Physician Fee Proposal Generates Calls for Changes

Margaret Dick Tocknell, for HealthLeaders Media , September 10, 2012

Rep. Jim Cooper (D-TN) also commented in support of direct reimbursements to licensed advanced practice nurse (APN), including CRNA for pain management procedures. "There is no evidence that trained and qualified APNs compromise patient safety or lead to over utilization of procedures. Research has shown that these providers increase access and decrease the cost of healthcare."

Physician value-based payment modifier (VBPM)

The ACA requires CMS to establish a value-based modifier that provides for differential payments based on the quality of care furnished compared to the cost of the care. The VBPM is required to be revenue neutral so increased payments to some physicians result in decreases for others

The AAFP is concerned that budget neutrality considerations limit CMS's ability to "specify the exact amount of the upward payment adjustment." The AAFP said it "will be challenging" for groups to subject themselves to "a new and untested program without prior knowledge of a potential award."

MGMA is concerned that several technical issues related to the VBPM have not been addressed. MGMA questions if the modifier can even be implemented for the first measurement year in 2013 and urges CMS "to withdraw this proposal until methodological and technical issues" are resolved. Among its concerns is that more time is needed to "test valid measures of cost, outcomes and quality as well as mechanisms to accurately adjust for risk before moving forward with a program that modifies physicians' payments based on CMS' definition of value."

CMS is expected to release the final physician fee schedule rule in November.


Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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