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Reform Update: AMA blasts new Medicare physician fee schedule, defends RUC


By Andis Robeznieks
Posted: August 12, 2013 - 3:15 pm ET
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The American Medical Association has issued a strong criticism of the proposed 2014 Medicare physician-fee schedule, and also fired back against attacks on its widely criticized Medicare physician payment advisory panel.

In its summary of the proposed fee schedule, the AMA accused the CMS of proposing “an arbitrary new policy” that would lower payment for more than 200 services that Medicare pays more for when the service is provided in a doctor's office and less when it's performed in a hospital outpatient department or ambulatory surgery center.

“The AMA will aggressively oppose this proposal and seek to delay implementation until the RUC can review these codes,” the AMA said.

In the proposed fee schedule, the CMS proposed that, starting in 2015, it would pay for care-management activities that don't involve face-to-face contact for patients with multiple chronic conditions.

The AMA gave credit to “the ongoing efforts” of the Specialty Society Relative Value Scale Update Committee, commonly known as the RUC, and the AMA Current Procedural Terminology Editorial Panel for convincing the CMS that current evaluation and management codes “do not adequately capture the costs of providing care to all Medicare patients.” It goes on to say that the CPT panel and the RUC will work with the CMS to “discourage overly burdensome requirements and to ensure that all the necessary resources are captured in the payment.”

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Responding to criticism of the RUC, the AMA summary noted that, using “objective screening criteria,” the panel has reviewed about 1,300 “misvalued service” codes and prompted the CMS to redistribute $2.5 billion within the fee schedule between 2009 and 2013.

The AMA's Specialty Society Relative Value Scale Update Committee, has come under fire for creating a situation where specialty physician services are overvalued and primary-care services are underpaid.

The AMA also noted its intention to argue against other elements within CMS' proposed fee schedule when it files its formal comments to the CMS.

While the document offered some praise to the CMS for modifications made to its Physician Compare website, the AMA also expressed concern that more improvement was necessary to ensure the accuracy of the website's search function and demographic data.

The AMA also warned that it will fight the CMS plan to double the number of physicians subject to penalties under its value-based modifier payment formula.

“The AMA has repeatedly argued that the value-based modifier is a flawed concept that cannot be equitably applied across the board to all physicians,” the summary stated. “Efforts to repeal the proposal, slow its expansion, limit potential penalties, and eliminate the two-year lag between performance and adjustment years will continue.”

Comments on the CMS proposed fee schedule are due Sept. 6.

Oregon's Medicaid transformation reports still a work in progress

The Oregon Health Authority has released the second of its healthcare transformation quarterly reports that track the progress of the state's Medicaid-reform initiative, which is been watched as a possible national reform model.

Oregon's Medicaid reform effort, launched with the help of a $1.9 billion grant from the CMS, is intended to generate $11 billion in savings over 10 years. It relies on regional coordinated-care organizations that receive global payments per beneficiary to provide comprehensive services.

The new quarterly report beefs up and refines the benchmark statistics provided in the first report. But it also reveals that, like the coordinated-care organizations that the effort draws its data from, the reports themselves are a work in progress.

The state's 15 coordinated-care organizations are providing coverage to about 93% of Oregon's 670,000 Medicaid beneficiaries. The new report included information about a 16th coordinated-care organization, Cascade Health Alliance, which will start serving Klamath County on Sept. 1. The report also establishes baselines for the regions covered by the PacificSource Community Solutions coordinated-care organization.

But the report's quarterly financial measurements are still incomplete, with benchmarks labeled on charts as being “in development” while the state waits for payment data on services that have been provided but not yet recorded by the coordinated-care organizations.

The report acknowledged that, while it continues to gain a more accurate picture of where the coordinated-care organization system started from last year, it still hasn't been able to show where it's going.

“This is the beginning of what will be a long journey toward a transformed healthcare system in Oregon,” the report stated. “Subsequent reports will show movement on each measure by displaying data on a quarter-by-quarter basis, measured against baselines. Trends in the data will help show how coordinated care is impacting the delivery of care, the health of Oregonians, and the cost of the healthcare system.”

The new report also contains explanations for why the state is measuring what it's measuring. For example, in the explanation for why the state is tracking hospital admission rates caused by short-term diabetes complications, the report stated: “Improving the quality of care for people with chronic disease to help them avoid hospital stays improves the patient experience of healthcare and improves overall health outcomes.”

Half of Fla. docs expect to 'continue practicing as normal'

Despite concerns over regulations, payments and medical malpractice reform, half of the physicians responding to a Florida Medical Association survey (PDF) plan to “continue working as normal” in the next one to three years.

Of the 560 Florida doctors surveyed via e-mail and social media between July 15-29, 50.5% said they would continue practicing as normal; 10% plan on cutting back their hours; 7% said they would retire; 5% said they would relocate and 4.3% said they'd work part time. Other responses included seeking employment with a hospital, seeking a nonclinical position in healthcare and opening a concierge medicine practice.

About 40.4% said their practice was participating or considering participating in an alternative payment model such as an accountable care organization or medical home.

Almost 70% said their practice had an electronic health record. Of those, 25.7% said it has improved the quality of care at their practice; 10% said it hasn't improved quality yet, but it's expected that it will; 8.9% said it may improve quality but isn't worth the investment; 21.4% said the EHR hasn't improved quality, and it's not expected to; 17.1% says it's decreased quality and it's not expected to improve; 3.9% said quality has decreased but they anticipate that it will eventually improve; and almost 13% reported that EHR implementation has had no effect.

Follow Andis Robeznieks on Twitter: @MHARobeznieks


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