In addition to a prescription drug benefit, a small reimbursement rate increase and a moratorium on surgical hospitals, the Medicare reform bill that narrowly passed Congress last month also contains the following provisions:
- Incentive grants for small, rural and low-volume practices instead of mandating that all providers use electronic prescribing technology; the issuance of final eRx standards from HHS by April 1, 2008; physicians prescription drug plans can pay higher fees to doctors who reduce medical errors, improve formulary compliance or reduce adverse drug reactions.
- Price reform for drugs administered in physicians' offices. Average wholesale price (AWP) minus 15% in 2004, average sales price (ASP) plus 6% in 2005, and competitive bidding as an option for physicians in 2006; a transitional payment increase of the practice expense reimbursement for drug administration in 2004 and 2005, and a required MedPAC review of the affect of payment changes for oncologists by January 2005 and for other specialties by January 2006.
- One percent reduction in payment to ambulatory surgical centers beginning in April 2004; five-year freeze in ASC payment rates from 2005 through 2009, with HHS to develop a new payment system after review of GAO study.
- Bringing the floor of the work geographic payment adjuster in the payment formula to 1.0 in 2004 through 2006, paying all doctors 100% of the national average.
- Bonus payments of 5% to physicians in scarcity areas in 2005 through 2007.
- Regulatory relief that includes due process for physicians, provider education and technical assistance, repayment plans and written responses from carriers.
- Special funding for rural health care, medical training programs and certain preventive care.
For more on Medicare, see page 12.