Special Update: Congress Passed One–Year SGR Fix as Part of Fiscal Cliff Legislation
Congress passed The American Taxpayer Relief Act of 2012, to avert the “fiscal cliff.” President Obama is expected to sign the legislation shortly.nnIn addition to various tax and spending measures, the legislation includes provisions of direct importance to medical group practices. The legislation:n
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- Prevents the Medicare physician payment SGR cut for one year. It eliminates the 27 percent Medicare physician payment cut, which took effect today and replaces it with a “zero percent update” to the Medicare physician fee schedule conversion factor for 2013. As has occurred with prior temporary extensions of this kind, this is not a fee schedule rate freeze. It means any conversion factor adjustments and RVU changes contained in the final fee schedule rule for 2013 may result in payment rate changes, but the massive SGR cut is nullified for a year.
- Turns off the January 2, 2013 sequester for two months. This prevents various defense and other automatic cuts from occurring, including an across the board, two percent cut for all Medicare providers. It’s expected Congress will revisit issues related to the sequester in the near future.
- Extends the Medicare 1.0 work RVU GPCI floor through December 31, 2013
- Increases the Medicare Part B equipment utilization assumption for advanced imaging services to 90 percent effective for fee schedules established for 2014 and subsequent years, thus reducing future payments
- Extends the Medicare therapy cap exception process through December 31, 2013
- Increases the Medicare therapy service multiple procedure payment reduction from 25 to 50 percent effective April 1, 2013
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A new report from the Agency for Healthcare Research and Quality (AHRQ) highlights the cumulative experiences of more than 100 grantees that implemented major health IT projects between 2004 and 2007.nnThe report, Effective Teamwork and Sustainability in Health IT Implementation, reviews grantee experiences related to planning, long-term use, partnerships, vendor relationships, and end-user perceptions a few years after the end of the project period. According to the grantees, the most important factors affecting the sustainability of health IT were the ability to demonstrate benefits from health IT to grantees’ organizations, clinician support, and cost–related issues. Grantees said that most health IT products that were implemented and upgraded during the study continue to be used. However, they reported that in order for health IT projects to be successful, clinician buy-in and support must be established early in the planning period and be sustained during implementation and maintenance phases. Effective planning, including completing a detailed workflow analysis, implementation plan and process re-design assessment prior to implementation, were strong markers of long-term viability.nn
ceive a 26.5 percent reduction in payments starting Jan. 1 unless Congress intervenes. Action to avert the cut is being considered as part of broader fiscal cliff negotiations on tax and spending policies. However, these discussions remain up in the air, creating uncertainty over the timing of a solution.nnThe latest estimates from the Congressional Budget Office (CBO) indicate that a one-year patch to prevent the SGR cut would cost $25 billion. While most members of Congress agree that the current Medicare payment system must be repealed, the cost is daunting. Details should emerge in the coming week.
nnOn Nov. 15, CMS posted its FY 2012 financial report. CMS CFO Deborah Taylor, a certified public accountant, prepared the 202-page document, which is required by law every year. Here are 10 of the biggest takeaways from the report.nnWhat the nation’s healthcare dollar looked like in 2012. Government health programs consume the largest parts of the U.S. healthcare system, and CMS’ report broke down the different healthcare payors and how much money they represented in FY 2012. Here’s how much each sector represented for every dollar spent on the U.S. healthcare last year:nn• Private insurance: 31.6 centsn• Medicare: 21 centsn• Medicaid: 16.3 centsn• Other government programs: 13.3 centsn• Out-of-pocket: 11.1 centsn• Other private programs: 6.7 centsnnFurthermore, Medicare and Medicaid, including state funding, represented 54 cents of every dollar spent on nursing homes, 49 cents of every dollar received by hospitals and 33 cents of every dollar spent on physician services.nnMedicare Part A Benefit Payments. Inpatient hospital spending accounted for 54 percent of Medicare Hospital Insurance, or Part A, benefit outlays in FY 2012. Managed care represented the next-highest total at 25 percent, while skilled nursing facilities received 12 percent of Part A payments.nnMedicare Part B Benefit Payments. Medicare Part B, or Supplementary Medical Insurance, covers all physician, hospital outpatient, home health, lab test and other services not covered by Part A. Physicians services accounted for the largest slice of Part B at 24 percent. Prescription drugs accounted for 21 percent, while hospital outpatient services represented 11 percent.nnMedicaid Enrollees. Children represented the largest portion of Medicaid beneficiaries in FY 2012 at 50 percent. The remaining enrollees were adults (23 percent), disabled (18 percent) and elderly (9 percent).nnFederal Medicaid costs. State and federal medical assistance payments and administrative costs totaled $452.5 billion last year. CMS’ share of Medicaid outlays totaled $260.1 billion of that total.nnMedicare and Medicaid Recovery Auditors. Medicare RACs recovered $2.3 billion in over–payments in FY 2012, as reported earlier. However, that figure does not include dollar amounts related to claims in the appeals process or claims that had been successfully appealed by providers.nnMedicaid RACs were supposed to go live Jan. 1, 2012, although not all states have finalized their programs. According to the report, “states that have been unable to implement Medicaid RAC programs by Jan. 1, 2012, have been submitting [state plan amendments] to CMS requesting implementation delay exceptions.” CMS released a Medicaid RAC final rule in September 2011, projecting savings of $2.1 billion over the next five years. Roughly $910 million of that total would be returned to states.nnSource: www.beckershospitalreview.com Bob Herman; December 7, 2012.
nnThere is no single, universal definition for ACOs. In its census, Oliver Wyman counted not just participants in Medicare’s various ACO programs, but also commercial ACOs and healthcare delivery organizations that apply some other name to themselves but follow the basic elements of the accountable care organization: They are healthcare providers that take responsibility for the full healthcare needs of a defined population, receiving savings payments based on cost savings and quality.nnThe ACA directed Medicare to create ACO programs – today there are 150 Medicare ACOs, and the number is expected to more than double in January, when Medicare announces the next class of participants in its Shared Savings Program. Because it is difficult to operate a single organization under a fee-for-service and an ACO model at the same time, most participants in Medicare ACO programs eventually shift their non-Medicare patients to ACO models as well.nnA total of 25 to 31 million U.S. patients currently receive their care through ACOs. They include:n
At the 98th meeting of the Radiological Society of North America in Chicago on Nov. 26, 2012, Keith J. Dreyer, DO, PhD, vice chairman of radiology at Massachusetts General Hospital in Boston and associate professor of radiology at Harvard Medical School, discussed the future of imaging informatics in the face of meaningful use.nnCMS’ meaningful use program is one of the ways the federal government is focusing on quality, safety and access with healthcare, said Dr. Dreyer. By urging providers to use certified electronic health record technology, the federal government is hoping that safety and quality of healthcare will increase while the cost of healthcare will decrease. According to Dr. Dreyer, physicians and radiologists need incentives to have a patient-centric focus in their healthcare decisions and that is what meaningful use is — an incentive.nnDr. Dreyer pointed out that more than 50 percent of physicians and 80 percent of hospitals have enrolled in the meaningful use program, with payments passing $7 billion, from when meaningful use legislation as part of the HITECH Act was first passed in February 2009 to when the most recent regulations — stage 2 of meaningful use — were released.nn”What does this mean for radiologists? Well, nearly all radiologists are eligible for the program. In 2011, 32 percent of radiologists said they planned to participate, and in 2012, that percentage has doubled,” said Dr. Dreyer. “While meaningful use can be a challenge for radiologists, there are various exclusions and temporary exemptions available. The thing to remember is that the stages of meaningful use are important.”nnThe stage 2 regulations for meaningful use have two specific objectives for imaging:n