Review of 2014 Medicare Physician Fee Schedule Final Rule Available

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The Centers for Medicare and Medicaid Services (CMS) final rule for the 2014 Medicare Physician Fee Schedule has been published, and most provisions went into effect January 1. Issues included in the final rule which have an impact on vascular surgeons have been posted on the SVS website. They include:

Non-Facility Cap

CMS has deferred imposing a cap on certain office-based services, which included services provided by vascular surgeons in angiography suites, for future consideration. SVS led a coalition of physician groups opposing this cap.

AAA Screening

CMS eliminated the referral requirement as part of the Welcome to Medicare Physician Exam, which also eliminates the one-year time limit for beneficiaries who are at-risk for AAA. SVS has been persistent in getting barriers removed so more beneficiaries can take advantage of this life-saving screening.

Physician Compare Website

CMS acknowledged problems with the website and will continue to make improvements. SVS has reviewed the keywords used for vascular surgery. CMS has asked physicians to review their Provider Enrollment, Chain and Ownership System (PECOS) information for accuracy.

Value-Based Payment Modifier (VBPM)

The Department of Health and Human Services is developing and implementing a budget-neutral payment system that will use a VBPM to adjust Medicare physician fee schedule payment based on the quality and cost of care physicians deliver to beneficiaries. This will be phased in over a two-year period beginning in 2015. Additional details are posted on the SVS website.

Physician Quality Reporting System (PQRS)

CMS has increased the number of measures that must be reported from three to nine measures in order to receive incentive payments. Beginning in 2015, payment incentives will end and a downward payment adjustment will apply to physicians who do not satisfactorily report data on quality measures for covered services. Also, PQRS measures groups will only be reportable through a registry starting in 2014. Additional details are posted on the SVS website.

Items and Services in FDA Investigational Device Exemption (IDE) Clinical Studies

IDE Clinical Studies are designed to generate clinical data on safety and/or effectiveness of a clinical device. SVS expressed concerns regarding the governance process for approval or denial of reimbursement and the two requirements to ensure CMS approval. CMS removed the two requirements, but did not clarify who will comprise the reviewing body or what the pre-submission process will be. Changes will be implemented by January 1, 2015. Additional details are posted on the SVS website.

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