CMS Issues Final Physician Payment Rates

Just before the Thanksgiving holiday, the Centers for Medicare & Medicaid Services (CMS) finalized physician payment rates and policies for 2014. Overall, the final rule focuses on improved care coordination. Specifically, quality reporting initiatives that are associated with Physician Fee Schedule (PFS) payments have been updated, including the Physician Quality Reporting System (PQRS) and the physician comparison tool on the Medicare.gov website.

The new policy also includes provisions for implementing the value-based payment modifier (Value Modifier) required by the Affordable Care Act. The Value Modifier affects how physician group practices will be paid based on the quality and cost of care that is provided to Medicare beneficiaries in fee-for-service programs.

For 2016, the Value Modifier will apply to group practices with 10 or more eligible professionals. For groups with between 10 and 99 eligible professionals, only upward adjustments will apply based on performance. For practices with 100 or more professionals, payment adjustments will be applied based on performance (upward or downward).

An anticipated result of the new policy is that there will be better quality and reporting coordination in 2014. CMS is finalizing several related proposals to the PQRS for 2014, including a new option for individual eligible professionals to report quality measures through qualified registries. Physicians will be able to report a quality measure once, but it will be applied to all quality reporting programs in which that measure is used.

PQRS measures also will be better aligned with the National Quality Strategy and meaningful use requirements. In addition, certain PQRS measures reported under the Group Practice Reporting Option (GPRO) will be publicly reported on the CMS Physician Compare website in 2014.

CMS is not finalizing its proposal to adjust relative values under the PFS to effectively cap the physician practice expense payment for procedures furnished in a non-facility setting at the total payment rate for the service when furnished in an ambulatory surgical center or hospital outpatient setting. Instead, CMS will take additional time to consider issues raised by the public commenters and plans to address this issue in future policies.