Tentative ‘Doc Fix’ Deal Would Cut Health Law’s Prevention Fund by $5B

From: Kaiser Health News – 2/15/12

Article Excerpt

After wrangling for weeks over how to finance a Medicare “doc fix,” House and Senate conferees have a plan.  The proposal would cut Medicare payments to hospitals and other providers for “bad debt,” Medicare payments to clinical laboratories and Medicaid “disproportionate share” payments to hospitals that serve many poor patients, and divert $5 billion  from the health law’s $15 billion prevention fund.

Read more…

From: MLN Matters MM7737 – 1/26/12

This article is based on Change Request 7737 that informs you that new Medicare Physician Fee Schedule (MPFS) payment files have been created and are available to Medicare contractors.

MLN Matters Article SE1202 Revised – 1/12/12

MLN Summary:

Physicians who furnish services to Medicare beneficiaries in areas designated as primary care geographic HPSAs by the Health Resources and Services Administration (HRSA) as of December 31, 2011, are eligible for a 10 percent bonus payment for services furnished from January 1, 2012, to December 31, 2012. If an area does not have a geographic primary care HPSA designation, but does have a geographic mental health HPSA designation, then only psychiatrists furnishing services to Medicare beneficiaries in the designated area are eligible for the ten percent bonus.

From: Washington Post – 12/15/11

Article Excerpt:

It was adopted by Congress in 1997 almost as an afterthought — a new formula to keep Medicare spending on doctors from growing faster than the economy as a whole.

But like a snowball that swells in size as it rolls down a mountain, the rate-setting formula has transformed into a budget-busting juggernaut that will hit doctors with a 27.4 percent pay cut for their Medicare patients in January unless legislators step in.

The cost of congressional intervention has ballooned just as formidably: Postponing the cuts — the solution Congress has turned to every year since 2003 — would cost $21 billion for a one-year delay and $38.6 billion for two years. Fully repealing the formula would add nearly $300 billion to the deficit, according to the Congressional Budget Office.

Read more…

Overnight Health: Republicans put together ‘doc fix’ offer

From: The Hill Healthcare blog – 12/8/11

Article Excerpt:

House Republicans seem to be coalescing around a two-year “doc fix” paid for with Medicare cuts — including cuts that could directly affect seniors. As expected, a two-year fix was included in the larger tax proposal GOP leaders pitched to their caucus on Thursday.

Doctors will face a nearly 30 percent cut in their Medicare payments if Congress doesn’t act by the end of the year. Republican lawmakers told The Hill after Thursday’s caucus meeting that leadership discussed a plan to avert that cut and give doctors a 1 percent pay increase in 2012 and 2013.

A two-year fix would cost roughly $38 billion, and Republicans might try to offset that cost by asking seniors to pay more for their Medicare benefits. Members said they’re looking at increased means-testing and other changes in Medicare’s premiums.

Read more…

Final Rules -  Physician Fee Schedule, Clinical Lab Fee Schedule, Other – CY 2012

CMS1524-FC & CMS-1436-F; Posted 11/1/11; FR 11/28/11

HFMA Summary:

The Centers for Medicare & Medicaid Services issued a final rule updating the Medicare physician fee schedule for 2012 and projected that total payments to more than 1 million providers will be approximately $80 billion.

The final rule reflects cuts in physician payment rates scheduled to go into effect on Jan. 1, based on the Sustainable Growth Rate formula. Without a change in law enacted by Congress, Medicare payment rates to providers will drop by an estimated 27.4 percent in 2012, less than the 29.5 percent reduction that CMS had estimated earlier this year, according to the rule.

MedPAC Approves Growth-Formula Recommendation

From: The Hill.com Healthwatch Blog – 10/6/11

Article Excerpts:

Medical groups quickly registered their disapproval Thursday after Congress’s Medicare advisory panel approved a proposal to replace the controversial formula for paying doctors.

The Medicare Payment Advisory Commission (MedPAC) passed a recommendation that would replace the “sustainable growth rate” (SGR) formula and its automatic cuts to doctors’ payments. But MedPAC’s alternative also includes automatic cuts — 6 percent per year for several years to most specialties. 

Read more… 

To Learn More about this issue, I have provided the following link to a Congressional Budget Office report that addresses SGR: CBO Report

Proposed Rules CMS 1524-P; FR 7/19/11

The federal register publication was released on Tuesday 7/19/11.  The original reporting of this proposed rule was included in the week of July 4^th, 2011 News You Need to Know.

CMS-1524-P; Filed 7/1/11; FR Publication 7/19/11

Based on current law (BBA of 1997) CMS is required to issue Physician payment rates based on a Sustainable Growth Rate (SGR) formula. This formula if implemented will reduce Physician payments by 29.5% in 2012. These reductions have been reversed out by Congress through legislation in every year but 2002. We anticipate that this will be reversed by Congress prior to the 2012 implementation. CMS projects total payments for Physician services to be $80 billion in 2012. I assume this will be significantly higher once Congress steps in.

Summary in Proposed Rule:

This proposed rule addresses changes to the physician fee schedule and

other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act of 2008. In addition, this proposed rule discusses payments for Part B drugs; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues. (See the Table of Contents for a listing of the specific issues addressed in this proposed rule.)

Click here to view CMS’s July 1^st press release.