CMS Releases Proposed Rule on Physician Fee Schedule; Includes New Language on Chronic Pain Management and Value-Based Modifier

On the evening of July 6, the Centers for Medicare & Medicaid Services (CMS) released CMS-1590, the "Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Pat B for CY 2013" proposed rule.

A number of items are contained in this 765-page proposed rule.    

Of particular interest to ASA, CMS proposed to address whether "chronic pain management is included within the scope of the statutory benefit for CRNA services." CMS noted varying viewpoints, including ASA’s, and ultimately proposed that CRNAs be reimbursed for "surgical services that are related to anesthesia and that a CRNA is legally authorized to perform by the state in which the services are furnished."  In other words, under the proposed rule a CRNA will be reimbursed for services related to chronic pain management as long as the CRNA is permitted to perform the service under the state scope of practice law. ASA plans to address and communicate a number of concerns with this interpretation to CMS. 

CMS also outlined how the agency intends to implement the Value-Based Payment Modifier (VBM) for calendar year 2015, including instituting the modifier for group settings (25 or more eligible professionals).  For those qualifying groups failing to participate in the Physician Quality Reporting System (PQRS) their VBM would be negative 1.0 percent.  For those groups participating in PQRS, there would be two tiers for assessing their VBM.  One tier would be for high performers, or those offering high-quality and low-cost, with upward VBM adjustment potential.  The second tier would be for poor performers, or low-quality and high-cost , with a VBM adjustment potential of negative 1.0 percent, or the same as those failing to participate in PQRS. This proposed rule did not include ASA’s suggested additions to the 2013 PQRS measures. 

The proposed rule also includes many issues that will impact payment for all specialties.  Table 84 (p. 683) illustrates the potential impact some of these issues will have on each specialty.  It does not reflect the 2013 SGR update, but it does encompass baseline (PPIS transition, new utilization and other factors), updated equipment interest rate assumption, discharge transition care management, and input changes for certain radiation therapy procedures. The cumulative impact ranges from a negative 19 percent for radiation therapy centers to a positive 7 percent for family practice.  The total cumulative impact on anesthesiology of the issues addressed in Table 84 is negative 3 percent, a combination of negative 2 percent for practice expense transition and other factors in the rule and negative 1 percent for the newly-covered discharge care management services

ASA is still closely analyzing the full 765-page rule.

Read the proposed rule.