CMS Releases 2013 Medicare Physician Fee Schedule Rule; Proposes Fee Increases for Primary Care, Projects 27% SGR Cut July 10, 2012 Advocacy, Medicare, News, Payment 2013 Physician Fee Schedule, Medicare Physician Fee Schedule Rule, SGR 0 The Center for Medicare and Medicaid Services (CMS) released the proposed Medicare Physician Fee Schedule Rule for 2013. Click here to view the full 765-page regulation. Here are some of the highlights: Pursuant to federal law, CMS projects a 27% reduction in the Medicare FFS payment rate due to the Sustainable Growth Rate (SGR) formula unless Congress acts before January 1, 2013 to stop the cut. CMS is proposing significant payment increases for primary care. For instance, Family Medicine would receive a 7% rate increase, Internal Medicine a 5% rate increase, others 3%. Some specialists would be hit with minor reductions. The largest cut by far is to Radiation Oncologists, by 14%. There are no changes to the payment localities. However, CMS spent 100+ pages detailing why they could not make the changes this year, how they intend to continue to study the issue and ask for public comments again in the future. At CMA’s urging, CMS withstood the heavy lobbying from Iowa and the Midwest state medical associations to make changes to the practice expense and work GPCI allocations. Fortunately, there are no significant changes in this area. SFMS/CMA staff are reviewing the detail of the proposed rule and will post additional findings shortly. In addition, SFMS/CMA will be making its annual push to Congress during the Lame Duck Session in November to repeal the Medicare SGR FFS payment formula and stop the 27% cut. We are working closely with the AMA, state medical associations, and specialty societies to develop a unified game plan for November. The Senate Finance Committee has held extensive hearings on alternative payment methods this year and they plan to develop legislation before the end of the year. There have also been multiple bills introduced, most notably a package by Congresswoman Schwartz (D-PA – who comes from a family of physicians) and Congressman Joe Heck (R-NV), a physician, which is gaining attention and momentum. The Schwartz-Heck bill would repeal the SGR, provide a period of stability with regular payment updates while alternative payment methods are piloted and finally, implement any of the successful models. The downside to this promising legislation is that it would cut payments to physicians who do not participate in any of the new payment methodologies. SFMS/CMA will weigh-in on all of these Medicare payment packages. We are also working to authorize private contracting for seniors. Comments are closed.
