In an effort to help primary care doctors, the Centers for Medicare and Medicaid Services (CMS) has proposed a rule to increase pay to family physicians by seven percent, and also to pay other primary care physicians between three and five percent more. This proposed rule will be part of the updated payment policies under the Medicare Physician Fee Schedule (MPFS), which will be effective in the calendar year of 2013. Medicare pays more than one million physicians and practitioners that provide essential health care to recipients of Medicare under the MPFS.

The aim of the payment increase under MPFS is to promote high quality, patient centered care. As a part of this new rule, CMS is proposing to pay for the care required for a patient to transition back to society after discharge from a hospital or nursing facility stay. To outline this plan, CMS suggested making a separate payment to the patient's community physician or practitioner to set-up patient care for 30 days following a hospital or nursing facility stay.

In an effort to improve overall quality, the public has been asked to comment on how Medicare can identify the full range of services provided by physicians and practitioners, either by face-to-face meetings or out of office patient care.

Every year since 2002, under the Sustainable Growth Rate (SGR), there have been significant reductions in MPFS payment rates. For the calendar year 2013, reduction is expected, due to the expiration of the adjustments made for 2012. CMS predicts a 27 percent reduction, and by law, will need to factor this into their calculations. Congress has managed to deflect cuts every year since 2003.

The current Administration has promised to "fix the SGR formula in a responsible way".

Implementation of the "Value Modifier"

The proposed rule also implements the Value Modifier, a part of the Affordable Care Act, by giving choices to physicians on how to participate.

The Value Modifier works by basing quality of care given to Medicare patients compared to costs and adjusting payments to individual or group physicians.

CMS will gradually phase in the Value Modifier over three years, from 2015 to 2017. For physician payment rates in 2015, the rule would apply the Value Modifier to groups of physicians with 25 or more professionals.

There is also an option for these groups to choose how the Value Modifier will be calculated if they participate in the Physician Quality Reporting System (PQRS).

Groups that meet these requirements, and choose not to participate in the PQRS, will have a Value Modifier of 1.0 percent payment reduction.

For those participating in the PQRS, groups with higher quality and lower costs would be paid more and groups with higher costs and lower quality would be paid less.

Lastly, the proposed rule strives to align quality reporting to reduce burden and complexity. The rule suggests changes to two quality reporting programs. The proposal by the PQRS includes lower burden, simplified options for reporting, and also coordinating quality reporting along the various programs in support of the National Quality Strategy. In addition, the proposed rule also addresses plans to update the Physician Compare Website to give recipients more information when choosing a physician.

The proposed rule will also include:
  • Medicare covered preventive services via an interactive telecommunications system.

  • As a requirement for certain high cost Medicare durable medical equipment items, a face-to-face meeting as a condition for payment.

  • A multiple procedure payment reduction furnished by the same doctor to the same patient on the same day.

  • Data collection on physical and occupational therapy and speech language pathology services.

  • Public comments on payment for advanced diagnostic molecular pathology services.

  • Revisions allowing Medicare to pay for portable x-ray services ordered by physician and non physician practitioners within the scope of Medicare benefit and state law.

  • Clarification that Medicare will pay for interventional pain management services provided by CRNA's when permitted by state law.
The proposed rule will appear in the July 30, 2012 Federal Register. Comments on the proposed rule will be welcomed up to 4th September, 2012. CMS says it will respond to them in a final rule with comment period to be issued by Nov. 1, 2012.

Written by Kelly Fitzgerald