The 2013 outlook in medicine: Is SGR action possible?
Penalties kick in
This year the Physician Quality Reporting System (PQRS) transitions from a pure incentive program to a mixed incentive/disincentive program. Previously, PQRS offered small bonus payments to physicians for successfully reporting on quality measures. Now, physicians who don't participate in the program will be assessed a penalty. The 1.5% cut to Medicare fees won’t come until 2015, but it will be based on participation this year. Physicians will see a 2% penalty in 2016 if they don't successfully report data during 2014.
"People don't realize that if they get past 2013, they won't have an opportunity to fix it for the next year," said Dr. Bruce Bagley, medical director for quality improvement at the American Academy of Family Physicians.
There are also penalties coming in Medicare's Electronic Prescribing (eRx) Incentive Program. To avoid a 2% penalty in 2014, physicians must meet Medicare's e-prescribing requirements by June 30, 2013.
Penalties from the Medicare Electronic Health Record (EHR) Incentive Program aren't coming until 2015, but Dr. Bagley said that physicians should take a good look at this program now to try to earn some money to offset the cost of EHR implementation. "The sooner you get going on this stuff, the better," he said.
A physician who starts participating this year can earn up to $39,000 over 4 years. Start next year and the bonus drops to $24,000. A 1% penalty takes effect in 2015, increasing to 2% the following year.
The transition to the ICD-10 coding set is another requirement that physicians need to keep in mind, ACP's Mr. Doherty said. The Department of Health and Human Services delayed the move to ICD-10 until October 2014, but Mr. Doherty said physicians can't afford to wait that long to prepare. The ACP is trying to convince federal officials to accept some alternative ways of coding that would both satisfy the ICD-10 requirements and be clinically relevant, he said.
Primary care gets a boost
Overall, the 2013 outlook will probably vary by specialty. The 2013 Medicare Physician Fee Schedule dealt some tough blows to subspecialists, making deep payment cuts in interventional cardiology, among others..
The 2013 fee schedule included two new transitional care management services codes (99495 and 99496) that will pay physicians for managing complex patients who have recently been discharged from a hospital or skilled nursing facility.
CPT code 99495 requires physicians or their staffs to make direct contact, by phone or electronically, with the patient or caregiver within 2 business days of discharge. A face-to-face visit with the patient is required within 14 calendar days of discharge. CPT code 99496 requires direct contact with the patient or caregiver within 2 business days and a face-to-face visit within 7 calendar days.
The ACP, the AMA, and other groups are developing a series of proposals calling on Medicare to begin paying for more of the non-face-to-face work involved in chronic care management.
