Medicare Physician Fee Schedule

On November 1, the Centers for Medicare & Medicaid Services (CMS) released the final 2013 Medicare Physician Fee Schedule, changing the physician fee schedule and other Medicare Part B payment policies and implementing certain provisions of the Affordable Care Act (ACA).

The regulation also discusses:

Particularly notable to family physicians, CMS finalized new Medicare coverage for two transitional care management (TCM) codes. These codes are designed to pay a patient’s physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or nursing facility stay.

The AAFP recognizes that CMS made an effort to help rectify the worsening gap between payment to primary care physicians and subspecialists. Of this estimated 7 percent, 2 percent stems from the phased-in use of the Physician Practice Information Survey (PPIS) data, and the remaining 5 percent is the CMS-estimated impact on family physicians, using an assumption that 5.7 million of the new TCM codes will be billed in 2013.

In a statement after the final rule became available, the AAFP highlighted that the regulation confirmed that - short of immediate Congressional action - Medicare payment for needed medical care services will be slashed by 26.5 percent.

The 2013 schedule once again focuses a bright light on the dysfunctional sustainable growth rate formula on which Medicare payment is based. It re-emphasizes the imperative that Congress needs to permanently change the basis for calculating Medicare physician payment.

The AAFP called on Congress to act immediately to prevent this cut from going into effect on January 1, 2013, and to reform Medicare physician payment permanently. On January 3, President Obama signed into law the American Taxpayer Relief Act. This law prevents the 26.5 percent reduction to Medicare physician payments by continuing the current rate through December 31, 2013. Therefore, the 2013 Medicare conversion factor is $34.0230. This law also extends the Medicare physician work geographical adjustment floor through December 31, 2013.

After the American Taxpayer Relief Act was passed by Congress, the AAFP released a statement urging Congress to follow through on previous promises and commit to permanently end the ordeal of temporary patches that ultimately drive up the cost of a meaningful solution and destabilize the Medicare system. Congress must make good use of these 12 months to repeal the sustainable growth rate (SGR) and put a sustainable payment system in place that helps re-balance the primary care physician workforce.”

Separate from the SGR but still impacting Medicare physician payments, the American Taxpayer Relief Act also delayed for two months (until March 31, 2013) the scheduled 2 percent cut in Medicare payments due to budget sequestration created by the Budget Control Act of 2011.