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November 14, 2012 News Headlines

HANYS’ Rural Conference Focuses on Securing Primary Care, New Partnerships

Exploring new partnerships to ensure sustainable health care in rural New York was a theme at this year’s Rural Conference, held November 7-8 in Syracuse.  The event featured discussions with HANYS’ leadership and presentations from organizations working to stabilize primary care and strengthen regional health planning aimed at improving population health.

HANYS President Daniel Sisto and Executive Vice President Dennis Whalen discussed the implications of the recent election results on health care policy and HANYS’ efforts to assist members in responding to the rapid pace of change, both at the state and federal level.  Part of that change will require hospitals and other providers to reach outside their walls to partner with other practitioners and local organizations to improve the health of their communities and deliver needed health care more efficiently. 

Speakers included representatives from the Community Health Care Association of New York State and the Chautauqua County Health Network, Inc., who described efforts to develop new primary care capacity in Western New York.  In addition, representatives from the Primary Care Development Corporation and the Fort Drum Regional Health Planning Organization discussed their efforts to stabilize the health care workforce and infrastructure in a collaborative that includes five hospitals, 32 primary care sites, three specialty practices, and two urgent care centers.

Conference participants also heard updates on Certificate of Need reform and rural health initiatives from the Department of Health and a discussion of key priorities for the coming year from the American Hospital Association.  Contact: Frederick Heigel

Final Medicare Physician Fee Schedule Rule for 2013 Includes a 26.5% Decrease

The final Medicare Physician Fee Schedule (MPFS) rule for calendar year 2013 includes a statutorily required 26.5% reduction to physician payments beginning January 1, 2013 in accordance with the sustainable growth rate (SGR) formula.  Congress acted several times to postpone any reduction and the delayed cumulative reduction has continued to grow.  The Obama Administration states that it is committed to fixing the SGR formula and averting these payment cuts.

While HANYS supports full and fair Medicare reimbursement to physicians, we strongly oppose alleviating the cut in a manner that reduces payments to hospitals and other health care providers already subject to billions of dollars in cuts.

Additional provisions in the rule include:

Transitional Care Management (TCM):  In place of the proposed TCM G code, the Centers for Medicare and Medicaid Services (CMS) is adopting the following new Current Procedural Terminology (CPT) codes for post-discharge transitional care management services, which requires a face-to-face visit in association with the non-face-to-face TCM services:

  • CPT code 99495 - Transitional care management services with moderate medical decision complexity (face to face visit within 14 days of discharge); and
  • CPT code 99496 - Transitional care management services with high medical decision complexity (face to face visit within seven days of discharge). 

Since these are new CPT codes they are subject to public comment.

Telehealth:  CMS adopted its proposal to add eight Healthcare Common Procedure Coding System codes to the list of services approved for coverage under the Medicare telehealth policy. 

Value-Based Payment Modifier:  In CY 2015, CMS will implement the physician value-based payment modifier that would adjust payments to physician groups with 100 or more (proposed at 25 or more) eligible professionals based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare fee-for-service program.

Physician Quality Reporting System (PQRS):   CMS adopted changes that would add, retire, and modify various individual measures.  In addition, CMS adopted 17 measures for inclusion in the PQRS administrative claims-based measure set for reporting the 2015 PQRS payment adjustment only. 

Electronic Prescribing (eRx) Incentive Program:  CMS adopted a threshold of 75 instances of the eRx from the proposed threshold of 225 for the 2013 and 2014 eRx programs.

The final rule will be published in the November 16 Federal Register.  A display version of the MPFS final rule is available on the CMS Web site.  Contact:  Melanie Graham