Health Policy 2013-2015
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CMS Releases 2013 Physician Utilization and Spending Data to Public: On June 1, the Centers for Medicare and Medicaid Services (CMS) released calendar year 2013 Medicare utilization and payment data for physicians in an effort to create greater transparency of the medical services they provide.  The data files include information on 950,000 physicians and other healthcare providers that allow for comparisons by specialty, as well as the types and volume of services provided.  The data also contain information on provider location, which allows for geographic comparisons.  An important shortcoming of the data is that it tells nothing about the quality of care provided.

Congress and Physicians Bid Farewell to SGR: On April 14, 2015, Congress sent to President Obama a bill to repeal the Medicare sustainable growth rate (SGR) formula and chart a new path toward a physician payment system that rewards not for volume, but for value. The President has said he will sign the bill. The vote ends a more than a dozen years of lobbying by the physician community to discard the flawed SGR.

House Passes SGR Repeal Bill; Action Moves to Senate: On March 26, the U.S. House of Representatives passed legislation by an overwhelming vote of 392 to 37 that would permanently repeal the Medicare sustainable growth rate (SGR) physician payment formula, averting a 21 percent SGR-induced cut scheduled for April 1, 2015, and would put Medicare on track to being a prudent rather than passive payer of Part B services. As of press time, it is expected the Senate will take up similar legislation that, if passed, the President has said he will sign into law.

Physician Quality and Resource Use Reports Now Available: Physicians Encouraged to Access Their Reports: On October 2, the Centers for Medicare and Medicaid Services (CMS) announced the availability of the 2013 Quality and Resource Use Reports (QRURs).  This is the first year that reports are being made available to all physician groups and solo practitioners. The 2013 QRURs contain quality and cost performance data for CY 2013, which is the performance period for the Value-Based Payment (VBP) Modifier that will be applied to Medicare Physician Fee Schedule payments for groups of 100 or more eligible professionals in 2015.

First Round of Physician-Industry Data Released to the Public: The Centers for Medicare and Medicaid Services (CMS) released on Sept. 30, 2014, the first round of data on consulting fees, research grants, travel reimbursements, and others gifts that medical device manufacturers and pharmaceutical companies provide to physicians and teaching hospitals.According to CMS, the published data contains 4.4 million payments valued at nearly $3.5 billion attributable to 546,000 individual physicians and almost 1,360 teaching hospitals.The next published report will include payment data for all of 2014 and will be published in June 2015. 

Detailed Summary of Proposed PQRS Changes Now Available: In 2015, physicians and other eligible professionals must satisfactorily participate in Medicare’s Physician Quality Reporting System (PQRS) to avoid a -2 percent payment adjustment to Medicare Part B fee for service payments in 2017. In the recently released Medicare Physician Fee Schedule Proposed Rule, CMS proposes a number of modifications to PQRS. A detailed summary prepared for UCAOA of the proposed changes is now available so physicians can begin to prepare for 2015 reporting changes. Successful PQRS participation is tied to the physician Value-Based Payment (VBP) Modifier, putting physicians who fail to successfully participate in PQRS at risk of a -6% Medicare payment adjustment in 2017 when the PQRS and VBP penalties are combined.  It is important to note that CMS can choose to modify, based on public comment, the proposed PQRS requirements. Final requirements will be published in the Medicare Physician Fee Schedule Final Rule in November.

UCAOA Summary: Proposed Medicare Physician Fee Schedule Payment and Policy Revisions for CY 2015: On July 3, the Centers for Medicare and Medicaid Services (CMS) released the CY2015 Physician Fee Schedule (PFS) Proposed Rule, which will be published in the Federal Register on July 11 and will be open for public comment until September 2. CMS anticipates releasing the final rule around Nov. 1, 2014 and the adopted changes will take effect Jan. 1, 2015. Please note this is a member resource.

Deal on SGR Repeal and Reform Policy Reached: Leaders of the congressional committees with jurisdiction over Medicare announced a deal on a sustainable growth rate (SGR) repeal and replacement policy. Agreement was announced with 53 days remaining before the current patch preventing drastic cuts to Medicare.

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