2012 Medicare Payment Rate Changes for Physician Fee Schedule

On July 1, CMS (Center for Medicare & Medicaid) issued a proposed rule that represents a 29.5% cut to Medicare physician payments unless Congress steps in to correct it.

See the CMS press release at http://go.cms.gov/kssRvx

Dr. Donald Berwick, head of CMS was quoted in the press release saying, “This payment cut would have serious consequences, and we cannot and will not allow it to happen,” said Dr. Donald M. Berwick, CMS administrator, in a statement. “We need a permanent SGR fix to solve this problem once and for all. That’s why the President’s budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix.” Physicians groups have clamored for the SGR (Sustainable Growth Rate) formula to be overhauled as part of the deficit reduction process, but that would also come with a $300BB price tag.

Some provisions of the proposed rule include:

• Physician Quality Reporting System (PQRS) – adding 26 new measures

• Value-based modifier-CY 2013 as the initial performance year

• Meaningful use

• Misvalued code Initiative

• Payment for certain Part B drugs

• 2012 e-prescribing incentive

• Multiple procedure payment reduction (MPPR)

• Physician payment during 3-day payment window

Comments are due back to CMS before August 30th. The final rule is expected by November 1st.