CMS proposes primary care, hospital outpatient pay rate hikes

The CMS kicked off the Fourth of July weekend early with a late Thursday regulation dump that included proposed changes for 2015 to Medicare rates for doctors and a proposal to raise Medicare outpatient payments to hospitals.

Also, the CMS intends to eliminate the exclusion for continuing medical education in the Open Payments program, more commonly known as the Sunshine Act, which requires drug and device companies to disclose payments to physicians. The reversal was included in the proposed Physician Fee Schedule for 2015.

The regulations also include a variety of changes to the Shared Savings Program for accountable care organizations, the Physician Quality Reporting System and the incentive program for electronic health records. And it would expand the array of telehealth services that qualify for Medicare reimbursement.

The proposed changes would benefit primary-care medicine at the expense of payments to specialties. Because the proposed changes in relative value units must be revenue-neutral under Medicare law, increasing payments in one area directly leads to cuts elsewhere.

The CMS proposed cutting Medicare payments for radiation therapy centers and radiation oncology services by 8% and 4% respectively, by reclassifying equipment purchases as indirect expenses of providing care.

At the same time, the rule would increase payments for family practice (2%), internal medicine (2%) and geriatrics (1%), due to changes stemming from the CMS previously undervaluing the work required in those specialties. In addition, independent laboratories would get a 3% pay bump based on increases in the costs of running such organizations.

“Consistent with amendments to the Affordable Care Act, CMS has been engaged in a vigorous effort over the past several years to identify and review potentially misvalued codes, and to make adjustments where appropriate,” CMS officials said in a statement.

“We identified most of these by reviewing high-expenditure services by specialty that have not been recently reviewed. Several other proposed services were identified in a variety of ways, including through our public nomination process.”

In addition, the CMS suggested raising Medicare payments to hospitals by 2.1% in 2015, while ambulatory surgery centers would receive a 1.2% boost in their Medicare pay, according to a 687-page proposed rule.

Both of those rates are higher than what the CMS proposed and ultimately finalized for 2014.

The 2.1% rate increase for hospitals was calculated from a 2.7% marketbasket increase minus a 0.4% productivity adjustment and a 0.2% cut required by the Patient Protection and Affordable Care Act. The rate for surgery centers reflected a 1.7% update to the Consumer Price Index offset by a 0.5% productivity adjustment.

In 2015, Medicare also proposed paying a bundled rate for ancillary services with an average cost of $100 or less. Exceptions to the packaging payment are preventive services, psychiatry-related services and services related to drug administration. —Joe Carlson and Bob Herman

Follow Joe Carlson on Twitter: @MHJCarlson

Follow Bob Herman on Twitter: @MHbherman