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CMS Sets 2014 Pay Rates for Hospital Outpatient and Physician Services

Cheryl Clark, for HealthLeaders Media, December 2, 2013

The new rules reflect changes in healthcare, says CMS, but hospital and medical groups express disappointment and call for attendant SGR reform.

The Obama Administration late Wednesday released two final rules dictating how doctors and outpatient hospital facilities will receive payment starting Jan. 1, 2014, and Jan. 1, 2015, with two key changes for physician fee schedules and outpatient payments.

Physician Fee Schedule Rule

In the first rule governing fees for physicians and other providers, primary care physicians and some non-physician providers will have a way to receive separate payments for care they provide to Medicare beneficiaries with two or more chronic conditions outside of the face-to-face visits—reimbursement for so-called chronic care management, starting Jan. 1, 2015.

"Health care is changing, and part of delivery system reform is recognizing this and making sure payment systems account for these changes," said Jonathan Blum, principal deputy administrator for the Centers for Medicare & Medicaid Services, in a news release announcing the new rule. The agency called the shift in payment philosophy "a milestone."

"We believe that successful efforts to improve chronic care management for these patients could improve the quality of care while simultaneously decreasing costs, through reductions in hospitalizations, use of post-acute care services, and emergency department visits."

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