HealthBlawg

David Harlow's Health Care Law Blog

    • Twitter
    • Facebook
    • LinkedIn
    • RSS
    • Email
  • About
  • Archives
  • Podcast
  • Press
  • Awards/Reviews
  • HIPAA
  • HCSM

MPFS 2012 — The 2012 Medicare Physician Fee Schedule is Finalized

November 7, 2011

CMS issued the final MPFS — the Medicare Physician Fee Schedule for 2012 — this past week. The key feature of the rule, for many folks, is the Sustainable Growth Rate-(SGR)-mandated 27.4% cut in Medicare professional serivces reimbursements. We now get to watch the drama unfold over the next eight weeks, as the MedPAC proposal to replace the SGR is bandied about, and the machinations of the supercommittee tasked with brokering a budget fix either do or do not get us closer to a reasoned approach to doing more with less.  The MedPAC idea is to drop the RBRVS conversion factor for specialty care payments 5.9% per year for two years, then hold it steady for 8 years, while keeping the primary care conversion factor flat for 10 years.  The net effect: physician payments will "only" double over the next 10 years.  (One clever idea squirreled away in the MedPAC report is that savings in the Medicare Shared Savings Plan (ACO) should be measured against a baseline of what Medicare would have spent on the care absent the changes in the proposed SGR fix — i.e., a higher baseline, with greater potential savings.  Another 50 clever ideas like this and we'll be talking about saving some real money.)

Well, the SGR will be fixed (or not) by Congress, not CMS.  The rest of the MPFS includes a variety of approaches to getting hands around the question of accuracy of the fee schedule.  For example, per the CMS presser:

  • CMS is expanding its multiple procedure payment reduction policy to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services.  This policy better recognizes efficiencies that are expected when multiple imaging services are furnished to the same patient, by the same physician or group practice, in the same session on the same day.
  • CMS is adopting criteria for a health risk assessment (HRA) to be used in conjunction with Annual Wellness Visits (AWVs), for which coverage began Jan. 1, 2011 under the Affordable Care Act.  The HRA is intended to support a systematic approach to patient wellness and to provide the basis for a personalized prevention plan. CMS is increasing AWV payment modestly to reflect the additional office staff time required to administer an HRA to the Medicare population.
  • CMS is expanding the list of services that can be furnished through telehealth to include smoking cessation services.  CMS is also changing the criteria for adding services to the telehealth list to focus on the clinical benefit of making the service available through telehealth.  This change will affect services proposed for the telehealth list beginning in CY 2013.
  • The final rule updates or modifies aspects of a number of physician incentive programs including the Physician Quality Reporting System, the ePrescribing Incentive Program and the Electronic Health Records Incentive Program.
  • The final rule also finalizes quality and cost measures that will be used in establishing a new value-based modifier that would adjust physician payments based on whether they are providing higher quality and more efficient care.  The Affordable Care Act requires CMS to begin making payment adjustments to certain physicians and physician groups on Jan. 1, 2015, and to apply the modifier to all physicians by Jan. 1, 2017.  CMS intends to work closely with physicians to ensure that efforts to improve the quality, safety, and efficiency of care do not diminish patient access to care.  The rule also finalizes CY 2013 as the initial performance year for purposes of adjusting payments in CY 2015.
  • The final rule also implements the third year of a 4-year transition to new practice expense relative value units, based on data from the Physician Practice Information Survey that was adopted in the MPFS CY 2010 final rule.

In addition, CMS is expanding the "potentially misvalued code initiative," an effort to ensure Medicare is paying accurately for physician services and more closely managing the payment system.

Finally, after struggling over time with varying requirements for lab test "requisitions" and "orders," which resulted in a CY 2010 requirement for a signed order prior to labs being drawn/done, CMS is backing off of that requirement, in response to comments detailing the ways in which this would reduce patient convenience and have the potential to negatively affect care.

Other issuances out the same day include the 2012 OPPS /ASC rule and the ESRD PPS rule.

David Harlow 
The Harlow Group LLC
Health Care Law and Consulting
 

 

Filed Under: Health care policy, Health Law, Medicare, Physicians

you might also like:

  1. 2007 Medicare physician fee schedule finalized

  2. MPFS in Crisis: Holding of Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule

  3. Medicare Physician Fee Schedule (2009 MPFS): Yes, there's a 5.7% cut, but it's packed with goodies like telehealth and gainsharing

« Accountable Care Organization Regulations – The ACO is a Camel, Not a Unicorn
Increasing Medicare Eligibility Age and the Law of Unintended Consequences »

Follow me on Twitter

David Harlow πŸ’‰πŸ˜· Follow 43,216 17,538

Mastodon @healthblawg@c.im #HealthCare #MedDevice #Compliance #Privacy @MyOmnipod #HIPAA #digitalhealth #HarlowOnHC #pinksocks Tweets are tweets No more no less

healthblawg
healthblawg avatar; David Harlow πŸ’‰πŸ˜· @healthblawg ·
6h 1639640904406544391

ICYMI> David Sand, CMO of ZeOmega, an #AI-infused engine for β€œpayviders” β€” Harlow on Healthcare https://healthblawg.com/2022/10/david-sand-zeomega.html?utm_source=twitter&utm_medium=social&utm_campaign=ReviveOldPost #digitalhealth #hcldr #hitsm

Image for the Tweet beginning: ICYMI>  David Sand, CMO Twitter feed image.
Reply on Twitter 1639640904406544391 Retweet on Twitter 1639640904406544391 1 Like on Twitter 1639640904406544391 0 Twitter 1639640904406544391
healthblawg avatar; David Harlow πŸ’‰πŸ˜· @healthblawg ·
7h 1639630885497769985

The latest Harlow On Health Care Daily #HarlowOnHC #digitalhealth #healthcare #innovation #privacy #hcldr Thx: @rwneilljr @chidambara09 @SarahClarkBDM #digitalhealth #ai

Image for twitter card

AI's growing impact on echocardiography

cardiovascularbusiness.com Cardiology has the second largest number of FDA-cleared AI algorithms, and many of them are ...

paper.li

Reply on Twitter 1639630885497769985 Retweet on Twitter 1639630885497769985 0 Like on Twitter 1639630885497769985 0 Twitter 1639630885497769985
healthblawg avatar; David Harlow πŸ’‰πŸ˜· @healthblawg ·
13h 1639535190774276096

ICYMI> Stephen Sweriduk, CMO of Shields Health Care on the evolution of diagnostic imaging β€” Harlow on Healthcare https://healthblawg.com/2022/01/sweriduk-shields-healthcare.html?utm_source=twitter&utm_medium=social&utm_campaign=ReviveOldPost #digitalhealth #hcldr #hitsm

Image for the Tweet beginning: ICYMI>  Stephen Sweriduk, CMO Twitter feed image.
Reply on Twitter 1639535190774276096 Retweet on Twitter 1639535190774276096 1 Like on Twitter 1639535190774276096 0 Twitter 1639535190774276096
Load More
Follow me on Mastodon

HIPAAtools

Hipaatools

The HIPAA Compliance Toolkit

The Walking Gallery

The Walking Gallery

Quick Links

  • Home
  • Categories
  • Archives
  • Podcast Interviews
  • HIPAAtools
  • HIPAA Compliance
  • Health Care Social Media
  • Speaking
  • In the Press
  • Blogroll

David Harlow

David Harlow

HealthcareNOW Radio

Connect with David

  • Twitter
  • Facebook
  • LinkedIn
  • RSS
  • Email
  • Subscribe
  • Contact
  • Book Me: Speaking
  • About
  • The Harlow Group LLC
Copyright © 2006–2023
HealthBlawg is a publication of The Harlow Group LLC. See Copyright notice and disclaimer.
Fair use with attribution and a link is encouraged. Click for more on David Harlow.
[footer_backtotop text="Back to top" href="#"]