CMS proposes additional cuts, delays to 2009 physician fee schedule

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The Centers for Medicare & Medicaid Services (CMS) has proposed to reduce the 2009 Physician Fee Schedule by another 5.4 percent. Also, agency officials said it will not process any payments to physicians until July 15 at the earliest, leaving the congressionally mandated 10.6 percent reimbursement reduction uncertain.

Total Medicare spending under the 2009 Physician Fee Schedule is projected at $54 billion, down 5 percent from the $57 billion projected for 2008, according to CMS Acting Administrator Kerry Weems.

Medicare’s current fee schedule calls for a 10.6 percent cut in physician reimbursement, effective today. However, the Medicare program will not process any physician and non-physician practitioner claims or the first 10 business days in July, CMS said. The notification can be seen as an attempt to give Congress the opportunity to make final decisions on the reimbursement cuts after the recess.

On June 24, the U.S. House of Representatives passed the Medicare Improvements for Patients and Providers Act, by a veto-majority vote of 355-59, seeking to prevent the looming 10.6 percent physician payment cut called for by Medicare’s Sustainable Growth Rate formula that was set to go into effect July 1. Yet, the Senate fell two votes short of the 60 needed for passage on June 26.

CMS stated that nearly 95 percent of physicians enrolled in Medicare accept the fee schedule rate as payment in full. Medicare pays 80 percent of the fee schedule rate, while the beneficiary is responsible for the remaining 20 percent.

The agency also has proposed additional changes to the Physician Quality Reporting Initiative (PQRI), which allows eligible professionals to report quality measures relating to their clinical practice. The proposed changes for the 2009 PQRI Program include:

  • Proposing that the final set of quality measures will be selected from 175 measures that fall into four broad categories: 113 current 2008 PQRI measures; 17 new measures that have been endorsed by the National Quality Forum; 20 new measures that have been adopted by the AQA Alliance ; and 25 new measures proposed for 2009 contingent on NQF endorsement or AQA adoption by July 31;

  • Increasing the number of conditions covered by measures groups to nine, adding coronary artery disease, HIV/AIDS, coronary artery bypass surgery, rheumatoid arthritis, care during surgery and back pain, to the original measures groups for diabetes, chronic kidney disease and preventive care.?
  • Reporting options that include two new reporting periods (Jan. 1, 2009 to Dec. 31, 2009, or July 1, 2009 to Dec. 31, 2009) to provide eligible professions with additional options for reporting PQRI data; and?
  • Accepting PQRI data via clinical registries and EHR systems.

CMS said it will accept comments on the proposed rule until Aug. 29, and will respond to those comments in a final rule to be issued by Nov. 1.  The revised policies and payment rates will become effective Jan. 1, 2009.