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Physician Fee Proposal Generates Calls for Changes

Margaret Dick Tocknell, for HealthLeaders Media, September 10, 2012

A proposed rule from the Centers for Medicare & Medicaid Services  to set  the Medicare physician fee schedule for 2013 drew more than 2,900 comments from a variety of stakeholders.

While there was general support for many of the provisions in the 765-page proposed rule, the comments provide insight into the complicated fee structure that providers must contend with in the delivery of healthcare services to Medicare beneficiaries. The comment period ended Sept. 6.

As first proposed in July, CMS says the changes to how fees are calculated would increase payments to family physicians by 7% while payments for other primary care practitioners would increase by 3% to 5%.  On the surface that’s good news but commenters also took issue with the complicated calculations required to arrive at the payment increase.

Other provisions of the proposed rule would update payments for Medicare Part B drugs, add Medicare-covered services that can be provided via telehealth, clarify when Medicare will pay for interventional pain management provided by certified registered nurse anesthetists, and implement portions of the Patient Protection and Affordable Care Act by establishing a face-to-face encounter as a condition of payment for certain durable medical equipment items, and provide additional payments for care coordination.

Based on a sample review of 25 comments from a mix of stakeholders, comments focused on six broad areas: care coordination, misvalued codes, multiple procedure payment reductions, Medicare telehealth services, scope of practice for certified registered nurse anesthetists, and the physician value-based payment modifier. All comments are available on regulations.gov.

Care coordination
In an effort to advance care coordination and reduce hospital readmissions, the proposed rule calls for CMS to make a separate payments to coordinate patient care for those critical 30 days following a stay at a hospital or skilled nursing facility. Reaction to this proposal was surprisingly mixed. Stakeholders support the idea of care coordination but have some problems with its implementation.

While the Medical Group Management Association (MGMA) supports post-discharge care management, it is concerned that CMS will pay for this new service "by decreasing reimbursement to specialties outside of primary care." The group wants CMS to "explore ways to pay for this service using the actual savings it will achieve under Part A."

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