Medicare updates include proposed physician fee schedule and Medicare Shared Savings Program
The 2015 Medicare physician fee schedule proposed rule is expected to be finalized by November 1st. The proposed rule will impact Medicare Part B in the areas of quality reporting and physician payments in 2014. The Medical Group Management Association (MGMA) reported recently on some of the key elements of change:

  • An approximate 24.4 percent physician payment cut due to the sustainable growth rate formula (SGR)
  • Implementation of the physician value-based payment modifier by applying the 2016 modifier to groups of 10 or more eligible professionals (EPs) and requiring large groups to assume risk through the quality-tiering component of the program
  • Changes to the Physician Quality Reporting System (PQRS), such as requiring EPs to report at least nine measures covering at least three of the National Quality Strategy Domains and adding a new “qualified clinical data registry” reporting method to the program
  • Limitations to the payment for approximately 200 services where the physician fee schedule non-facility payment is higher than the total payment to furnish the same service in a facility setting (either a hospital outpatient department or an ambulatory surgery center)

The MGMA provides a detailed 2014 Proposed Medicare Physician Fee Schedule Analysis that members can download.

Medicare Shared Savings Program (MSSP)

In developing the Advance Payment Accountable Care Organization (ACO) Model, the Centers for Medicare and Medicaid Services (CMS) is responding to input from stakeholders received on the proposed rule for the Shared Savings Program, and comments received (PDF) on the initial Advance Payment Model announced in May 2011.

The Advance Payment ACO Model is meant to help smaller ACOs with less access to capital participate in the Shared Savings Program. Some providers have expressed a concern about their lack of ready access to the capital needed to invest in infrastructure and staff for care coordination.

In 2013 CMS approved additional accountable care organizations (ACOs) to participate in the Medicare shared savings program. There are currently 35 ACOs across the county. These groups joined existing previously selected groups. It’s not just major organizations that this affects, but even small practices which means that most providers need to evaluate whether or not to participate in these shared savings organizations. There are several steps to gaining approval and learning more is the first step.

The MSSP awards selected groups with a portion of savings generated from more efficient care of assigned fee for service Medicare patients. Through the Advance Payment ACO Model, selected organizations will receive an advance on the shared savings they are expected to earn. Participating ACOs will receive three types of payments:

  • An upfront, fixed payment: Each ACO will receive a fixed payment.
  • An upfront, variable payment: Each ACO will receive a payment based on the number of its historically-assigned beneficiaries.
  • A monthly payment of varying amount depending on the size of the ACO: Each ACO will receive a monthly payment based on the number of its historically-assigned beneficiaries.

Advance payments are structured in this manner to acknowledge that new ACOs will have both fixed and variable start-up costs. Take the quick and basic “Eligibility Checker” for the Advance Payment ACO Model on the application information page. 




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