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On July 6, 2012, the Centers for Medicare & Medicaid
Services (CMS) announced proposed changes to the Medicare Physician
Fee Schedule (MPFS) for services furnished by physicians during
calendar year 2013. These payment changes will affect different
specialties in different ways. For example, payments to family
physicians will increase by approximately 7% and to other
practitioners (including primary care physicians) of between 3% and
5%. By contrast, CMS proposes reductions in payments during 2013 to
physicians with certain other specialties. For example, payments to
anesthesiologists and cardiologists will be reduced by 3% in 2013.
The payment reduction to anesthesiologists and cardiologists,
viewed by CMS as "capital intensive" specialties, is
primarily due to a change in the assumed interest rates for
borrowings to purchase equipment and other capital items used in
those specialties.
Included within the proposed payment schedule is a new separate
payment to a patient's community physician or practitioner for
coordination of the care of patients during the first thirty (30)
days after discharge from a hospital or nursing home stay. This
represents the first time that CMS has proposed to pay for the care
required of patients as they transition back into the community
after a stay at a hospital or skilled nursing home. This discharge
transition care payment contributes 5% of the proposed 7% increase
in payments to family practitioners. In the announcement that
accompanied the proposed regulations, CMS noted that this payment
for discharge transition care management dovetails with the
Affordable Care Act mandated program to reduce payments to
hospitals that have excess readmissions for certain conditions.
CMS also noted that unless Congress acts to postpone (or repeal)
the previously scheduled payment reductions under the Sustainable
Growth Rate (SGR) methodology, payments under MPFS will be reduced
by approximately 27%. Since 2003, SGR cuts have been averted by
Congress.
Also included within the proposed rules are changes to several
previously implemented quality reporting initiatives and, as
authorized by the Affordable Care Act, a program in which physician
groups can participate on a voluntary basis through which their
payments are adjusted based on the quality and cost of care they
provide to their patients. Groups with 25 or more physicians that
elect not to participate in the physician quality reporting program
will be subject to a 1.0% payment reduction.
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