CMS Issues Final Rule Calling for 27.4% Cut in Doctor Payment Rates
On Tuesday, CMS issued final rules for hospital and physician payments for 2012 with a proposal to cut physician reimbursements by 27.4%, AHA News reports (AHA News, 11/1).
Since 2002, Congress annually has passed a series of short-term bills to block scheduled cuts to Medicare reimbursement rates under the sustainable growth rate formula that determines Medicare reimbursement rates for physicians.
The most recent "doc-fix" bill, enacted in December 2010, is scheduled to expire on Jan. 1, 2012, at which point physicians face a 29.4% payment rate cut (California Healthline, 10/28).
Final Rule for Physician Payments
However, the physician payment final rule calls for a payment cut of 27.4%, because Medicare cost growth was lower than expected (CMS release , 11/1). The still-steep payment cut -- and resulting backlash -- has renewed HHS officials' calls for Congress to pass a permanent fix to the SGR formula.
Calling U.S. physicians "the backbone of our health care system," HHS Secretary Kathleen Sebelius said that the Obama administration is "100% committed to fixing the flawed Medicare payment system and protecting Medicare beneficiaries' access to doctors" (HHS release, 11/1).
HHS also finalized cost and quality measures that will help establish a new value-based modifier to adjust payments for physicians who provide higher quality, more efficient care. The rule also finalized CY 2013 as the initial performance year for CY 2015 payment adjustments (CMS release , 11/1).
Additional changes announced on Tuesday include:
- Slight payment increases for annual Medicare beneficiary wellness visits;
- Amended values for 300 "misvalued" physician fee schedule services codes;
- Changes to how CMS adjusts Medicare payments based on local practice costs;
- A reduction -- in some cases, up to 50% -- for some imaging payments for repeated scans within the same visit; and
- An expanded list of telehealth services covered by Medicare (Daly, Modern Healthcare, 11/1).
The rule is scheduled to be published in the Federal Register on Nov. 28, and CMS will accept comments until Jan. 3, 2012. The agency says it will respond to comments in the CY 2013 rules (CMS release , 11/1).
Outpatient, ASC Final Rule
Specifically, the agency will increase hospital outpatient rates by 1.9% and raise ambulatory surgical center payments by 1.6% (Robeznieks, Modern Healthcare, 11/1).
The rule added a clinical process of care measure to the Hospital Value-Based Purchasing Program that aims to protect patients against catheter-associated infections. In addition, the rule institutes performance periods, standards, and a weighting scheme for the FY 2014 program.
It also expands reporting measures for Hospital Outpatient Quality Reporting Program and for the first time establishes a quality reporting program for ambulatory surgical centers, which includes four outcomes measures and one surgical infection measure.
The rule is scheduled to be published in the Federal Register on Nov. 30, and CMS will accept comments until Jan. 3, 2012. The agency says it will respond to comments in the CY 2013 rules (CMS release , 11/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.