Medicare's 2013 Proposed Fee Schedule: The Physician Impact

Every year CMS publishes the Medicare Physician Fee Schedule (MPFS) for the coming calendar year. On July 9, CMS issued the proposed MPFS for calendar year 2013. These proposed rules can greatly impact physicians, both positively and negatively.

Some of the key elements of the 2013 MPFS which are likely to impact physicians include the following:

1. Medicare has proposed a 7 percent increase in payments to family physicians. Other types of primary-care practitioners would see increases between 3 percent and 5 percent. These increases are in line with the government’s stated effort of improving preventative care. Unfortunately, certain other specialties face decreases in reimbursement as a result.

2. The MPFS includes an interesting proposal to allow payment to practitioners for care related to transitioning the patient back to the community during the 30- day period following discharge from a hospital or nursing facility. This focus on patient transitioning is an effort to decrease re-hospitalizations, which are costlier than payments for proper transition care. This could, in fact, be a source of additional income for physicians focusing on patient rehabilitation and geriatric care.

3. The proposed rule would add a face-to-face requirement as a condition of payment for certain high-cost Medicare DME items. This rule is likely intended to make it more difficult for providers to be reimbursed for DME traditionally dispensed by ancillary staff. It’s important that physicians consult with counsel to be sure that all dispensing is in accord with federal laws.

4. Multiple procedure payment reductions are proposed on the technical component of second and subsequent cardiovascular and ophthalmology diagnostic services furnished by the same doctor, to the same patient, on the same day. The professional component from any doctor in a practice performing second and subsequent CT, MRI, or ultrasound scans on the same patient on the same day will be reduced by 25 percent. Since patients receiving multiple scans are often the most ill, this modification could significantly impact patient care as well as the reimbursement of those groups that care for them. Although it’s likely this rule was intended to prevent excessive and unnecessary testing, without additional qualification it is likely to create hardship for patients legitimately requiring multiple same-day diagnostic tests.

5. CMS has also proposed reduced payments for the technical component of two kinds of radiation therapy: intensity-modulated radiation treatment (IMRT) and sterotactic body radiation therapy (SBRT). According to the American College of Radiology, this would mean technical component cuts up to 28 percent for IMRT and 40 percent for SBRT.

5. On a positive note, CMS has increased the number of services that will be covered when provided via an interactive telecommunication system. As telemedicine continues to grow, this expansion will be welcomed by many physicians, although it primarily still relates to preventative care.

6. Medicare will cover portable X-rays ordered by non-physician practitioners acting within the scope of the patient’s Medicare benefit and state law. Currently, only MDs or DOs can order portable X -rays. This change will be particularly important in rural or healthcare shortage areas where patients are largely serviced by non-physician practitioners.

7. A proposal to clarify when Medicare will pay for interventional pain management services provided by CRNAs is also included in the MPFS. This provision is a means of extending access for more patients to pain management services in areas where states have determined that CRNAs may provide these services.

There is much more to the proposed MPFS and the above is merely a summary of some key points impacting physicians. Additionally, all of the proposals are subject to commentary by September 4, 2012 before being finalized November 1, 2012. Physicians impacted by these proposed rules should consider responding before the deadline. You can see the rule here prior to formal publication on July 30, 2012.

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