CMS Threatens to Slash Medicare Payments by 27.4%

Ok, technically CMS just issued a teaser of their final Medicare payments rule which is due to finalized and out November 28, 2011.  But when you really look at it and think about it, it really is a threat of you vs. the federal government.  At the beginning of this month CMS (Center for Medicare & Medicaid Services) released a final rule stating that unless Congress does something by January 1, 2012 physicians and non-physicians (who receive reimbursements under the Medicare Physician Fee Schedule) will have subsequent payments slashed by 27.4%.  Although this number is down from the 29.5% cut CMS had estimated would occur earlier this year (because Medicare physician services have fallen below increased practice costs).

Remember last year when you had to wait with baited breath every month to see if you were going to receive a Medicare payment, always guessing at what the reimbursement rate might be?  Well, then you will also remember that you have been living with Medicare nicely this entire year after the government passed a longer than 1 month solution (from about Nov 2010 through this entire year).  Unfortunately, it was still a temporary solution to a long-term problem. 

Apparently these short-term, patchwork stays of Medicare, with occasional percentage pay raises has been lumbering along since 2002.  A permanent fix has been procrastinated for almost 10 years now.  Talk about having a feeling of insecurity!  The continuing problem is the SGR (Sustainable Growth Rate) formula that is used to create the Medicare payment schedule.  If the government can’t handle the SGR issue after ten years, how do they think they are going to handle the many more rates and issues involved with Obamacare?  If you think about this too long, you will surely get a headache.  Just make sure that you are prepared for whatever may occur come January and really make sure that you get your opinion and voice out to anyone and everywhere that it might help.

To make things even more interesting they are attaching some cost and quality measures to this “final rule” as well which will include the following:

• An up to 50% reduction for some imaging payments for repeated scans on the same visit.
• A telehealth services expansion for things that will be covered by Medicare.
• CMS adjustments to payments based on local practice costs will change.
• Values to be amended for 300 “misvalued” physician fee schedule service codes.
• Some slight increases for Medicare beneficiary annual wellness visits.

The “final rule” for all of this is due to be published to the Federal Registry on November 28, with a comment period lasting until January 3, 2012.

Additional Information:

• http://www.fiercepracticemanagement.com/story/cms-final-rule-slash-medicare-payments-274/2011-11-02
• http://www.californiahealthline.org/articles/2011/11/2/cms-issues-final-rule-calling-for-274-cut-in-doctor-payment-rates.aspx?p=1
• http://www.poweryourpractice.com/cms-to-cut-medicare-payments-by-27-4-percent-in-2012/