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CMS: 10.1% reduction in payments for physician services in 2008
Oncologists may see shortfall of opportunities to participate in Physician Quality Reporting Initiative.
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The Centers for Medicare and Medicaid Services has implemented a negative 10.1% update in payment rates for the 2008 Physician Fee Schedule final rule, and physicians can expect another 1% reduction in payment as a result of the budget neutrality adjuster.
A large number of oncology Physician Quality Reporting Initiatives were submitted too late and, therefore, will not occur in the next calendar year, putting oncologists at a great disadvantage at earning the PQRI incentives. There are hematology and past oncology measures that will continue.
The negative 10.1% reduction is the result of the Sustainable Growth Rate implemented in 2003. The SGR requires a negative update when the actual spending rate exceeds the target rate. Although negative updates have been imposed by CMS every year since 2003, Congress has intervened at the last minute to prevent them.
“We are concerned about this issue every year at this time,” Samuel Silver, MD, PhD, editor of the Policy, Patient and Practice Issues section for Hem/Onc Today, said in an interview. “There is no question that there will be decreased payment because of the budget neutrality issues. There may be a huge decrease in payment if the conversion factor reduction takes place.”
Quality measures
CMS will continue payments for preadmission-related services for IV infusion of immunoglobulin for an additional year because of the difficulty in procuring these products and scheduling infusions, according to a CMS press release.
The rule also increased the Relative Value Unit for anesthesia services by 32% and increased the value of physician visits to patients’ homes.
The revised payments, quality incentive rates and policy changes will go into effect on Jan. 1, 2008. Medicare will pay an estimated $58.9 billion to health care professionals under the new rule. The final rule outlines PQRI measures that were endorsed by the National Quality Forum.
CMS implemented the voluntary PQRI for 2007, as directed by the Tax Relief and Health Care Act of 2006. Since July 1, 2007, eligible professionals who report specific measures on quality of care furnished to Medicare beneficiaries may earn an incentive of up to 1.5% of the allowed charges.
According to the press release, the PQRI measures emphasize the importance of electronic health records and electronic prescribing for delivering high-quality health care. The Physician’s Assistance and Quality Initiative Fund will provide $1.35 billion for physician payment and quality improvement initiatives in 2008.
“CMS will continue to work with Congress and physician groups to identify payment methods that help improve the quality and efficiency of care in a way that is mindful to not increase costs to taxpayers, Medicare, or its beneficiaries,” acting CMS Administrator Kerry Weems said in a press release. “Medicare needs to compensate physicians appropriately for the services they furnish to people with Medicare. We believe the early work on the Physician Quality Reporting Initiative is one of those reforms that can help lead to better quality and more efficient care.” – by Emily Shafer