government

Primary care boosted in proposed Medicare pay rule

CMS outlines new benefits and physician incentives for 2011 but also projects a 6.1% reduction to overall doctor pay.

By Chris Silva — Posted July 23, 2010

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The Centers for Medicare & Medicaid Services has issued a proposed Medicare physician fee schedule rule that it says will expand preventive services for Medicare beneficiaries, improve payments for primary care services and promote access to health care.

The proposed rule, announced June 25, would implement provisions in the national health reform law that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including a new annual primary care visit benefit, CMS said. However, it also projects a 6.1% reduction to physician payment rates in 2011 as mandated under the sustainable growth rate formula -- and that would be on top of a roughly 23% cut that is planned for the end of November.

"Beginning in 2011, Medicare will cover an annual wellness visit that will offer an opportunity for the physician and patient to develop a more comprehensive approach to maintaining or improving the patient's health and reducing risks of chronic disease," said Jonathan Blum, deputy administrator and director of CMS' Center for Medicare.

Blum said the proposed rule would improve access to primary care services by implementing a 10% bonus payment for primary care services furnished by primary care doctors. CMS will use claims data and specialty designations from prior years to determine who will be eligible for the incentive each year. Lawmakers stipulated that only family physicians, internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists and physician assistants will receive the bonus -- and only if at least 60% of the care they provide is considered primary care.

The proposed rule also would: implement a payment incentive program for general surgeons performing major surgery in underserved areas; allow physician assistants to order post-hospital extended care services in nursing homes; and pay certified nurse midwives providing Medicare services, including services for women with disabilities, the same rates as physicians.

Blum expressed concern about the impact that the continuing threat of Medicare payment reductions may be having on physicians.

"Although over 97% have chosen to participate in Medicare for 2010 ... we are hearing more stories of physicians limiting the number of beneficiaries they will see," he said. "We are also concerned about the diversion of scarce Medicare resources as we have to adjust our payment operations to the constantly changing legislative landscape."

CMS will accept comments on the proposed fee schedule rule until Aug. 24 and issue a final rule on or about Nov. 1.

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