CMS proposes fee schedule with 30% physician pay cut

Because it's required to release a proposed fee schedule that reflects current law, the Center for Medicare & Medicaid Services' (CMS) proposed rule, released on July 1, includes a 29.5 percent cut to physician fees for 2012. This proposed cut represents the 11th of its kind based on the sustainable growth rate (SGR) formula, which the American Medical Association and other physician groups say should be overhauled as part of the deficit reduction process. Changing the formula would cost an estimated $300 billion, with the figure rising with each passing year.

"This payment cut would have serious consequences, and we cannot and will not allow it to happen," said Dr. Donald M. Berwick, CMS administrator, in a statement. "We need a permanent SGR fix to solve this problem once and for all. That's why the President's budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix."

In addition, CMS has proposed to identify and correct "potentially misvalued codes," looking to determine whether evaluation and management (E/M) codes are undervalued and if some of the highest-expenditure non-E/M codes are undervalued, Internal Medicine News reports.

CMS also says it wants to extend its multiple procedure payment reduction policy to the professional component of advanced imaging services, which would reduce payment by 50 percent for subsequent procedures furnished to the same patient on the same day in the same session, resulting in an estimated $200 million in savings, according to the CMS.

In one area that expands reimbursement potential, CMS proposed quality and cost measures to establish a new value-based modifier that would reward physicians for providing higher quality, more efficient care. CMS is proposing to look at 2013 as the initial performance year for purposes of adjusting payments in 2015, as required by the Affordable Care Act.

Comments to the proposed rule can be submitted until August 30. The final rule is expected by November 1.

To learn more:
- read the press release from CMS
- see the article from Internal Medicine News

Related Articles:
Medicare reimbursement could be slashed 30 percent in 2012
Doc groups demand SGR fix as part of deficit reduction