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Without Congressional Interventional Physicians Could See 27 Percent Payment Reduction

July 27, 2012:

Deborah C. Hall, Clinical/Technical Editor

The Centers for Medicare and Medicaid Services indicated in an early-July proposed rule that it would reduce physician Medicare payment by 27 percent under the sustainable growth rate (SGR) methodology in 2013 unless Congress averts the cuts, which it most likely will do. Payment cuts mandated by a payment formula have been proposed each year since 2003, and each year Congress has acted to postpone the reduction.

The rule also addressed:

  • Establishing separate payments to providers for transitioning patients back to community services
  • Expanding the Medicare telehealth covered services to include a number of preventive services
  • Applying the multiple procedure payment reduction to the technical portion of second and subsequent cardiovascular and ophthalmological diagnostic services when provided by the same provider

The rule also addresses two other major initiatives, the Physician Quality Reporting Program and the value-based payment modifier.

For PQRS, CMS is proposing 264 individual measures that eligible providers can select to report quality. Other revisions include:

  • Revising the EHR-based reporting mechanism so that it aligns with the proposed reporting criteria for meeting the clinical quality measure component of meaningful use under the Medicare EHR Incentive Program
  • Decreasing from 30 to 20 the minimum threshold of patients on which eligible providers (EPs) are required to report measure groups via a registry

CMS proposes to phase in the value modifier beginning in 2015 with groups of physicians with 25 or more eligible professionals. Calendar year 2013 will be the performance period for determining the value modifier to be applied in 2015, and 2014 will be used as the performance period for calendar year 2016. Providers who do not meet the PQRS satisfactory report criteria would have their value modifier set at –1 percent. This downward adjustment would be made in addition to the 1.5 percent payment adjustment that is required under the PQRS for failing to meet the satisfactory reporting criteria.

The revisions to the Medicare physician fee schedule have been released for display and can be found here. The regulation is to be published in the July 30 Federal Register.


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