CMS Proposes Payment Changes for Physicians’ Services in 2008

The Centers for Medicare and Medicaid Services (CMS) projects that it will pay approximately $58.9 billion to 900,000 physicians and other health care professionals in calendar year 2008, under a proposed rule released that would revise payment rates and policies under the Medicare Physician Fee Schedule.

“This proposed rule builds on the changes the Centers for Medicare and 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” acting CMS administrator Leslie V. Norwalk, Esq. said in a press release. “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 Quality Reporting Initiative in 2008.”

The Tax Reform and Health Care Act of 2006 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, provided that the measures are either endorsed by the National Quality Forum or adopted by the AQA Alliance.

As required by the sustainable growth rate formula specified in the Medicare statute, the estimated update to the physician fee schedule for 2008 is –9.9%.

“For the past 5 years, Congress has intervened to prevent the implementation of the negative updates resulting from this formula,” Norwalk continued. “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.”

The proposed rule would make a number of changes to payments for specific services paid under the Medicare physician fee schedule.

Comments will be accepted on the proposed rule until August 31, and a final rule will be published in the fall. The final rule will be effective for services on or after Jan. 1, 2008.

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