The delay could be seen as an inconvenience and a hindrance to effective planning and budgeting but, for several years now, the schedule has reflected a severe decrease in payments called for by Medicare's sustainable growth-rate payment formula. But that cut always gets postponed at the 11th hour—or later—by Congress. If Congress fails to act this year, a 24.4% SGR-driven cut in Medicare pay will go in effect Jan. 1.
Because of the SGR drama, the final rule has seldom been the final word in recent years.
“The fee schedule has been a moving target in the past years,” said Ian Stewart, vice president for business systems, finance and operations for Downers Grove, Ill.-based Advocate Medical Group. “The first round always shows the full reduction of the expected 25-plus percentage reduction and then, as has happened in years past, the waiting game from Congress to vote in a fix for the SGR issues begins. The biggest issue for us is the actual implementation of the new 2014 fee schedule on 1-1-2014 with an unknown rate payment structure and conversion factor not being approved until late December by Congress.”
Anders Gilberg, senior VP for government affairs for the Medical Group Management Association, noted that the final fee schedule could also contain hundreds of pages of policy proposals. For example, in the 600-page proposed schedule released back in July, the CMS asked for feedback on a proposal to pay doctors for non-face-to-face patient care-management activities starting in 2015. (Physician groups generally praised the concept, but criticized the associated administration and documentation as burdensome.)
“It takes time for physician practices to understand and incorporate these into their business,” Gilberg said. “It does impact the ability to plan to some extent.”
Follow Andis Robeznieks on Twitter: @MHARobeznieks