Medicare proposal links surgical center payments to quality

The Centers for Medicare and Medicaid Services on Friday unveiled its proposed payment rates for physicians, outpatient hospitals and dialysis facilities in 2012.

The proposed rule for hospital outpatient departments and ambulatory surgical centers establishes for the first time a quality reporting program for the surgical centers. Starting next year, they would have to track eight quality measures that would inform Medicare reimbursements starting in 2014.

The proposal also strengthens the hospital value-based purchasing program, created by the healthcare reform law. The program ties a portion of Medicare reimbursements to performance on several quality measures, starting in 2014.

The proposed rule also creates a process for certain physician-owned hospitals to request a waiver from the healthcare reform law's expansion ban.

And it would allow eligible hospitals to participate in an electronic reporting pilot as part of the Medicare Electronic Health Record Incentive Program.

Outpatient departments are scheduled to get a 1.5 percent fee increase, while ambulatory surgical centers would get a 0.9 percent bump. CMS predicts that it will pay out almost $42 billion to more than 4,000 hospitals that participate in the outpatient payment system in 2012; some 5,000 ambulatory surgical centers meanwhile will get almost $3.5 billion.

In its rule on physician pay, CMS proposed roughly $200 million in cuts for imaging procedures. When a doctor performs multiple imaging procedures — such as CT scans and MRIs — on the same patient on the same day, payment won't be the same for every test. CMS said it plans to pay for the first procedure in full, then apply a 50 percent cut to the "professional component" portion of the bill for each subsequent test.

The physician payment rule must reflect current law — which, under the much-maligned "sustainable growth rate" formula (SGR), calls for a nearly 30 percent cut in doctors' payments at the end of the year. CMS accounted for that cut in the rule, as it's required to do, but also took the opportunity to call for a permanent fix to the formula.

"This payment cut would have serious consequences and we cannot and will not allow it to happen," CMS Administrator Don Berwick said in a statement. "We need a permanent SGR fix to solve this problem once and for all. That's why the President's budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix."

Finally, dialysis facilities can expect a 1.8 percent payment update in 2012, while their quality incentive program also gets a boost.

Comments are due by Aug. 30; final rules should come out Nov. 1.

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