Medicare Physician Payment Rule Factors in GPCI

The Patient Protection and Affordable Care Act established the value modifier, which in 2014 will pay physicians more than the Medicare fee schedule if they successfully report on quality measures and spend less than the national average per patient. It will also pay physicians less if they spend more than the national average and do not successfully report on quality measures.

• Multiple procedure cuts. In response to comments from AMA, the AMA/Specialty Society RVS Update Committee (RUC), and many specialties, CMS scaled back its proposal to apply a 50% reduction to the professional component (PC) of certain imaging services. Instead, the rule applies a 25% reduction to the payment for the PC of second and subsequent CT, MRI, and ultrasound services furnished by the same physician on the same patient in the same session on the same day.
• Lab test signatures no longer required. CMS has retracted the requirement for physicians to sign paper lab requisitions for clinical diagnostic laboratory tests-a policy AMA strongly opposed.
• Annual wellness visit (AWV) changes. CMS is increasing the payment for the AWV codes to recognize additional resources associated with adding a health risk assessment to the service's requirements, but is continuing its policy of not covering a physical exam as part of these services.
• RUC. In a significant accomplishment, the RUC persuaded CMS that the resources involved in hospital observation care visits and hospital inpatient visits are equivalent. CMS also accepted the vast majority of the RUC's recommendations. However, the RUC had recommended that CMS begin paying for telephone calls, anticoagulant management, team conferences, and patient education in 2012. CMS did not announce any plans to consider payment for these services, but emphasized that the agency will continue to work with stakeholders to ensure that care coordination and primary care services are appropriately recognized.

The payment impact by specialty is available online. The fee schedule and additional information is available on CMS' website at www.cms.gov/physicianfeesched.

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