A look at proposed 2014 Medicare payment, quality provisions

The Centers for Medicare & Medicaid Services (CMS) recently 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.

Aside from the more than 22 percent across-the-board cut associated with the legally mandated Sustainable Growth Rate (SGR), CMS estimated 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. The American College of Cardiology (ACC) has identified some of the other important proposals for cardiology:

  • 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 on CardioSource.org.