HFMA NEWS

The Centers for Medicare and Medicaid Services (CMS) on June 30 proposed new changes to the 2009 Medicare Physician Fee Schedule (MPFS) that would result in a reduction in Medicare payments to physicians and other providers by 5.4 percent. Total Medicare spending under the 2009 fee schedule is projected at $54 billion, down 5 percent from the $57 billion projected for 2008.

CMS is also proposing additional improvements to the Physician Quality Reporting Initiative (PQRI); proposed changes for the 2009 PQRI program include increasing the number of conditions covered by measures groups to nine--adding coronary artery disease, HIV/AIDS, coronary artery bypass surgery, rheumatoid arthritis, care during surgery, and back pain to the original measures groups for diabetes, chronic kidney disease, and preventive care.

Comments are due by Aug. 29, and the final rule will be issued by Nov. 1. The revised policies and payment rates will become effective Jan. 1, 2009. Download the proposed rule.

Despite wide recognition that existing physician and hospital payment methods do not foster high-quality and efficient care for people with chronic conditions, little innovation in provider payment strategies is occurring, according to a new study by the Center for Studying Health System Change (HSC) commissioned by the California HealthCare Foundation.

“Existing payment systems, primarily fee for service, encourage a piecemeal approach to care delivery rather than a coordinated approach appropriate for patients with chronic conditions,” said Paul B. Ginsburg, PhD, president of HSC. “We get what we pay for in health care, and as long as we pay physicians and hospitals in a piecemeal fashion, we’re generally going to get piecemeal care.”

The study’s findings are detailed in a new HSC research brief, Getting What We Pay For: Innovations Lacking in Provider Payment Reform for Chronic Disease Care. Along with describing several pilot programs designed to alter financial incentives for providers caring for chronically ill patients, the study identifies the main barriers to reforming payment for chronic disease care, including fragmented care delivery; lack of payment for nonphysician providers and services supportive of chronic disease care; potential for revenue reductions for some providers; and lack of a viable reform champion. Read the research brief.