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
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