Wednesday, July 17, 2013
This Week's News
This Week's News
Policy, pay changes for 2014 Medicare fee schedule unveiled in proposed rule
A proposed rule released last week calls for changes to the Medicare Physician Fee Schedule in 2014 that include support for complex chronic care management, expansion of the value-based payment modifier and updates to Medicare quality reporting programs.
"Currently, Medicare only pays for primary care management services as part of a face-to-face visit," the Centers for Medicare & Medicaid Services (CMS) stated in an accompanying fact sheet. "In the proposed rule, in order to support primary care, CMS proposes to make a separate payment to physicians for managing select Medicare patients' care needs beginning in 2015."
Under the proposed rule, physicians caring for Medicare patients with two or more significant chronic conditions would be eligible to receive payment for maintaining a plan of care and providing such coordination services as communicating with other treating health professionals and managing medications.
This proposal responds to a care coordination model developed by the CPT® Editorial Panel and the AMA/Specialty Society Relative Value Scale Update Committee. The AMA will continue to work with CMS to ensure that the final model implemented in 2015 allows physicians to provide the maximum benefit to Medicare patients.
CMS also proposes expanding the value-based payment modifier program, which will adjust physician payments based on cost and quality data. Instead of applying to practices with 100 or more eligible providers, the program will apply to practices with just 10 or more eligible providers and will increase the potential penalty to 2 percent.
Another significant proposal is downgrading rates for more than 200 "misvalued" codes so that payments for services provided in a physician's office would be capped at a rate that is equal to the combined payments to the facility and the physician when the same service is provided in a hospital outpatient department or ambulatory surgical center.
This change ignores the fact that hospital outpatient departments are paid a rate that is averaged across a group of services that can vary significantly in costs. For hospitals, payments above and below the cost of the service are assumed to average out over time. But physicians who often don't perform the full range of services in the group cannot offset losses on some services with profits on others.
Other changes set forth in the 600-page proposed rule include revisions to measures and reporting requirements for such Medicare programs as the Physician Quality Reporting System and the electronic health record meaningful use program.
The AMA is reviewing the proposed rule and will submit detailed comments by the Sept. 6 deadline. Physicians who would like to submit their own comments to CMS can view instructions for doing so in the first two pages of the proposed rule.
Additional information about the proposed rule is available in CMS fact sheets about the rule's policy and payment changes and changes to the quality programs. The final rule is expected to be issued in early November.