Health Law

The final Medicare physician fee schedule, Hospital Outpatient PPS and Ambulatory Surgery Center fee schedules for 2011 were released by CMS last week.  They will be formally published in the Federal Register later this month.

As usual, the fee schedules include a fair number of regulatory amendments that are not, strictly speaking, fee schedules, which you can read about at the links above.  A number of the changes are driven by the ACA -- e.g., elimination of out-of-pocket costs for most preventive care.

Top of mind on the physician side is the SGR formula-driven pay cut, included in the 2011 MPFS regulation: about a 25% cut for physician reimbursement is now on its glide path to being effective December 1, with a slight additional cut to be effective January 1.  As I wrote last week on the whole SGR fiasco:

Here's a ... link to the 2007 MedPAC report, "Assessing Alternatives to the Sustainable Growth Rate System," and a link to the Congressional testimony given on the MedPAC SGR report by Glenn Hackbarth.  It's remarkable to consider how many elements of MedPAC's recommendations made their way into the ACA, while the SGR formula was left alone.  As we move forward into the realm of bundled payments and quality incentives (Massachusetts is getting there first), capping FFS inflation is just not where we ought to be focusing our energies.  Here's hoping that when Don Berwick and Kathleen Sebelius get hauled in to testify at lots of Congressional committee hearings next year they get to put a bug in the ears of the legislators about this issue so that a long-term solution to the SGR issue may be implemented that will be consonant with the way the rest of the health care market is headed.  

Finally, ASC payments will now be fully transitioned to a new ASC payment system, de-linked from hospital-level reimbursement.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting