New Rules Are Out! Last week, the Centers for Medicare and Medicaid Services (CMS) released two final regulations of note to cardiovascular professionals. These rules determine the payment levels and associated policies for services provided under the Physician Fee Schedule and the Hospital Outpatient Prospective Payment System. Overall, the rules indicate a 1.7 percent increase in payment for hospital outpatient services and a 24 percent decrease in physician fee schedule services. The large overall decrease in physician payments is associated with the long-standing Sustainable Growth Rate (SGR) formula. The ACC continues to urge Congress to permanently address this issue. See more on that issue here. Changes unrelated to the SGR result in a 1 percent increase for services provided by cardiologists.
In addition to the overall payment changes, there are a number of provisions of particular importance for cardiovascular professionals, including the following:
- Payments to hospitals for many common services provided in the outpatient setting will be packaged into office visits also provided in the hospital setting as well as packaged into other major hospital services. This includes all laboratory services. CMS had proposed packaging some imaging services such as echocardiography but did not finalize this proposal as a result of significant lobbying work by ACC and the American Society of Echocardiography pointing out the folly of such an action. In a similar policy, CMS will pay the same for all outpatient clinic visits, no longer recognizing different levels of service for evaluation and management. This applies to hospital services only. Different physician payment rates for the varying levels of evaluation and management services remain in place.
- Payments to hospitals for the technical components of SPECT and echocardiography services in the hospital will increase and payments for many CT and MR services will decrease due to technical changes associated with how costs are categorized in the hospital system. Payments for the physician interpretation will not substantially change.
- CMS had proposed that hospital outpatient payments for device-intensive cardiovascular services, such as PCI and ICD placement, be paid on a bundled basis referred to as a "comprehensive APC" that is similar to the DRG payment system used for inpatient services, rather than being paid for each individual APC code. CMS finalized this proposal but delayed the implementation date to 2015.
- CMS deferred a proposal to cap practice expense payments for services provided in the office so that the total payment would not exceed the amount Medicare would pay for the same service in the hospital. This change would have cut the physician payment for a number of lower extremity revascularization services by an average of 40 percent.
- Physician groups of 10 or more providers (includes MD/DO, PA, NP) will have their payment adjusted under the value-based modifier in 2016. The payment adjustments will be based on cost and quality data for patients seen during 2014.
- Physicians will have expanded opportunities to use registries to participate in the Physician Quality Reporting System (PQRS) program. Expect more from the ACC's National Cardiovascular Data Registry (NCDR®) regarding opportunities for this in coming months.
More information on this regulation will be available as ACC staff reviews and analyzes it. The ACC has developed several resources to help you navigate the 2014 rule: