Trick or Treat: late this afternoon the Centers for Medicare and Medicaid Services (CMS) released its Final Rules for the 2015 Medicare Physician Fee Schedule (PFS) and the 2015 Update to the Outpatient Prospective Payment System (OPPS). In September, EDPMA commented on the proposed rules. In the November Advocacy Newsletter, we will provide you with a full analysis of the final rules and let you know where we were successful in urging change. For now, here are a few highlights and some links to CMS fact sheets:
PFS Final Rule
Under the 2015 final fee schedule, CMS estimates that the changes to the malpractice RVUs will produce a 1% increase for the specialty of emergency medicine. Emergency medicine was one of only nine specialties out of over 50 to receive a positive impact adjustment. However, it is important to remember that this increase will be more than offset on April 1, 2015, if the scheduled 24% cut to all reimbursement rates – which is mandated by the Sustainable Growth Rate (SGR) formula – is not prevented by Congressional action. Fortunately, for many years, Congress has been passing legislation that delays this scheduled cut and may well do so again this year.
In the area of quality reporting, EDPMA had strongly urged CMS to slow efforts to phase out claims-based reporting for the Physician Quality Reporting System (PQRS). In the final rule, CMS acknowledged that it “under[stood] the concerns associated with moving away from the claims-based reporting mechanism,” and would be finalizing an option for providers to continue to meet PQRS requirements using the claims-based method in 2017. We will more fully analyze the specific measures for which CMS will continue to allow the claims-based reporting mechanism in our November Advocacy Newsletter.
CMS issued three fact sheets on the PFS Final Rule: on policy and payment changes, physician quality reporting, and the value-based payment modifier.
OPPS Final Rule
In the Final Rule on the 2015 Update to the OPPS, CMS affirmed its decision to hold off on collapsing emergency department (ED) facility codes (a proposal that was considered last year) while it explores additional payment methodologies and their implications. EDPMA had strongly supported CMS decision this year to hold off on the collapsing proposal until stakeholders had an opportunity to weigh in on the proposal.
CMS also finalized its proposal to remove the physician certification requirement from most hospital admissions, recognizing the duplicative nature of this requirement. EDPMA had supported this modification in its comment letter.
CMS issued two fact sheets on the OPPS Final Rule: one on policy and payment changes and another on quality reporting changes.
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