Medicare payments to rheumatologists will stay about the same next year under the proposed 2013 Medicare physician fee schedule.
The fee schedule proposal, which was published in the Federal Register on July 30, outlines the allowed charges for physician services under Medicare, as well as new payment policies. Officials at the Centers for Medicare and Medicaid Services (CMS) estimate that on average there will be no change in the payments to rheumatologists in 2013.
Dr. Charles King II, a rheumatologist in Tupelo, Miss., and chair of the Committee on Rheumatologic Care for the American College of Rheumatology, said some rheumatologists would lose money next year if they get hit with penalties for failing to meet requirements in Medicare’s e-prescribing and electronic health record programs.
"At best it would be a neutral proposition for us," Dr. King said.
Rheumatologists will likely miss out on a payment increase proposed for physicians who provide primary care services. Under the 2013 fee schedule proposal, CMS is seeking to pay physicians for coordinating the care of their patients who have been discharged from a hospital or nursing home.
Medicare proposes to create a new G code that would allow physicians to bill for postdischarge transitional care services such as obtaining and reviewing the patient’s discharge summary; reviewing diagnostic tests and treatments; updating the medical record within 14 business days post discharge; establishing a new care plan; educating the patient or caregiver within 2 business days post discharge; and communicating with other health care providers.
The G code would apply when a Medicare beneficiary is discharged from an inpatient hospital, a skilled nursing facility, an outpatient hospital observation unit, partial hospitalization services, or a community mental health center.
Officials at CMS estimate that the use of the new G code could increase payments to family physicians by 7% and to internists by 5% starting in January 2013.
Dr. King said it’s unlikely that rheumatologists would be able to take advantage of the proposed G code for postdischarge transitional care services. However, the ACR plans to ask CMS to consider allowing rheumatologists to bill for some of the other non–face-to-face care coordination work that rheumatologists perform on a regular basis.
The 765-page fee schedule proposal also details the 27% across-the-board cut to physician fees scheduled to take effect on Jan. 1. The reduction is required by law, based in part on spending targets set under the Sustainable Growth Rate (SGR) formula, which links fees to changes in the gross domestic product.
That formula has been criticized by physicians and lawmakers for years. While no long-term solution to the SGR problem has ever gained traction, lawmakers have taken short-term measures to keep the physician fee cuts from going into effect over the last several years.
Dr. King said he doesn’t believe the 27% cut will become a reality in 2013 either. "I don’t think there’s a person alive who thinks that cut is going to go through," he said.
But the uncertainty that accompanies the yearly ritual of passing a short-term patch for the cut is creating an enormous burden on physicians, he said.
The 2013 fee schedule proposal also outlines the implementation of the physician value-based payment modifier, which adjusts physician payments based on the quality and cost of the care they provide. The program, which was mandated under the Affordable Care Act, will be phased in over 3 years starting in 2015.
The proposed rule would implement the physician value-based payment modifier for all medical groups with 25 or more eligible providers starting in 2015.
Groups that do not participate in the Physician Quality Reporting System would see a 1% cut in Medicare payments. Groups that do participate would be paid in part based on their performance. Groups with higher quality and lower costs would be paid more, and those with lower quality and higher costs would be paid less, according to CMS. The payment adjustments made in 2015 will be based on 2013 performance in the PQRS.
CMS will accept public comments on the proposed rule until Sept. 4. The agency plans to finalize the rule by Nov. 1.