CMS Releases 2012 Physician Fee Schedule and HOPD/ASC Proposed Rules

CMS released proposed rules for policy and payment changes to the 2012 physician fee schedule and for hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs), effective Jan. 1, 2012.

Download the CMS fact sheets:

The physician fee schedule rule will be published in the Federal Register on July 19 and the HOPD/ASC rule will be published on July 18. CMS will accept public comments on the rules until Aug. 30 before releasing the final rule by Nov. 1, 2011. AGA will submit comments for CMS’s consideration.

AGA is currently reviewing these proposed rules in depth and will provide a more comprehensive analysis on the impact to GI in AGA eDigest and the AGA Washington Insider.

Physician Fee Schedule Proposed Rule

CMS has proposed a 29.5 percent cut to physician reimbursement rates, which would be the eleventh time the sustainable growth rate formula (SGR) resulted in a payment cut. These cuts would go into effect on Jan.1, 2012. Since being adopted in 1997, the cuts have been averted through legislation every year except fiscal year (FY) 2002.

AGA understands and appreciates the concerns about government spending, but steps must be taken to protect and strengthen the Medicare program. Before access to care is further threatened for the millions of patients who depend on the Medicare program, Congress must replace the SGR formula with a stable and equitable payment mechanism that reflects the costs of caring for Medicare beneficiaries and ensures access to high quality care.

The proposed rule would update a number of physician incentive programs, including the Physician Quality Reporting System, and includes proposed quality and cost measures to establish a new value-based modifier that would reward physicians for higher quality and more efficient care. Included in the proposed measures are the AGA—American Medical Association — Physician Consortium for Performance Improvement® IBD Measures Group.

HOPD/ASC Proposed Rule

CMS is projecting an increase in payment rates for services in HOPDs, other than those of cancer hospitals, of 1.1 percent for FY 2012; the estimated net increase in payment to cancer hospitals for FY 2012 would be approximately 9 percent. To allow CMS and hospitals to more effectively plan for future quality measurement requirements, CMS is proposing to add nine quality measures to the current list of 23 measures to be reported by HOPDs, bringing to the total number of measures to 32 that are to be reported for purposes of the FY 2014 payment determination.

The ASC payment system is updated annually by the consumer price index for all urban consumers (CPI-U), which CMS estimates to be 2.3 percent for FY 2012. CMS projects that the productivity adjustment for FY 2012 will be 1.4 percent, and therefore, CMS is proposing to apply a 0.9 percent update for FY 2012. For the first time, CMS is proposing to implement a quality reporting program for ASCs. To allow CMS and ASCs to more effectively plan for future measurement requirements, CMS is proposing to add eight quality measures to be reported by ASCs beginning in FY 2012 for FY 2014 payment determination. These measures include seven outcome and surgical infection control measures to be reported by ASCs on Medicare claims using quality data codes, and one healthcare-associated infection measure reported through the National Healthcare Safety Network. 

Stay tuned to AGA eDigest and the AGA Washington Insider for more comprehensive analyses of these proposed rules.