This post was authored by Bo Walpole Jr. MD, MBA, FACC, chair of ACCPAC.
It’s that time of year again, where we’re on the edge of our seats wondering what next year will bring for physician payment. On Nov. 1, the Centers for Medicare and Medicaid Services (CMS) released the 2013 final Medicare Physician Fee Schedule, which sets payment rates and related policies for next year. While 2010 was a particularly uprooting year, one that we haven’t quite recovered from yet, each year brings its own challenges.
So what’s in store for next year? In addition to the 26.5 percent cut stemming from the flawed Sustainable Growth Rate (SGR) and across the board cuts of 2 percent associated with sequestration provisions of the Budget Control Act of 2011, we face an overall -2 percent impact on cardiovascular medicine.
Next year, PCI is also in the line of fire. We’ll see physician work RVU reductions of roughly 20 percent to the family of PCI codes and roughly 27 percent to the family of EP/ablation codes. Another concern is CMS’ decision to expand a multiple procedure payment reduction (MPPR) to cardiovascular services, resulting in 25 percent reductions in certain cases. Unfortunately, CMS decided to move in this direction despite the ACC, other stakeholders and 60 members of Congress voicing strong objection earlier this year. (See congressional sign-on letter.)
Additionally, the final rule lays out details for the Physician Quality Reporting System (PQRS) and e-prescribing, and Value-Based Payment. In each of these cases, there are definitely incentives for successful participation, however, we are now entering the phase where many of these programs are transitioning to penalties for non-participation. It’s important that we all stay on top of the varying deadlines for these programs and weigh the costs and benefits associated with not participating. The College has resources for members in the Physician Payment Resource Center in the Advocacy section of CardioSource.org and includes frequent reminders about deadlines in the weekly ACC Advocate newsletter.
These are challenging times across the health care spectrum, with sequestration, the fiscal cliff and the debt ceiling looming over the country, and we must continue to work together to ensure the voice of cardiology is heard loud and clear on the Hill. The good news is that 104 out of 122 ACCPAC-supported candidates won their elections last week. That’s an astounding 90 percent success rate and means, at the very least, that we have potential allies on both sides of the political spectrum as we work to encourage health policies that allow us to provide quality, cost-effective care to our patients!
Now is the time to foster partnerships with these lawmakers through legislator practice visits and other grassroots events. We can provide them with first-hand perspectives of how their decisions impact health care for patients with cardiovascular disease; facilitate the delivery of high-quality, cost-effective cardiovascular services; and fund cardiovascular research and prevention.
I also urge you to check out the agenda and register for the Cardiovascular Summit that will take place Jan. 10 – 12 in Las Vegas. The Summit will bring together health policy leaders, payers and other stakeholders who will delve into the impact of the elections, health reform implementation, evolving payment models, coding and documentation and more. There is no better time to be involved in these conversations!
Stay tuned to The ACC Advocate, CardioSource.org and the Nov./Dec. issue of Cardiology magazine for more information on the implications of the 2013 Medicare Physician Fee Schedule on cardiology. You can also hit the ground running in 2013 by preparing for coding changes now. The ACCF/AMA CPT Reference Guide for Cardiovascular Coding is your one-stop resource for understanding significant new code revisions; efficiently and accurately reporting cardiovascular services and procedures; brushing up on CPT guidelines; and guidance on general intent and use of radiological and cardiovascular diagnostic and therapeutic procedures and services. In addition, a special webinar on Nov. 28 from 3-5 p.m. ET will explore major coding changes for 2013. Learn directly from those who presented the codes and sat at the table during the CPT and RUC processes. Register now.