January 2014
The essential resource for your practice
Volume XXI, Number 1

Senate Makes Last Minute Votes Before Session Adjourns

The Senate acted on sustainable growth rate (SGR) and urotrauma before their session adjourned for the holiday.

SGR: On December 18, by a vote of 64 – 36, the Senate passed the Bipartisan Budget Act of 2013, which was signed by the President on December 26.  The Budget Act, which passed the House in late December, also contains the Pathway for SGR Reform Act (link removed)  – the three-month sustainable growth rate (SGR) “patch” that will prevent physician Medicare reimbursement rates from being cut by 24 percent.

Table of Contents


Coding Corner:

New Codes for Prostate Pathology Services

Summary of the 2014 Medicare Physician Fee Schedule Final Rule

On December 26, 2013, President Obama signed into law the “Pathway for SGR Reform Act of 2013.” This new law prevented the scheduled 24 percent payment reduction under the 2014 Medicare Physician Fee Schedule (MPFS) from taking effect on January 1, 2014. Although the MPFS final rule released on November 27, 2013 called for a 20.1 percent reduction, largely as a result of the statutory sustainable growth rate (SGR) formula, when adjustments to the relative value scale are combined with the conversion factor, the net reduction is about 24 percent. The new law averts the 20.1 percent cut and replaces it with a 0.5 percent increase for services provided through March 31, 2014, resulting in a conversion factor of $35.8228 for calendar year (CY) 2014. The short-term fix will give lawmakers more time to permanently repeal the SGR and finalize other Medicare payment reforms. 

CMS is currently revising the 2014 MPFS to reflect the new law’s requirements as well as technical corrections identified since publication of the final rule in November. The new law also extends several provisions of the Middle Class Tax Relief and Job Creation Act of 2012, as well as provisions of the Affordable Care Act (ACA). Section 1102 of the new law extends the existing 1.0 floor on the physician work geographic practice cost index through March 31, 2014. As with the physician payment update, this extension will be reflected in the revised 2014 MPFS. While Medicare sequester cuts applicable to the MPFS remain at 2.00 percent for now, Section 1205 of the law realigns the sequester amount for fiscal year 2023, which will increase to 2.9 percent for the first six months, then drop to 1.1 percent for the remainder of the year.

For The Record

GAO Report: HHS Should Do More To Improve Qualified Clinical Data Registry Use

The U.S. Department of Health and Human Services (HHS) needs to do more to ensure that clinical data registries (CDRs) improve the quality and efficiency of health care for Medicare beneficiaries, according to a recent Government Accountability Office report (GAO). The American Taxpayer Relief Act of 2012 instructed HHS to establish a new “qualified” clinical data registry (CRD) program for physicians treating Medicare patients to collect clinical information and use it to improve the quality and efficiency of care.

Practices Prepare for Open Payments Implementation

In the wake of the Open Payments Program enactment, physicians are beginning to feel the shift in their business relationships manufacturers and/or group purchasing organizations (GPOs).  The Open Payments Program, also known as the “Physicians Payment Sunshine Act” established under the Affordable Care Act (ACA) requires any manufacturer of medical devices, drugs, and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals to the Centers of Medicare and Medicaid Services (CMS). In addition, manufacturers and GPOs must report to CMS certain ownership or investment interests held by physicians and their immediate family members.  Applicable manufacturers and GPOs began collecting the data on August 1, 2013.  The first data reporting requirement takes place on March 31, 2014 and will cover all data collected from August through December of 2013.