effective Jan. 1, 2009 for newly enrolling suppliers, but would allow existing suppliers until Sept. 30, 2009 to come into compliance.
The proposed fee schedule 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 Jan. 1, 2009.
CMS said it will accept comments on the proposed rule until August 29 and respond to those comments in a final rule to be issued by November 1. The revised policies and payment rates will become effective Jan. 1, 2009.
How will CMS' MPFS effect your practice? Do you agree with the terms? Send your comments to Associate Editor Chelsey Ledue at chelsey.ledue@medtechpublishing.com.