CMS Releases 2013 Physician Fee Schedule and HOPD/ASC Proposed Rules

On July 6, CMS released proposed rules for policy and payment changes to the 2013 Medicare physician fee schedule (MPFS), as well as for hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs), effective Jan. 1, 2013.

Download the CMS fact sheets:

The physician fee schedule and HOPD/ASC proposed rules will be published in the Federal Register on July 30. CMS will accept public comments on the rules until Sept. 4 before releasing the final rule by Nov. 1, 2012. 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 projects a significant reduction in MPFS payment rates under the Sustainable Growth Rate (SGR) methodology due to the expiration of the adjustment made for calendar year (CY) 2012 in the statute. For CY2013, CMS estimates a 27 percent cut to physician reimbursement rates. These cuts would go into effect on Jan. 1, 2013. 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 also proposes changes to a number of physician incentive programs, including the Physician Quality Reporting System (PQRS), the electronic prescribing (eRx) program and the PQRS-Medicare electronic health record incentive pilot. The rule includes additional details for implementing the value-based payment modifier required by the Patient Protection and Affordable Care Act (PPACA) that will affect physician payments based on quality and cost of care furnished to Medicare beneficiaries. Additionally, a new gastroenterology PQRS measure, “Endoscopy and Polyp Surveillance: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients,” is proposed for claims and registry reporting.

HOPD/ASC Proposed Rule

CMS is projecting an increase in payment rates for services in HOPDs of 2.1 percent for FY 2013. In addition, the notice for proposed rule making proposes to continue the statutory 2 percentage point reduction in payments for hospitals failing to meet the hospital outpatient quality reporting requirements.

The ASC payment system is updated annually by the consumer price index for all urban consumers (CPI-U). For CY 2013, CMS is proposing to increase ASC payment rates by 1.3 percent or by the consumer price index for CPI-U of 2.2 percent minus a multifactor productivity adjustment of 0.9 percent, as required by the PPACA. CMS also estimates that for the third consecutive year, ASC payment rates in CY 2013 will be stable at 57 percent of payment rates for the same services as the proposed hospital outpatient prospective payment systems CY 2013 rates.

CMS is proposing additional requirements for the ASC quality reporting program including procedural requirements that apply to the reporting of quality data, and a policy for updating measures and data completeness requirements. CMS is proposing a methodology for applying the 2 percent payment reduction when program requirements are not met. CMS previously finalized the measure sets that apply to CYs 2014 through 2016 and is not proposing to make any changes to these measure sets.

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