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Medicare Physician Payment Rule Factors in GPCI

HCPro Staff for HealthLeaders Media, February 10, 2012

The interim feedback reports will be provided to physicians during the summer of each program year. Despite strong opposition from the physician community, CMS finalized its proposal to use 2013 as the reporting period for the 2015 PQRS penalty. If CMS determines that a physician or group practice has not satisfactorily reported quality data for the 2013 reporting period, then its 2015 payments will be reduced 1.5%. The rule also redefined "group practice" under the Group Practice Reporting Option as a group of 25 or more eligible professionals.

  • Value modifier. While acknowledging the strong opposition of CMA, AMA, and others in organized medicine, CMS finalized its proposal to base payment adjustments in 2015 on yet-to-be-determined cost and quality measures to be finalized in November 2012. Quality measures for the modifiers will most likely be based on PQRS and EHR measure sets.

Cost measures to be used in the modifier will be based on average total per capita cost for the physician's patients and per capita cost for four conditions (chronic obstructive pulmonary disease, heart failure, coronary artery disease, and diabetes). CMA will continue to oppose the value modifier payment methodology and urge Congress to withdraw it.

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1 comments on "Medicare Physician Payment Rule Factors in GPCI"


MediTouch EHR (3/5/2012 at 7:56 PM)
The financial adjustment to Geographic Practice Cost Index (GPCI) will greatly benefit physicians in California and around the country, and most importantly it will help <a href="http://www.healthfusion.com/eprescribing.asp">ePrescribing (eRx)</a>. Without the redistribution provided by GPCI, e-prescribing adoption would face a much more difficult path, especially in such a large, powerful state (California).