The Centers for Medicare and Medicaid Services is making several proposals to refine Medicare payments to physicians under the Medicare Physician Fee Schedule, which is expected to increase payment rates for primary care services.
The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals and other settings.
The American Academy of Family Physicians says the proposals are a “very strong step in the right direction.”
“A 6-8 percent increase in physician payments isn’t the total fix by any means, but it’s a start,” said Ted Epperly, MD, president of the AAFP.
The Medicare law requires CMS to adjust the MPFS payment rates annually based on a formula that includes the Sustainable Growth Rate, which was adopted in the Balanced Budget Act of 1997.
The formula has yielded negative updates every year since 2002, although CMS took steps to avert a reduction in 2003 and Congress has taken action to prevent reductions every year since then.
Based on current data, CMS is projecting a rate reduction of 21.5 percent for CY 2010.
CMS is proposing to remove physician-administered drugs from the definition of “physician services” for purposes of computing the physician update formula in anticipation of legislation to provide fundamental reforms to Medicare physician payments.
“The removal of physician-administered drugs from the broken Medicare physician payment formula is a major victory for America’s seniors and their physicians,” said AMA President J. James Rohack, MD. “Instead of yet another band-aid fix, (this) action paves the way for Congress to ensure stable payment rates that reflect increasing medical practice costs and preserve seniors’ access to care.”
Physicians won’t specifically be affected, as it is based upon what services they provide within their profession. Radiologists are estimated to take a pretty good hit, along with cardiologists and other sub-specialists. Primary care physicians are slated to gain from many of the changes.
The proposed rule also contains provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative (PQRI).
Professionals or group practices that meet the requirements of each program in CY 2010 will be eligible for incentive payments for each program equal to 2 percent of their total estimated allowed charges for the reporting periods.
“This is a bold proposal from CMS,” said Brett Baker, director of the American College of Physicians regulatory and insurer affairs department. “The fact that it will have such a big impact for a large number of groups, pushback from many of them should be expected.”
CMS will accept comments on the proposed rule until August 31 and issue a final rule by Nov. 1.