New CMS Fee Rule Includes 1.1% Raise, Bonuses

Physicans could gain up to 5.1% total.

BY MARY ELLEN SCHNEIDER

< previous article | Table of Contents | next article >

Physicians will have the potential to gain as much as a 5.1% increase in their Medicare payments next year, according to a final rule issued by the Centers for Medicare and Medicaid Services.

The projected pay raise is a combination of the 1.1% payment increase mandated by Congress this summer, as well as a 2% incentive payment available for physicians who successfully participate in Medicare's voluntary pay-for-reporting program, and another 2% for those who implement electronic prescribing in their practices next year.

TO GAIN INCENTIVE PAYMENTS, PHYSICIANS WILL NEED TO PARTICIPATE IN THE PQRI AND MEET REQUIREMENTS FOR BEING A SUCCESSFUL E-PRESCRIBER.

The 2009 Medicare Physician Fee Schedule final rule was released Oct. 30 and will be published in the Federal Register on Nov. 19. In the final rule, the CMS estimates that total Medicare spending on the physician fee schedule for 2009 will reach $61.9 billion, up about 4% over 2008 projections.

Without the intervention by Congress over the summer, physicians would be facing a deep payment cut come January. As part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which was enacted in July, Congress eliminated a 10.6% pay cut scheduled to go into effect in July and another 5.4% cut scheduled for January.

By law, CMS officials are required to adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payments based in part on the gross domestic product. Over the past several years, Congress has stepped in to eliminate scheduled pay cuts under the formula. However, since the SGR formula has not been altered, over time physicians will face even more significant pay cuts unless Congress acts to change or replace the SGR.

In addition to the payment update and incentives provided in the final rule, the CMS is also making a technical change to how it calculates the statutorily required budget neutrality adjustment. Previously, the CMS has applied budget neutrality to work relative value units (RVUs), but under a mandate in the MIPPA, the agency now will make the adjustment to the conversion factor.

This change is expected to benefit primary care providers and others who provide cognitive services since increases to work RVUs were implemented in 2007 and 2008. However, the change is expected to result in lower payments for services with a significant practice expense element such as imaging and in-office procedures.

In order to acheive the incentive payments outlined in the new physician fee schedule final rule, physicians will need to successfully participate in the Physician Quality Reporting Initiative (PQRI) and meet the requirements for being a successful electronic prescriber.

The new e-prescribing initiative is similar to but separate from the PQRI, according to the CMS.

To earn an incentive payment for e-prescribing, physicians will need to report on Medicare's e-prescribing measure in at least half of applicable cases. In addition, physicians need to use a qualified system that is able to generate a medication list, allows health care professionals to print and transmit prescriptions electronically and conduct safety checks, provides information on lower-cost alternatives, and provides information on formularies and insurance authorization requirements.

Physicians who are able to meet the e-prescribing requirements can earn a 2% incentive in 2009 and 2010. The incentive will drop to 1% in 2011 and 2012, and 0.5% in 2013. And starting in 2012, there also will be penalties for not using e-prescribing. In 2012, the CMS will begin reducing physician payments by 1% for failing to use e-prescribing.

The physician fee schedule final rule also includes increased incentives for participating in the PQRI from 1.5% to 2% of covered professional charges. In addition, the CMS has added 52 new quality measures for a total of 153 available measures in 2009.

The new measures are related to the management of osteoarthritis, rheumatoid arthritis, back pain, coronary artery bypass graft, chronic kidney disease, melanoma, oncology, coronary artery disease, hepatitis, and HIV/AIDS.

The 2009 PQRI program is also offering more ways to report data. Physicians can continue to report data as part of Medicare claims or use a clinical registry.

In addition to the payment provisions, the final rule also includes some additional benefits for patients under Medicare.

For example, the final rule waives the Part B deductible for beneficiaries when they get their initial preventive physical exam or Welcome to Medicare Physical. The rule also broadens the scope of the initial physical to include end-of-life planning and body mass index assessments. These changes were mandated as part of the MIPPA.

Another change mandated by the MIPPA and included in the final rule is expanded coverage for preventive services recommended by the U.S. Preventive Services Task Force. Starting Jan. 1, the CMS will begin accepting requests for National Coverage Determinations based on evidence from the task force

< previous article | Table of Contents | next article >

Society for Vascular Surgery - 633 N. St. Clair, 24th Floor; Chicago, IL 60611; Phone: 312-334-2300 or 800-258-7188; Fax: 312-334-2320; Email: vascular@vascularsociety.org
© 2010 VascularWeb. All rights reserved. Use of the VascularWeb site constitutes acceptance of all of the policies, rules and regulations for the site.