Urologists face 2% cut under proposed 2013 CMS fee schedule

July 18, 2012

Urologists face a 2% cut in Medicare reimbursement in 2013, according to the recently released 2013 proposed fee schedule from the Centers for Medicare & Medicaid Services.

Urologists face a 2% cut in Medicare reimbursement in 2013, according to the recently released 2013 proposed fee schedule from the Centers for Medicare & Medicaid Services.

In the schedule, released July 6, payments to family physicians will increase by approximately 7% and other practitioners providing primary care services between 3% and 5%. Those increases will come at the expense of reimbursement to specialists in order to achieve budget neutrality.

Other specialties facing reimbursement cuts include radiation oncology (14%), radiology (4%), and pathology (2%). Increases in reimbursement are slated for pediatrics (5%), obstetrics/gynecology (1%), and ophthalmology (1%).

Separately, for calendar year 2013, CMS projects a reduction of 27% in Medicare physician fee schedule payment rates under the sustainable growth rate (SGR) methodology due to the expiration of the adjustment made for calendar year 2012 in the statute. CMS is required by law to include this reduction in these calculations. Congress has acted to avert the cuts every year since 2003.

The proposed rule would also continue the implementation of the physician value-based payment modifier that was included in the Affordable Care Act by providing choices to physicians regarding how to participate. The value modifier adjusts payments to individual physicians or groups of physicians based on the quality of care furnished to Medicare beneficiaries compared to costs. The law allows CMS to phase in the value modifier over 3 years from CY 2015 to CY 2017.

For the CY 2015 physician payment rates, the proposed rule would apply the value modifier to all groups of physicians with 25 or more eligible professionals. The proposed rule also provides an option for these groups to choose how the value modifier would be calculated based on whether they participate in the Physician Quality Reporting System (PQRS).

The proposed rule also continues efforts by CMS to align quality reporting across programs to reduce burden and complexity and proposes changes to two quality reporting programs that are associated with the Medicare Physician Fee Schedule: the PQRS and the Electronic Prescribing Incentive Program.

CMS is accepting comments on the proposed rule until Sept. 4, and will issue a final fee schedule by November. To view the proposed rule, click here.

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