The Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would increase payments to family practitioners by approximately 7 percent and other practitioners providing primary care services between 3 and 5 percent. The 7 percent increase for family practitioners continues the Administration’s policies to promote high quality, patient-centered care. For CY 2013, CMS is proposing to explicitly pay for care required to assist a patient transition back to the community following a discharge from a hospital or nursing facility. In addition, the proposed rule states that CMS would make a separate payment to a patient’s community physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay.
CMS also projects a significant reduction in MPFS payment rates under the Sustainable Growth Rate (SGR) methodology because of the expiration of the adjustment made for CY 2012 in the statute. For CY 2013, CMS projects a reduction of 27 percent.
The proposed rule would also continue the careful implementation of the physician value-based payment modifier (Value Modifier) that was included in the Affordable Care Act (ACA) by providing choices to physicians regarding how to participate. The Value Modifier adjusts payments to individual physicians or groups of physicians based on the quality of care furnished to Medicare beneficiaries compared to costs.
The proposed rule continues efforts by CMS to align quality reporting across programs to reduce burden and complexity. Also, proposed are changes to two quality reporting programs that are associated with the MPFS – the PQRS and the Electronic Prescribing (eRx) Incentive Program – as well as the Medicare Electronic Health Records (EHR) Incentive Pilot Program which promotes the use of health information technology. .
The proposed rule also includes:
- A proposal to include additional Medicare-covered preventive services on the list of services that can be provided via an interactive telecommunications system;
- A proposal to implement a durable medical equipment (DME) face-to-face requirement as a condition of payment for certain high-cost DME items;
- A proposal to apply a multiple procedure payment reduction (MPPR) policy to the technical component of the second and subsequent cardiovascular and ophthalmology diagnostic services furnished by the same doctor to the same patient on the same day;
- A proposal to collect data on patient function to improve how Medicare pays for physical and occupational therapy and speech language pathology services;
- A request for public comments on payment for advanced diagnostic molecular pathology services;
- A proposal to revise a regulation that only allows Medicare to pay for portable x-rays ordered by an MD or DO. The revised regulations would allow Medicare to pay for portable x-ray services ordered physicians and non-physician practitioners acting within the scope of their Medicare benefit and state law;
- A proposal to clarify when Medicare will pay for interventional pain management services provided by Certified Registered Nurse Anesthetists (CRNAs) when permitted by state law. This proposal will foster access to pain management services in areas where states have determined that CRNAs may provide these services.
The proposed rule will appear in the July 30, 2012 Federal Register. CMS will accept comments on the proposed rule until September 04, 2012. The final rule with comment period will be issued by November 1, 2012.
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