August 2011 Washington Update

As this issue of Annals of Long-Term Care: Clinical Care and Aging went to press, the American Geriatrics Society (AGS) was preparing a comprehensive response to the 2012 Physician Fee Schedule recently proposed by the Centers for Medicare & Medicaid Services. As mandated by Medicare’s problematic Sustainable Growth Rate (SGR) formula, the fee schedule calls for a 29.5% cut in fees, effective January 1, 2012. AGS has long advocated for a viable alternative to the unworkable SGR payment protocol, and in July 2011, the organization launched its latest advocacy campaign calling for an alternative protocol to the SGR for compensating providers appropriately.

The 29.5% cut in physician fees will take effect unless Congress intervenes to block or defer it, as lawmakers have done in previous years. Each time Congress defers the cuts, however, the SGR mandates steeper cuts the following year. In addition to calling for a 29.5% cut in payments, the 2012 Physician Fee Schedule proposes to do the following:

• Review all Evaluation and Management codes, with half reviewed by July 2012 and the remainder by July 2013. Under the new schedule, there will be no more 5-year reviews; all codes will be eligible for review annually.

• Expand the Multiple Procedure Payment Reduction (MPPR) policy, which currently applies only to the technical component of certain advanced imaging services, so that it also includes the professional component of those services.

• Change the code descriptors for inpatient telehealth consultation G-codes to include emergency department telehealth consultations, effective January 1, 2012.

• Amend the annual Medicare Preventive Visit regulations to take into account health risk assessments.

• Change the Physician Quality Reporting System’s definition of “group practice” to refer to a physician group practice with at least 25 eligible professionals who have reassigned their billing rights to the group’s Taxpayer Identification Number.

• Initiate a move toward having certain specialties report data concerning specified measures relevant to their respective specialty.

• Take steps toward reporting information about the quality of care provided by physicians and other healthcare professionals. The healthcare reform law requires CMS to implement a plan for making this information available by January 2013. The agency proposes to start with reporting on group practice performance, rather than individual physician performance.

CMS has invited comments on these changes and is also seeking input regarding which physician services and resources are needed to provide effective care coordination at discharge from the hospital. The agency has requested commentary on this issue so that it can ensure that hospital discharge care coordination services are appropriately valued.

AGS members who have comments they would like AGS to consider including as part of its response to CMS about the proposed 2012 fee schedule should send an e-mail to Susie Sherman, coordinator of public affairs and advocacy, at ssherman@americangeriatrics.org.

In July 2011, the American Geriatrics Society (AGS) and more than 100 additional organizations wrote a letter to President Obama urging that any agreement to raise the debt ceiling include a provision to replace Medicare’s Sustainable Growth Rate (SGR) formula with a viable alternative.

“Any serious proposal to confront the fiscal challenges facing our nation, and the Medicare program in particular, must address the massive funding deficit caused by the repeated failure to replace the SGR,” wrote AGS and its 112 cosigners.

The letter went unheeded, as the compromise reached between Congress and the Administration and enacted into law, failed to take this important step. Nor did the legislation include any of the cuts to Medicare that were reportedly “on the table.” It caps discretionary spending across the board, except for the Medicare, Medicaid, and Social Security programs.

Although the debt ceiling has now been raised and default was narrowly avoided, the deficit debate resumes this fall. The deal that emerged requires Congress to appoint a 12-member panel, being deemed the “Super Congress,” consisting of three Republicans and three Democrats from the House and three Republicans and three Democrats from the Senate. If, by the end of the year, this group fails to come up with a plan that reduces the deficit by $1.2 trillion over the next decade, automatic cuts will go into effect.

Social Security is the only program completely off limits to the panel; the panel is not restricted from recommending cuts to Medicare and Medicaid. Should the group fail to reach an agreement, the automatic cuts to Medicare are limited to a maximum of 2% of the program’s cost. Medicare cuts must come from payments to providers and insurers, not benefits, and seniors’ premiums cannot be increased.

AGS and groups such as the American Medical Association, the American College of Physicians, the American College of Cardiology, the American College of Surgeons, and other organizations that signed the letter to the president will continue to follow the situation closely. AGS will continue its push to see any Medicare reform include replacing the SGR with a sustainable, appropriate formula for physician fees.