Medicare Physician Payment Rule Factors in GPCI

HCPro Staff for HealthLeaders Media, February 10, 2012

The final 2012 Medicare physician payment rule from CMS includes an adjusted fee schedule for the Geographic Practice Cost Index (GPCI) that some industry leaders say is a great deal more fair to many physicians.

As a result of intense lobbying by the California Medical Association (CMA), CMS adjusted the fee schedule so that a larger percentage (3%) of the payments are adjusted for geographic differences in practice costs. This adjustment prevented large cuts in 2012 and will help California physicians in future years.

CMA provides the following summary of other major changes in the fee schedule:

  • E-prescribing. CMS finalized its proposal for the 2012 and 2013 incentive, and 2013 and 2014 penalty programs. Despite continued CMA and AMA opposition, physicians will need to report 10 times during the first six months of 2012 and again in 2013 to avoid application of e-prescribing penalties in subsequent years.

Physicians may use claims-, registry-, or electronic health record (EHR)-based reporting methods. Improvements to the program, which the CMA and AMA supported, include allowing the use of a certified EHR to e-prescribe and making it easier to avoid the penalties by (1) not requiring physicians to link the e-prescribing codes to qualifying visits, and (2) allowing physicians to apply for additional hardship exemptions online.

  • Physician Quality Reporting System (PQRS). In response to CMA/AMA advocacy, CMS finalized its proposal to provide interim feedback reports for physicians reporting individual measures and measure groups through claims-based reporting for 2012 and beyond. These reports will be a simplified version of the annual feedback reports that CMS currently provides and will be based on claims for the first three months of each program year.
Facebook icon
LinkedIn icon
Twitter icon