CMS fee schedule favors PCPs, and cardiologists face cuts

The Centers for Medicare & Medicaid Services (CMS) has released final rules with changes in Medicare’s payment of physician fees, including what the American College of Cardiology (ACC) described as cuts to “important cardiovascular services.”

One final rule will raise payments to primary care physicians (PCPs) serving Medicaid beneficiaries. Under this provision, certain physicians who provide eligible primary care services will be paid Medicare rates in effect in calendar years 2013 and 2014 instead of state-established Medicaid rates, which may be lower than federally established Medicare rates.

“By improving payments for primary care services, we are helping Medicaid patients get the care they need to stay healthy and treat small health problems before they become big ones,” said U.S. Department of Health and Human Services' Secretary Kathleen Sebelius in a release.

Based on the final rule, a patient’s physician or practitioner will be paid for coordinating the patient’s care 30 days following a hospital or skilled nursing facility stay. The changes are expected to increase payment to family practitioners by 7 percent and other primary care practitioners by 3 to 5 percent “if Congress averts the statutorily required reduction in Medicare’s physician fee schedule,” according to CMS.

CMS added that under the Balanced Budget Act of 1997’s sustainable growth rate (SGR) formula, Medicare payment rates for more than a million physicians and non-physician practitioners could be cut across the board by 26.5 percent, but the agency noted that Congress has overridden the requirement annually since 2003.

ACC President William Zoghbi, MD, warned that fee changes and SGR uncertainties could affect cardiovascular care. “This year’s final rule cuts payments for important cardiovascular services at a time when many cardiology practices are already vulnerable,” he said in a release. “Further cuts in reimbursement targeted at physicians only will make healthcare delivery unsustainable. Furthermore, the ongoing uncertainties about Medicare payments that are a direct result of the SGR formula make it nearly impossible to plan and invest in the future.” 

Other rule items include implementation of the physician value-based payment modifier and provides an option for groups of physicians to choose how the value modifier is calculated based on whether they participate in the Physician Quality Reporting System (PQRS). The rule makes changes to the PQRS and the Electronic Prescribing (eRx) Incentive Program and updates the Medicare Electronic Health Records Incentive Pilot Program. It also laid out next steps to enhance the Physician Compare website, including posting names of practitioners who, as part of the Million Hearts campaign, successfully report measures to prevent cardiovascular diseases.

The final rules will be published on Nov. 16 and comment periods will close on Dec. 31. Payment changes are scheduled to go into effect in January 2013.