The National Association for Medical Direction of Respiratory Care

The Washington Watchline

Be Careful What You Ask For -- SGR Repeal Does Not Mean Financial Relief

Washington politics will never cease to amaze us. Emerging from the background of legislative chaos created by partisan policy dis-agreements over deficit spending in the Fiscal Year 2016 budget, HR 2, a bill to repeal the Sustainable Growth Rate formula, was introduced March 24 by leaders of the House Energy and Com-merce and Ways and Means Committees and passed by an as-tounding vote of 392 to 37 on March 26. This legislation resurrects HR 4015, which was passed by the House of Representatives a year ago 238 to 181, with the great majority of Democrats oppos-ing the bill.

Physician Compensation in Medicare; 2015 and Beyond

Absent legislative action, payments to physicians under Medicare will but cut by 21.2 percent starting April 1. With the cur-rent “doc fix” expiring at the end of this month, some action will have to be taken quickly to avoid precipitous payment cuts. Given the burdens Congress is facing at this time the odds again favor another short term extension. As discussed in the July 2014 Washington Watchline, it appears that Congress hopes the issue of the Sustainable Growth Rate (SGR) formula will fade away as an increasing number of physicians accept salaried arrangements.

Physician Profiling

Concerns about medical errors and the quality of care have led to legislative efforts to establish programs in Medicare that measure the performance of physicians and health care organiza-tions and promote public profiling of providers. This is often re-ferred to as increasing transparency in healthcare. Provisions in the 2015 Medicare fee schedules increase the specificity of pro-vider profiling on the Hospital Compare and Physician Compare websites.

Increased Scrutiny of Hospital Acquired Physician Offices

The January issue of NAMDRC’s Washington Watchline usually deals with areas of our practice that will be under scrutiny by the Health and Human Services Office of Inspector General (HHS OIG) for the coming year. The recently released HHS OIG 2015 Workplan proposes no new projects for 2015. However, one high profile project worth commenting on is the ongoing review of provider-based billing for services delivered in physician offices and the new billing requirements mandated by the Centers for Medicare and Medicaid Services (CMS) in the 2015 Physicians Fee Schedule.

Will the 2015 Changes to the Medicare Physicians Fee Schedule Improve Medical Care?

CMS released the 2015 calendar year Physician Fee Schedule (PFS) final rule on Halloween, October 31st . Following the publication of the proposed rule last summer, detailed comments were submitted to the Centers for Medicare and Medicaid Services (CMS) by the Medicare Payment Advisory Commission, The American Medical Association, The American College of Physicians, The American College of Cardiology, The Society of Thoracic Surgeons, The Association of American Medical Colleges, The American Hospital Association and the Medical Group Management Association among others.

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