Physicians are slated next month to begin receiving a 1.1 percent
across-the-board payment increase in Medicare.
The payment update is the result of a dramatic, last-minute vote by
Congress earlier this year to reverse a scheduled 10.6 percent decrease that
was to have gone into effect in July (Psychiatric News, August 1).
Instead, Congress approved a 0.5 percent increase for the remainder of 2008
and the 1.1 percent increase for 2009.
The change was included in the historic Medicare Improvements for Patients
and Providers Act (HR 6331), which reversed the government's 40-year-old
discriminatory payment for outpatient psychiatric services.
In addition, the fee schedule for 2009 includes financial incentives for
physicians who use electronic health records and who report quality measures.
Two Centers for Medicare and Medicaid Services (CMS) quality-improvement
programs—the Physician Quality Reporting Initiative (PQRI) and the
Electronic Prescribing Incentive Program—will provide financial
incentives of up to 4 percent of total Medicare allowed charges for
participation. The e-prescribing program offers incentives to clinicians who
use a qualified e-prescribing system. Participation in both programs involves
the reporting of designated administrative codes on billing claims.
The PQRI program will continue in 2009 with 153 measures, including three
on major depressive disorder, and a new measure on screening for unhealthy
alcohol use. Physicians who report using at least three measures applicable to
their practice between January 1 and December 31, 2009, will receive a bonus
of up to 2 percent of their total Medicare allowed charges for that
The Electronic Prescribing Incentive Program is new for 2009. Clinicians
who meet the requirements for being a successful e-prescriber will be eligible
for an additional 2 percent bonus in 2009 and 2010, a 1 percent bonus in 2011
and 2012, and a 0.5 percent bonus in 2013. Clinicians who do not meet the
requirements for being a successful e-prescriber will have their payments
reduced by 1 percent in 2012, 1.5 percent in 2013, and 2 percent in 2014 and
in each subsequent year.
Being a successful e-prescriber means reporting the availability and use of
a qualified e-prescribing system in at least 50 percent of covered encounters
between January 1, 2009 and December 31, 2009. Information about both programs
and about what constitutes a qualified e-prescribing system is posted on APA's
Web site at<www.psych.org/pqri>.
As in past years, the payment reduction reversal succeeded only in
postponing the bad news: under current projections, physicians are slated to
face a massive 21 percent payment cut in 2010. And APA, the AMA, and other
physician groups remain committed to achieving a permanent reform of the
Medicare payment formula, especially the so-called sustainable growth rate
(SGR) component. The SGR mandates that increases in volume be balanced by
reductions in payment, but does not account for increases in physician
At last month's Interim Meeting of the AMA House of Delegates, delegates
approved a report by the AMA's Council on Medical Services calling for a
systematic discussion by organized medicine of options for reforming the
Medicare payment system. The council has asked for input and feedback from
states and specialty societies regarding options that were outlined in the
report. CMS will be taking that feedback and finalizing the report for
consideration by the house at the AMA's annual meeting in June 2009.
APA's Office of Health Systems and Financing, in collaboration with
relevant councils, will be reviewing the report and forwarding comments to the
AMA. For complete reporting on the CMS report, see the next issue of
"The American Medical Association supports rebasing the sustainable
growth rate to move forward with a permanent fix," said AMA board member
James Rohack, M.D., in a statement issued after last month's House of
Delegates meeting in Orlando, Fla. "We agree that it is the best course
to address the current Medicare payment crisis and ensure access to health
care for America's seniors.
"The AMA continues to work with medical state and specialty societies
in an effort to develop a broadly supported approach to reform. We are closely
examining Medicare demonstration projects, including the patient-centered
medical home and other payment reforms to improve care coordination. We hope
to see additional projects so we can build a solid foundation for long-term
"Our ultimate goal is to eliminate the SGR, and we are committed to
working with Chairman [Pete] Stark and the... chairs and ranking members on
the Senate Finance Committee and the House Energy and Commerce Committee to
find the best solution."
At the AMA meeting last month, Medicare payment and other administrative
problems associated with the program were prominent on the agenda. Delegates
expressed special outrage about lengthy delays experienced in getting enrolled
as a Medicare participatng physician, resulting in long periods of
The House of Delegates easily approved a resolution calling on the AMA to
seek legislation mandating that CMS impose a requirement on its carriers and
Medicare administrative contractors that complete enrollment and re-enrollment
applications must be processed within 30 days of receipt, with appropriate
feedback to the applicant. The resolution also calls for imposing financial
penalties on carriers for unjustified delays in enrollment and
"We know how physicians are being imposed on by not getting their
enrollment in a timely fashion and losing income," said AMA board member
Peter Carmel, M.D., during reference committee hearings on the resolution."
The board suggests that we urge Congress and CMS that they must put
more resources into the CMS payment process so you get your reimbursement
within 30 to 40 days."
For reports on other actions taken at the AMA meeting, see
Parity Law to Be Focus of AMA Education Effort and the next issue
of Psychiatric News.
Actions taken by the AMA House of Delegates at its November meeting
are posted at<www.ama-assn.org/ama/pub/category/20272.html>.▪