- RESOURCES & EDUCATION
- PRACTICE MANAGEMENT
On May 10, the Senate Finance Committee held the first in a series of hearings focused on Medicare physician payment and potential reforms that could be implemented to address the Medicare Sustainable Growth Rate (SGR) formula and current payment system. Additional roundtables will examine the perspectives of the private sector health plans and physicians. The roundtable entitled, “Medicare Physician Payments: Understanding the Past So We Can Envision the Future,” reviewed the history of the SGR formula and its flaws. The panel included four former Centers for Medicare & Medicaid Services (CMS) administrators: Tom Scully J.D., Mark McClellan, M.D.,Ph.D., Bruce Vladeck, Ph.D., and Gail Wilensky, Ph.D. There was universal agreement among the participants that the SGR needs to be repealed. The witnesses and members of the Senate Finance Committee discussed the merits of various new models, including capitated and bundled payments and coordinated care models all incorporating quality of care measures as a long-term solution. The panelists all agreed there is no viable alternative to the current system, which is ready to be implemented and, suggested that in the short-term, Congress should direct CMS to revise the current system to better reflect physician treatment patterns and reward doctors for providing quality care. At the conclusion, Senate Finance Committee Chairman Max Baucus (D-MT) requested that the panelists provide the committee with short-term and long-term recommendations for resolving the SGR problem.
The House Ways & Means Committee have also asked physician groups, including ASCRS, for their ideas on reforming the system. The specific questions from the committee focus on use of quality and outcome measures; utilizing electronic health records and patient registries; experiences with alternative methods, such as bundled payments and shared savings models; regulatory burdens that impact physicians and their ability to treat beneficiaries; and possible alternatives to fee-for-service. The comments are due to the committee on May 25.
This week, Senate Majority Leader Harry Reid (D-NV) took procedural steps to begin consideration of the FDA drug & device user fee reauthorization bill (S. 3187) next week. The Administration offered strong support for the legislation. The bill, which is similar to the House bill (H.R. 5651), reauthorizes the user fee programs that help fund the FDA’s reviews of medical devices and prescription drugs, along with additional FDA reforms. Majority Leader Reid repackaged the original committee approved bill and added new provisions regarding rare and pediatric disease drug development and reporting requirements for medical mobile applications.
He also encouraged senators to file amendments to the bill if they have concerns, but not hold up the legislation. Stakeholders and members of Congress also continue talks focused on reaching agreement on a few provisions for inclusion in a manager’s amendment. Members of the House of Representatives are also continuing to make small changes to their version of the bill, which could be considered by the full House at the end of May. The goal is to send the final bill to the President by the beginning of July.
As part of the recently released Medicare Regulatory Reform Rule, effective July 16, ASCs will no longer be required to stock a CMS-mandated list of emergency equipment, but will be free to assemble the tools most necessary for their own specific patient population and procedures. The conditions for coverage (CfC) for ASCs currently require them to have available in the operating room a prescribed list of emergency equipment. The revised CfC requires each ASC's governing body and medical staff to determine, in accordance with standards of practice, which equipment must be on hand to maintain safety and ensure rescues. This adaptation emerged from CMS's awareness that some of the equipment requirements are outmoded, and not all specified equipment is necessary for the particular emergency needs of every ASC.
CMS updated its Physician Compare website to include a new Group Practice option including Search, Compare, and Profile pages. The new features allow users to search by Group Practice name, get maps and directions, and do side-by-side comparisons of Group Practices. Physician Compare includes data on individual providers including practice phone numbers and addresses, Medicare participation status and education information, and participation status in the Physician Quality Reporting System and e-prescribing incentive program. The information is based on data found in the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). Therefore it is imperative that physicians and other health care professionals keep their Medicare enrollment information up-to-date.
CMS is requesting that providers review the new Group Practice comparison feature and provide feedback to PhysicianCompare@Westat.com.
In early March, CMS sent quality and resource use reports (QRURs) to nearly 24,000 physicians in Iowa, Kansas, Missouri, and Nebraska. Washington Physician Services (WPS), the Medicare contractor in Iowa, Kansas, Missouri, and Nebraska, emailed practices a web link to access the reports, but as of late March, only 3,300 out of 23,730 had downloaded the reports. CMS compiled individual quality and resource use reports for physicians treating patients in the aforementioned states. The underlying premise for the program is that patients receive better and more efficient care when their various physicians can compare their approach to treatment costs compared with the approaches of other doctors treating similar patients in the same area. All doctors treating a given patient during a specified period of time will be compared collectively with other groups of physicians. The reports rely on data provided via claims through the Medicare physician quality reporting system (PQRS) and detail per capita cost and quality reporting information in 2010. The primary purpose of the reports is to give doctors a preview of how data will be used to adjust Medicare pay for some physicians under a budget-neutral value-based modifier that will take effect in 2015, which means it will not involve additional Medicare funding, so some physicians deemed to be lower performers based on the quality and efficiency of their care will receive reduced payments so higher performing physicians can receive bonuses. CMS has yet to determine which physicians will have the value-based purchasing modifier applied to their payments in 2015. The agency anticipates releasing a proposal this year on how the modifier will work.
ASCRS, the AMA, and medical societies representing physicians in the four states are encouraging doctors to download the reports and provide feedback on the program. Physician input is critical as CMS moves forward with plans to use 2013 Medicare claims to determine bonuses and penalties for selected physicians in 2015. Physicians with questions about specific data within their individual report are asked to email CMS_Medicare_Physician_Feedback_Program@mathematica-mpr.com.
Version 5010 Enforcement Discretion Period Ends June 30
As a reminder, the enforcement deadline for Version 5010 compliance ends June 30. The deadline for all HIPAA-covered entities to upgrade to Version 5010 electronic standards was January 1. However, CMS initiated an enforcement discretion period until June 30 to give the industry additional time to complete testing. The delay was partially because of medical specialty groups, including ASCRS and the AMA, expressing concerns regarding the timeline and requesting more time and additional help from health plans and clearinghouses in identifying errors in Version 5010 claims.
If you have not yet finalized your Version 5010 upgrade, you should be working to complete this step as soon as possible. Make sure to view the Version 5010 section of the ICD-10 website to find helpful factsheets on the upgrade to Version 5010 and previous listserv messages discussing the Version 5010 upgrade.
CMS subject matter experts will provide an overview of the 2013 Electronic Prescribing Payment Adjustment and an overview of the 2012 Physician Quality Reporting System/Medicare EHR Incentive Pilot.
On Friday, April 20, over 175 ASCRS eyePAC contributors and their guests gathered at the Art Institute of Chicago. The guests enjoyed a private reception where they were given a private tour leading up the grand staircase and into the 19th century impressionist art gallery. eyePAC raised $60,000 from the contributions to attend the event.
To find out more about the articles in this communication or to read more about legislative and regulatory issues that affect you and your practice, visit the ASCRS and ASOA websites. You can also visit http://www.specialtydocs.org/, the web site of the Alliance of Specialty Medicine.
© 2012 ASCRS/ASOA