Congress staves off Medicare pay cut, averts fiscal cliff

Physicians dodged a 26.5 percent cut in Medicare physician payments when Congress passed the American Taxpayer Relief Act on Jan. 1. The bill enacts a "zero percent update" to the Medicare physician fee schedule conversion factor for 2013, averts the fiscal cliff and delays automatic cuts under sequestration for two months.

Because the bill provides a temporary extension rather than a rate freeze, physicians may still see conversion factor adjustments and changes to relative value units for services. The one-year fix expires on Dec. 31, 2013.

To pay for the patch, Congress had to find offsets of roughly $30 billion. These cuts will come from other Medicare programs, most of which affect hospitals, pharmacies, and dialysis clinics. Though lawmakers considered reversing the Medicaid primary care bonus provided under the Affordable Care Act to help pay for the cost of a temporary fix, this increase was left intact.

Additionally, the bill extends the geographic work adjustment (1.0 floor) through Dec. 31, 2013; increases the Medicare Part B equipment utilization assumption for advanced imaging services to 90 percent effective for fee schedules established for 2014 and subsequent years; extends the Medicare therapy cap exception process through Dec. 31, 2013; and increases the Medicare therapy service multiple procedure payment reduction from 25 percent to 50 percent effective April 1, 2013.

The Colorado Medical Society, American Medical Association, and other physician organizations continue to push for a permanent repeal of the sustainable growth rate formula that forces this annual crisis in payments to physicians who care for Medicare beneficiaries.

Jeremy Lazarus, M.D., psychiatrist and president of the American Medical Association, said in a statement, "This last-minute action on the part of Congress is a clear example of how the Medicare program is increasingly unreliable for physicians and patients. This instability stalls progress in moving Medicare toward new health care delivery models that can improve value for patients through better care coordination. Physicians want to work with Congress to move past this ongoing crisis and toward a Medicare program that ensures access to care and the best health outcomes for patients and a stable, rewarding practice environment for physicians."

The Colorado Medical Society, joined by 12 other physician associations, filed a lawsuit in the Colorado District Court on Dec. 28 to halt the implementation of a rule by the Colorado Board of Chiropractic Examiners that would improperly extend medical authority to chiropractors to administer drugs.

Changes to existing Rule 7(c) would authorize chiropractors to administer non-FDA approved compounds -- including glandular extracts, enzymes, homeopathic and botanical medicines -- topically, orally, and by inhalation and injection, after completing just 24 hours of study and a certification exam. CMS fears that improper injections could cause patients to suffer serious adverse outcomes and side effects.

An opinion issued by the attorney general in early December stated that these changes "exceed the legislative scope of authority" granted to the Board of Chiropractic Examiners. The Office of Legislative Legal Services, the legal arm of the legislative branch that staffs the Joint House-Senate Committee on Legal Services, added that the board does not have the authority to establish a new level of certification for chiropractors who administer injections, which the rule also specifies.

The new rule would have gone into effect Jan. 14, but shortly after the lawsuit was filed, the Colorado Board of Chiropractic Examiners issued an emergency rule announcing that they will delay its implementation until April 30, 2013, to allow the Colorado Legislature to decide if Rule 7(c) is appropriate.

Click here to read the full legal complaint filed. Click here to read the sharp rebuke of the proposed rule in the Chronicle of Chiropractic, a source for news on conservative, traditional chiropractic written by the Foundation for Vertebral Subluxation.

Medicaid Primary Care Payment Increase: Attestation Required

Changes to Medicaid primary care reimbursement were enacted as part of the Affordable Care Act (ACA). Eligible physicians will receive supplemental payments for services rendered between Jan. 1, 2013, and Dec. 31, 2014, that raise the Medicaid reimbursement to Medicare rates. A recent study shows that for many Colorado physicians this change would represent an estimated 32% fee increase on average. To be eligible for the supplemental payment, physicians must self-attest as having a specialty in family medicine, general internal medicine, and/or pediatric medicine. Only physicians can complete this form (staff or other representatives are not allowed).

Make sure that you are eligible for these increased payments by visiting the Colorado Department of Health Care Policy and Financing attestation page here. Learn more about ACA enhanced payments for Medicaid primary care physicians here.