Breaking news! The Centers for Medicare and Medicaid Services (CMS) today released the final 2012 Medicare Physician Fee Schedule, which sets payment levels and other associated policies for next year. This wide-ranging rule covers a number of issues of importance to the cardiovascular community. As required by current law, physicians will receive a 27.4 percent cut in overall Medicare payments, barring any Congressional action. (Read more on this topic in a new blog post by ACC CEO Jack Lewin, MD.) Outside of the legally mandated cuts associated with the SGR, the rule is estimated by CMS to have a -2 percent impact on payments to cardiologists. However, individual impacts will differ substantially based on the mix of services provided by a practice.
The rule includes the following items related to payment for specific cardiovascular services:
- Physicians will no longer report separate removal and replacement codes when replacing pulse generators on pacemakers and ICDs and will instead report a single code for the combined service. The result of these coding changes and subsequent valuation efforts is an approximately 29 percent drop from current rates of payment.
- Payment rates for the professional component of advanced imaging services (CT, MR, ultrasound) provided by the same physician on the same day will be reduced by 25 percent for the second service. CMS had proposed to reduce these payments by 50 percent in the proposed rule released in July - a cut that was strongly criticized by your ACC and other organizations. However, CMS indicates that it will consider reductions for other services provided by the same physician on the same day in the future.
The rule also details a series of policies that will help to determine payment adjustments in the future. Highlights include:
- Physicians who did not report electronic prescribing in the first half of 2011 or who do not file a hardship exemption by Nov. 8 will receive payments that are 1 percent lower than indicated by the physician fee schedule. Physicians who successfully reported their use of e-prescribing in 2011 will avoid a penalty in 2013. Those who did not successfully report in 2011 can avoid the 2013 penalty by reporting e-prescribing at least 10 times between Jan. 1, 2012 and June 30, 2012.
- Physicians successfully participating in the Physician Quality Reporting System (PQRS) will receive a 0.5 percent bonus on all Medicare payments for 2012. This bonus will continue the next two years and transition to a penalty in 2015. However, the penalty in 2015 will be based on 2013 participation, similar to the e-prescribing penalty. Cardiologists will be required to report on at least one "core measure" rather than being able to select from all available measures.
- CMS has begun to finalize details related to the planned expansion of public reporting of physician quality and the use of performance data to adjust payment starting in 2015.
The ACC will continue to work with CMS throughout the year to ensure that decisions made by the agency continue to allow access to high quality cardiovascular care.
Questions/Comments contact
advocate@acc.org
.