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CMS Proposes First Update to Physician Fee Schedule Since SGR Repeal

July 9, 2015
by Rajiv Leventhal
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On July 8, the Centers for Medicare & Medicaid Services (CMS) released the first proposed update to the physician payment schedule since the repeal of the Sustainable Growth Rate (SGR) through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

In April, President Barack Obama signed MACRA, a bill that now permanently repeals the long-maligned SGR formula for Medicare physician payment. In broad terms, MACRA ends physician payment incentives under the meaningful use program within the HITECH (Health Information Technology for Economic and Clinical Health) Act, and those under the Physician Quality Reporting System (PQRS), replacing the incentives in those programs with a new program called the Merit-based Incentive Payment Program, or MIPS.

In CMS’ first proposed rule since the SGR formula was scrapped, Medicare transformation focused around person-centered and outcomes-driven care are key themes. CMS points out that “the proposed rule includes updates to payment policies, proposals to implement statutory adjustments to physician payments based on misvalued codes, updates to the Physician Quality Reporting System, which measures the quality performance of physicians participating in Medicare, and updates to the Physician Value-Based Payment Modifier, which ties a portion of physician payments to performance on measures of quality and cost.”

In the proposed 2016 Physician Fee Schedule rule, CMS is also seeking comment from the public on implementation of certain provisions of the MACRA, including the new MIPS program. The proposed rule also seeks comment on a proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers. The proposal follows the American Medical Association’s recommendation to make advance care planning services a separately payable service under Medicare.

The release of the rule triggers a 60-day comment period, during which time CMS welcomes the input of stakeholders and the public, the agency said. 



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