American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

2011 Physician Fee Schedule Final Rule

CMS released its final rule for policy changes to the 2011 physician fee schedule effective Jan. 1, 2011, and its implementation of key provisions under recently enacted health-care reform legislation, the Patient Protection and Affordable Care Act (ACA).

Read the CMS press release. 

Read the CMS fact sheets:

• Final 2011 Policy, Pay Changes in Medicare Physician Fee Schedule.
• Physician Quality Reporting System and E-Prescribing Program.
   

CMS will accept comments on certain aspects of the final rule with comment period until Jan. 2, 2011. The final rule will be published in the Federal Register on Nov. 29. The GI societies submitted extensive comments on the proposed rule to CMS in August.

Status of Medicare Physician Reimbursement

Over the summer, Congress passed a 2.2 percent update in reimbursement rates, retroactive from June 1 through Nov. 30, 2010, which is set to expire on Dec. 1. CMS indicated that the total reduction in fees between November and January under the sustainable growth rate formula (SGR) will be 24.9 percent.

AGA anticipates that Congress will attempt to craft a long-term solution to the SGR and if that cannot be achieved, will pass another temporary fix to overturn the large cuts. AGA will continue to provide updated information on Congressional action on physician reimbursements through AGA eDigest and the AGA Washington Insider, a policy blog for GIs.

Components of the Final Rule

At this time, the conversion factor will be set at $25.5217.

Effective Jan. 1, 2011, the ACA waives the Part B deductible for tests that begin as colorectal cancer screening tests, but, based on findings during the test, become diagnostic or therapeutic services. AGA advocated heavily for this change. AGA is also working with our advocates in Congress to ensure that the coinsurance is waived when a screening colonoscopy becomes therapeutic.  

We are pleased that the ACA extends the preventive focus of Medicare coverage to provide coverage for annual wellness visits during which beneficiaries receive personalized prevention plan services. AGA views this as an opportunity to counsel beneficiaries on colorectal cancer screenings.

The Physician Quality Reporting Program (PQRI) will provide a 1 percent payment incentive for 2011, a 0.5 percent incentive payment from 2012 through 2104, and penalties for non-participation in PQRI of 1.5 percent in 2015 and 2 percent in 2016.

For the 2010 PQRI, the AGA Digestive Health Outcomes Registry™ is qualified for reporting on the hepatitis C measures group for at least 30 patients, two of whom must be Medicare Part B fee-for-service patients. In the final 2011 rule, however, CMS indicates that it may not release the list of eligible registries until mid-2011 after it reviews new registry requirements.
 
The gastroenterology individual measures and hepatitis C measures group remain in the final 2011 PQRI measures.

The rule adds key changes to the e-prescribing incentive program for 2011, specifically, e-prescribers who participate and qualify for the Medicare electronic health records incentive program for 2011 may not receive a separate, additional Medicare eRx Incentive Program payment. There will be broader opportunities for group practices with fewer than 200 members to participate in the eRx Incentive Program as group practices.

The ACA also authorizes that physicians will qualify for an additional 0.5 percent incentive beginning in 2011 if they satisfactorily report data on PQRI measures through a maintenance of certification program.

CMS will proceed with developing a “Physician Compare Web site,” which will be populated with 2011 PQRI data including names of providers submitting 2011 PQRI data.

The rules implement an ACA requirement that physicians referring patients for MRI, CT and PET scans in which they may have a financial interest disclose to a patient in writing at the time of the referral that there are other suppliers of these imaging services, along with a list of five other suppliers in a 25-mile radius of the referring physician’s office.

Stay tuned to AGA eDigest and the AGA Washington Insider for a more comprehensive analysis of this final rule and for information on the Nov. 2 final rule for hospital outpatient departments and ambulatory surgical centers.

 

Updated 11/03/10