Medicare


Medicare News

Tell Lawmakers to Repeal the SGR Now – New Toolkit Makes it Easy

You know that the current Medicare system is broken for physicians and their patients. Medicare’s flawed sustainable growth rate formula has repeatedly called for steep reductions in physician payments under Medicare and has required annual scrambles to prevent or reverse those cuts. Now is the time to replace the SGR with a new system altogether, and you can help.

Members of Congress have taken steps towards repealing the SGR formula that could make real reform achievable this year and transform the program into an effective, 21st century model of care. 

Take action and tell lawmakers to fix Medicare now! OMA member volunteers delivered this message and more to Oregon lawmakers in Washington, DC, in September. Add your voice by sending an e-mail to your representative and senators; it’s easy with the AMA’s grassroots system at www.FixMedicareNow.org/physician-action. You can also call them using the toll-free grassroots hotline at (800) 833-6354.

Why does it matter?

Once again, physician services face a 24.7 percent cut due to the flawed SGR payment formula. Cutting approximately $180 million from physician services in Oregon would greatly exacerbate the growing gap between Medicare payment updates and practice cost inflation. This increasingly unstable system threatens physicians and patients alike and must be fixed now.

Grassroots tools and resources make it easy to learn more and take action

The OMA, AMA and other medical societies are ramping up our grassroots efforts this fall to put concerted pressure on members of Congress to repeal the SGR formula once and for all. An important component of this effort is a new interactive website, www.FixMedicareNow.org.  The site is designed to engage both patients and physicians in the campaign to repeal the SGR and to educate policymakers on the urgent need to do so.

It's time to fix Medicare now! Let's make 2013 the year we finally repeal the SGR and move toward a Medicare program that supports physicians providing high-quality patient-centered health care. Take action now!

CMS Releases 2014 Physician Fee Schedule Proposed Rule

CMS has released the Medicare physician fee schedule proposed rule for 2014 and intends to issue the final rule by Nov. 1, 2013. CMS will accept public comments on the proposed rule until Sept. 6, 2013.

In addition to setting 2014 payment rates for physician services, CMS says the proposed rule:

  • Continues implementation of the physician value-based payment modifier by applying the 2016 modifier to groups of 10 or more eligible professionals
  • Makes changes to criteria for earning a Physician Quality Reporting System bonus and avoiding penalties under this program. 2014 will be the last year a bonus will be available for PQRS.
  • Establishes a separate payment beginning in 2015 for complex chronic care management services furnished to patients with multiple complex chronic conditions
  • Modifies Geographic Practice Cost Indices based upon statutory requirements and recommendations from the Medicare Economic Index Technical Advisor Panel
  • Limits the payment for certain services where the physician fee schedule nonfacility 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)
  • Increases the amount of information about physicians and practices on the Physician Compare website, including quality measure performance

A copy of the full proposed rule is available at http://bit.ly/12mLEay. CMS has issued a fact sheet on the proposed policy and payment changes and another fact sheet on the physician quality reporting programs and the value-based payment modifier.

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Medicare Program Overview

From the Centers for Medicare and Medicaid

Medicare is a health insurance program for:

  • people age 65 or older,
  • people under age 65 with certain disabilities, and
  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare has:

Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services.

Medicare deductible and premium rates may change every year in January.

Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

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Oregon's Medicare Part B Carrier

Noridian Healthcare Solutions is the Medicare Part B carrier for Oregon. Their website, www.noridianmedicare.com/partb is very useful for obtaining the latest news regarding Medicare Part B as well as obtaining any necessary Medicare forms for your practice.

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2013 Medicare Fee Schedule

The 2013 Medicare Physician Fee Schedule can be accessed through the Noridian website: www.noridianmedicare.com/partb/fees/index.html.

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Enrollment

Noridian Healthcare Solutions has a comprehensive website on Medicare Part B Enrollment information, which includes necessary forms and educational resources: https://www.noridianmedicare.com/p-medb/enroll/.

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Medicare Reimbursement Resources and the SGR

The Sustainable Growth Rate (SGR) is a component of the CMS formula used  to calculate physician payments for providing services to Medicare patients. It is based on the GDP and not on actual health care practice costs.

  • The SGR will lead to steep cuts in physician compensation for services to Medicare patients. The SGR is a target expenditure growth number. If actual expenditures exceed the SGR, physicians’ payments are cuts.

The SGR is based on the following factors:

  • Estimated change in fees for physician's services.
  • Estimated change in beneficiaries enrolled in Medicare's fee-for-service program.
  • Estimated growth in real gross domestic product (GDP) per capita.
  • Estimated change in expenditures due to law and regulation.

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