CMS proposes 9.9% physician fee reduction for 2008

Washington, DC-The update to the physician fee schedule for 2008 would be –9.9% under a rule proposed July 2 by the Centers for Medicare & Medicaid Services (CMS). The rule, called regulation CMS-1385-P, would take effect Jan. 1.

The reduction is mandated by the sustainable growth rate formula specified in the Medicare statute, according to Leslie V. Norwalk, acting CMS administrator.

“For the past 5 years, Congress has intervened to prevent the implementation of the negative updates resulting from this formula,” she noted. “CMS will continue working with Congress as well as physician groups to identify payment methods that help improve the quality and efficiency of care in a way that is cognizant of the costs to taxpayers and to Medicare and its beneficiaries.”

In the proposed rule, CMS outlines measures from seven categories for inclusion in the 2008 Physician Quality Reporting Initiative (PQRI) as long as the measures are endorsed by the National Quality Forum (NQF) or adopted by the AQA Alliance. The proposed rule also would retain the 2007 PQRI measures that have been endorsed by the NQF.

The NQF supports four of eight ophthalmology measures for retention in the 2008 PQRI, according to information released by the American Society of Cataract and Refractive Surgery (ASCRS)/American Society of Ophthalmic Administrators (ASOA). Those measures relate to optic nerve evaluation for primary open-angle glaucoma; documentation of the presence or absence of macular edema and the level of severity of disease for those with diabetic retinopathy; communication with the physician managing ongoing care for those with diabetic retinopathy; and a fourth, unspecified measure on age-related macular degeneration.

CMS-1385-P also proposes several changes to payments for particular services paid under the Medicare physician fee schedule. For example, according to ASCRS/ASOA, the rule would adopt the recommendations of the American Medical Association’s Relative Value System Update Committee regarding ophthalmology “eye codes.”

The rule also specifies that payment for the technical component of some ophthalmologic imaging procedures be subject to hospital outpatient prospective payment system caps specified in the Deficit Reduction Act of 2005.

The agency will accept comments on the proposed rule until Aug. 31, and a final rule will be published this fall. For more information, go to www.cms.hhs.gov/center/physician.asp.