CMS to Cut Physicians' Medicare Payments 26.5% in 2013 Unless SGR Bypassed

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CMS has issued its final rule on the Medicare physician fee schedule (pdf) for 2013, saying Medicare reimbursement rates for physicians will be slashed by 26.5 percent on Jan. 1, 2013, unless Congress bypasses the sustainable growth rate.

Here are six primary points from CMS' final rule, many of which carried over from the proposed rule in July.

•    Sustainable growth rate. The SGR, which is the formula used to adjust Medicare physician payment rates, is currently expected to cut physician rates by 26.5 percent. However, every year since 2003, Congress has temporarily bypassed the SGR to ensure there would be no cuts to physician Medicare payments, and another temporary "doc-fix" is likely this year during a lame duck session.

•    Primary care emphasis will stand. Primary care physicians and extenders will see increased payments next year, assuming there is an SGR fix, as the final rule solidified new policies in total allowed charges. Family practice physicians will see the largest Medicare payment increases at 7 percent, and several other primary care providers — such as internal medicine physicians, pediatricians, and nurse practitioners — will see payment boosts ranging from 3 to 5 percent. The total allowed charges figures are similar to those that were in the proposed rule.

As stated in the proposed rule, CMS also said a new policy will pay a patient's physician or practitioner to coordinate care in the 30 days following a hospital or skilled nursing facility stay.

•    Specialists will still see reduced charge rates. The proposed rule stated that many specialty physicians will see their Medicare rates decrease, and that carried forward in the final rule as well. Here are some of following specialties that will see the biggest decreases in Medicare total charge rates/payments: independent laboratory providers (14 percent), neurologists (7 percent), radiation oncologists (7 percent), pathologists (6 percent), interventional radiologists (3 percent) and cardiologists (2 percent).

•    Physician value-based payment modifier and Physician Quality Reporting System. CMS said it will apply the value-based payment modifier — which is a tool that provides different Medicare payments to physicians based on quality of care and cost of care comparisons — to groups that have 100 or more physicians in 2015 instead of groups of 25 or more in the proposed rule.

•    Information technology. The final rule also expanded Medicare telehealth services and simplified reporting within the Medicare Electronic Health Records Incentive Pilot Program for physicians.

•    Certified registered nurse anesthetists. Medicare will now pay CRNAs for providing all services that are allowable under state law and within the full extent of their state's scope of practice.

More Articles on the Medicare Physician Fee Schedule:

SGR Update: How Much is the Repeal Cost for 2012?

Physicians Go to Capitol Hill to Testify on Medicare's Physician Payment System

6 Points on the Medicare Physician Fee Schedule Proposed Rule for 2013

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