Medicare 2013 PPFS: Focus on Primary & Coordinated Patient Care
Medicare 2013 PPFS:
On July 6, 2012, the Centers for Medicare & Medicaid Services ("CMS") released the 2013 Medicare proposed physician fee schedule ("PPFS"). The 2013 PPFS policies would affect payments for physician services provided on or after January 1, 2013, and continue in effect through the remainder of the year. CMS will be accepting comments on the rule through September 4, 2012, which can be submitted electronically here.
Earlier this year, a CMS analysis revealed that based on the current payment methodology there is a 27% projected decrease in the 2013 physician payment rate. While this adjustment represents a current concern for the healthcare provider community, it is anticipated that additional legislation will postpone any decrease as a function of the sustainable growth rate ("SGR") methodology. Despite the fact that anticipated legislation will likely bar such payment cuts from occurring in 2013, the PPFS rule does offer key insights into the policy-making approach that is moving the healthcare industry in new directions.
Notably, as baby boomers continue to join the ranks of Medicare enrollees at a growth rate of 2% annually,1 the 2013 proposed Medicare fee schedule reflects a continuing trend in aligning physician reimbursement with the specialties needed for management of chronic disease and preventative care. Based on the proposed relative value changes to procedure codes in the 2013 PPFS, the following specialties are expected to see increased reimbursement for the services they typically provide:
In addition, the proposed rule also introduces procedure codes and related reimbursement to emphasize the need for transitional care and new care models, including the following:
While the 2013 proposed rule is still in the comment period, there are actionable items to be considered by physician practices, both independent and hospital-owned:
If you have any questions about the information above or would like to discuss your strategic response to the proposed rule with PYA, please contact Linda ClenDening at (800) 270-9629 or Nancy McConnell at (888) 420-9876.
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