CMS Releases Proposed 2012 Physician Payment Rule

Early last week, the Centers for Medicare & Medicaid Services (CMS) proposed a physician payment rule for 2013 that would reallocate payments for physicians to family and other primary care physicians by 7 and between 3 to 5 percent, respectively. The increase in pay come from redistributions and would result in proposed reductions in payments from other specialties. Specialists would take a cut in order to pay for the payment increase for primary care physicians, nurse practitioners and physician assistants. Specialties that would receive payment reductions include orthopedic surgery (1 percent), anesthesiology (3 percent), and neurosurgery (1 percent), among others.

The proposal for 2013 also contained a 27 percent cut in Part B payment rates as part of the sustainable growth rate (SGR) methodology. The proposed cuts are unlikely to occur however, as Congress is expected to intervene and pass legislation before the end of the year to avert cuts to reimbursements.

The rule also continues implementation of the physician value-based payment modifier (VBPM) that was included in the Patient Protection and Affordable Care Act (PPACA). The VBPM adjusts payments based on the quality of care furnished to Medicare beneficiaries compared to costs. The proposed rule would apply the modifier to groups of physicians with 25 or more eligible professionals and would provide an option for these groups to choose how the modifier would be calculated based on whether they participate in the Physician Quality Reporting System (PQRS). For groups of 25 or more that do not participate in the PQRS, CMS’ proposal sets their modifier at a 1 percent payment reduction.

To access CMS’ proposed rule, click here.

CMS Selects 89 New Participants for Shared Savings Program

CMS announced early last week that 89 new accountable care organizations (ACO’s) have been selected to participate in the second phase of the Medicare Shared Savings Program (MSSP). The newly selected organizations bring the total number of groups participating in Medicare shared savings initiatives to 154, 27 of which that are participating in the Medicare Shared Savings Program.

According to CMS, almost half of the new ACOs are physician-driven organizations serving fewer than 10,000 beneficiaries. Participation in an ACO is purely voluntary for providers, but each ACO must take responsibility for managing the health of at least 5,000 beneficiaries.

ACOs that are successful in providing high-quality care while reducing costs may share in the savings to Medicare. Quality is measured by performance on 33 measures relating to; carecoordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations and the patient experience of care.

Senator/MedPAC Concerned About Dual Eligible Program

In a letter sent to the Department of Health and Human Services (HHS), Senator Rockefeller (D-W. VA) Chair of the Senate Finance Committee’s Health Care Subcommittee, expressed his concerns over the potentially negative consequences of the Medicare/Medicaid dual eligible demonstration program.

Though supportive of the goals of the initiative, Senator Rockefeller stated that he feared that the current structure of the program runs contrary to the objectives he sought out when he wrote this section of the PPACA. Specifically, the Senator is worried that the demonstration places an emphasis on savings over quality care, and as a result, it could “erode beneficiaries’ rights and access to care,” and that more testing on the program needs to take place.

The MedPAC commissioners also sent a separate letter on July 11 to CMS’ acting Administrator Marilyn Tavenner, with similar concerns. In late May, the Alliance for Specialty Medicine sent Mrs. Tavenner a letter advising CMS to delay the implementation of the program – citing its concern over the potential adverse effects the program could have on access to specialty care for the dual beneficiary population.

To access the Alliance letter to CMS on Dual Eligibles, please click here.