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July 09, 2007

CMS to publish proposed 2008 Medicare physician fee schedule and rules

CMS put its 2008 physician fee schedule "on display" last Monday; I was on the beach, so this post had to wait.  The rule is scheduled to be published in the Federal Register July 12.

Related goodies:  SGR adjustment of minus 9.9% is still on the books, though the federales say PQRI will help pick up the slack. (Not!) P4P continues its inexorable march, picking up where PQRI for the second half of 2007 leaves off.  (See earlier HealthBlawg posts on PQRI and SGR.)

The press release begins:

The Centers for Medicare & Medicaid Services (CMS) projects that it will pay approximately $58.9 billion to 900,000 physicians and other health care professionals in calendar year (CY) 2008, under a proposed rule released today [July 2] that would revise payment rates and policies under the Medicare Physician Fee Schedule (MPFS).  This proposed rule is a further step in Medicare’s efforts to ensure that payment policies provide incentives to improve the quality of care.

“This proposed rule builds on the changes the Centers for Medicare & Medicaid Services made last year to pay more appropriately for practice expenses and to transform Medicare into an active purchaser of higher quality services, rather than just paying for procedures” said acting CMS Administrator Leslie V. Norwalk, Esq.  “It also includes an important new initiative to encourage the use of electronic prescribing to improve the speed and accuracy of care furnished to beneficiaries, as well as proposals for additional quality measures for use in the Physician Voluntary Reporting Initiative in 2008.”

The Tax Reform and Health Care Act of 2006 (TRHCA) directed that quality measures in future years be developed through the notice and comment rulemaking process.  In this proposed rule, CMS outlines measures from seven categories for inclusion in the 2008 Physician Quality Reporting Initiative (PQRI), provided that the measures are either endorsed by the National Quality Forum (NQF) or adopted by the AQA Alliance.

The 2008 proposed measures include existing measures from the AQA Starter Set, other measures from the NQF Ambulatory measure set, and new quality measures currently being developed with input from American Medical Association (AMA) Physician Consortium for Performance Improvement (physician measures), the Pennsylvania Quality Improvement Organization (QIO) (non-physician and structural measures), and the American Podiatric Medical Association.  The proposed rule would also retain the 2007 PQRI measures to the extent that they have been NQF endorsed.

As required by the sustainable growth rate (SGR) formula specified in the Medicare statute, the estimated update to the physician fee schedule for 2008 is -9.9 percent.

“For the past 5 years, Congress has intervened to prevent the implementation of the negative updates resulting from this formula,” said Ms. Norwalk.  “CMS will continue working with Congress as well as physician groups to identify payment methods that help improve the quality and efficiency of care in a way that is cognizant of the costs to taxpayers and to Medicare and its beneficiaries.  The Medicare program needs to compensate physicians appropriately for the services they provide to people with Medicare.  But how the program pays also matters.  We think the early work on the PQRI program is one of those reforms that could help lead us to a point where we can promote better quality care and more efficient care.”

Additional specialty-specific changes and updates are detailed in the press release and rule.

Update 7/12/07:  Here's the 2008 MPFS as published in today's Federal Register.  See my additional posts on proposed regs slipped into the fee schedule regarding the Stark physician self-referral prohibition rules, ambulance services and IDTFs

-- David Harlow


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