CMS Releases Proposed 2014 Medicare Physician Fee Schedule and Hospital Outpatient Rule

 The Centers for Medicare and Medicaid Services (CMS) has released two proposed rules with important ramifications for cardiovascular professionals. These rules address Medicare payment and quality provisions for physicians  and hospital outpatient services  in 2014. The rules indicate that physicians will receive a more than 22 percent decrease in 2014 as a result of the legally mandated Sustainable Growth Rate (SGR) and that hospitals will receive a 1.8 percent increase in payment. As in previous years, the ACC continues to fight to avoid the physician payment cut. Aside from the across-the-board cuts associated with the SGR, CMS estimates that the physician rule will increase payments by 2 percent to cardiologists between 2013 and 2014. This estimate is based on typical practice and can vary widely depending on the mix of services provided in a practice. Some of the other most important proposals for cardiology contained in the rule include:
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  • A proposal to implement the elements of the American Taxpayer Relief Act of 2012 that indicate that participation in a clinical registry would also be considered participation in the Physician Quality Reporting System (PQRS). While the rule still needs more analysis, opportunities for physicians to participate using ACC registries should remain an option under this proposal.
  • A proposal to expand the Value-Based Purchasing Program to include all physicians in groups of 10 or more. In 2013, only physicians in groups of 100 or more are eligible for inclusion in the Value-Based Purchasing Program. In addition, physicians would no longer to be able to "opt in" to receive a bonus or penalty, but would instead be automatically opted into a payment adjustment.
  • A proposal to increase the threshold for successful reporting in PQRS from three measures to nine measures, covering three "domains" contained within the National Quality Strategy.
  • A proposal in the hospital outpatient rule to use new "cost centers" to determine payment for services and procedures. Although further analysis is required, this is likely to cause a decrease in payment for services that involve CT and MR and an increase for services that include implantable devices such as ICD and pacemaker.

Take a closer look at how the proposed Physician Fee Schedule and HOPPS rules will impact cardiology and stay tuned for ACC's comments that will be submitted at the end of the summer. In addition, physician payment, health reform and SGR will be hot topics of discussion with members of Congress as part of this year's Legislative Conference taking place Sept. 22-24 in Washington, DC. Don't miss this opportunity to ensure the voice of cardiology is heard on Capitol Hill.

Keywords: Value-Based Purchasing, Health Care Reform, Outpatients, Centers for Medicare and Medicaid Services, U.S., Fee Schedules, United States

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