Medicare Physician Fee Schedule Final (MPFS)
The 2012 Medicare Physician
Fee Schedule Final (MPFS) Rule contained a cut of 27.4% in reimbursement mandated by the Sustainable Growth Rate (SGR) formula. This
cut is a bit less than the 29.5% reduction put forth in the 2012 Proposed Rule
for the MPFS, but still represents a major blow to providers in the Part B
setting. In
total, CMS projects total payments under the MPFS in calendar year 2012 will be
approximately $80 billion.
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The SGR is
the annual growth rate formulary used to establish physician reimbursement
under Medicare and there have been 11 times that the SGR has called for a cut since
the formula first came into existence – the majority of which have been repealed
by legislative action after the release of a Final MPFS Rule. There has been legislation that holds of the 27.4% cuts until the end of February, but offered no permanent solution.
The 2012 Final Rule for the
MPFS begins implementation of parts of the Patient Protection and Affordable Care Act (Healthcare
Reform as we lovingly refer to it) including Section 3007 which requires CMS to
apply a value modifier comparing the quality of care delivered to the cost of
that care, to physician payment rates. All physicians and physician groups
under the MPFS will be held to the value modifier by 2017. The items relating
to the value modifier include quality of care measures (e.g., cardiovascular
and chronic conditions and preventive measures) and cost measures (e.g., total
per capita cost and per capita cost for conditions such as chronic obstructive pulmonary
disease, heart failure, diabetes and others).