On October 6, 2011, the Medicare Payment Advisory Commission (MedPAC) voted to recommend that Congress repeal and replace the statutory sustainable growth rate (SGR) formula for updating the Medicare physician fee schedule (MPFS). Without legislative action, CMS estimates that the SGR formula would result in an almost 30% MPFS cut in 2012. As discussed in
Sustainable Growth Rate (SGR)
CMS Issues Proposed CY 2012 Physician Fee Schedule Rule
By Debra A. McCurdy on
July 19, 2011, the Centers for Medicare & Medicaid Services (CMS) published its proposed update to the Medicare physician fee schedule (MPFS) for calendar year (CY) 2012. Most notably, the proposed rule calls for a negative 29.5% update for 2012 under the statutory sustainable growth rate (SGR) formula. For 2012, CMS projects a conversion factor of $23.9635, compared to the 2011 conversion factor of $33.9764. While Congress is expected to consider legislation to advert the upcoming cut, as it has in previous years, the scope, timing, and outcome of any such legislative “fix” is still speculative. The sweeping proposed rule includes numerous other policy proposals, which are summarized after the jump.
Continue Reading CMS Issues Proposed CY 2012 Physician Fee Schedule Rule
MedPAC Recommends Changes to Medicare Ancillary Services Policies
By Debra A. McCurdy on
The Medicare Payment Advisory Commission (MedPAC) has released its June 2011 “Report to the Congress: Medicare and the Health Care Delivery System.” Most notably, the report includes a number of recommendations that have generated much controversy to address the growing use of ancillary services, particularly non-hospital diagnostic imaging services. According to the report, MedPAC seeks…
Congressional Hearings on Health Policy Issues
By Debra A. McCurdy on
A number of Congressional panels have held hearings this month on health policy issues, including Senate Health, Education, Labor and Pensions (HELP) Committee hearings entitled “First, Do No Harm: Improving Health Quality and Patient Safety” and “Diverting Non-Urgent Emergency Room Use: Providing Better Care and Lower Costs.” Both the House Energy & Commerce Subcommittee on…
CMS Estimates 29.5% Cut in 2012 Medicare Physician Fee Schedule (MPFS) Conversion Factor Without Congressional Action
By Debra A. McCurdy on
CMS recently released its preliminary estimate that, in the absence of a statutory change, the 2012 MPFS conversion factor (CF) will be $23.9396 — a 29.5% reduction from the December 2011 CF. Contributing to this decline is an expected 17.2% reduction mandated by the Sustainable Growth Rate (SGR) and a requirement that the update be…