The steep cut to Medicare physician pay is scheduled under the contentious sustainable growth-rate formula, which Congress has moved to override each year since cuts took effect in 2003 and the American Medical Association has lobbied to repeal. Congress last delayed a scheduled physician pay cut of roughly 20% in June and in the latest CMS rule, the agency called a long-term solution “critical” and said officials “are committed to permanently reforming the Medicare payment formula.”
The CMS said the rules also include newly adopted payment incentives of 10% for primary-care providers and general surgeons in health professional shortage areas under the Patient Protection and Affordable Care Act. Provisions of the Affordable Care Act, combined with inflation and wage updates and other adjustments, will reduce home health payments by 4.89% in 2011, the CMS said.
The final rule for outpatient hospital payments increases the quality measures that must be reported in the 2012, 2013, and 2014 to receive full payment and also implements a prohibition on new or expanded physician-owned hospitals, the CMS said. The agency said it would increase to 15 the number of measures reported in 2012 and add another eight in 2013, but did not adopt proposed measures for 2014.
The CMS said the outpatient hospital and ASC rule will adopt the health reform law provision that prohibits new or expanded physician-owned hospitals. The rule also implements new Affordable Care Act provisions to identify and redistributed unused residency slots.