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    What the 2013 Medicare fee schedule means to you

    Shared savings, quality reporting highlighted, but SGR threat remains

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    (Getty images:Medioimages/Photodisc)
    Medicare may begin paying you for the time you spend coordinating care for patients after they are discharged from a hospital or nursing home. That's one of the changes primary care and other physicians will see if the agency's proposed 2013 Medicare Physician Fee Schedule is adopted in November.

    The Centers for Medicare and Medicaid Services (CMS) also is proposing to add some preventive counseling and screening services to its telehealth benefits and give you options for how to participate in the program designed to improve the quality of healthcare.

    The agency estimates that the changes will increase payments to family doctors by 7%. The American College of Physicians (ACP) estimates that internal medicine physicians will see a 5% increase. The 339-page proposed rule was published in the Federal Register July 30.

    Looming, however, is the possibility of a 27% reduction in Medicare reimbursements, unless Congress acts before the end of the year to fix the sustainable growth rate formula used to calculate Medicare payments.


    Proposed new PQRS individual quality measures
    Seen in a larger context, experts say, the proposed rule is part of CMS' ongoing efforts to move healthcare away from the current model that rewards doctors for the number of services they provide and toward models that reward quality of outcomes and team-based care, as exemplified by accountable care organizations and the Patient-Centered Medical Home (PCMH) model.

    Two large organizations representing primary care physicians (PCPs) are pleased with the proposed schedule—both with its specific proposals and its tone. "The most important thing, as far as we're concerned, is that there's explicit language in the proposed rule recognizing the value of primary care, and the expressed intention by CMS to improve payments for primary care services," says Glen Stream, MD, FAAFP, MBI, president of the American Academy of Family Physicians (AAFP).

    "We're really pleased to see so much interest around the medical home model," says Shari M. Erickson, MPH, director of regulatory and insurer affairs for the ACP. "It's encouraging to see this, because it is something we've been advocating for quite a while, and now they're interested in figuring out how to pay more appropriately for this type of work."

    NEW BILLING CODE FOR CARE COORDINATION

    The most important change in the proposed schedule for primary care is the addition of a Healthcare Common Procedure Coding System "G" billing code to cover time spent coordinating care for a patient returning to a community setting after being discharged from a hospital or skilled nursing facility. "They [CMS] are looking for better post-discharge coordination," says Maxine Lewis, a coding specialist in Cincinnati, Ohio, who contributes to the Coding Cues column in Medical Economics. "It's for services like following up to make sure discharged patients are getting their proper medications, patient education, family education. They want this post-discharged management care serviced." (See "Getting paid for post-discharge care coordination," below, for a full description of the services covered under the code.)

    The AAFP estimates that payment under the new code for "post-discharge transitional care services" would be $94.62 and would move about $95 million overall to primary care from other services each year. The ACP, meanwhile, estimates the new code will account for 60% of the additional revenue a typical internist would earn under the new schedule. Currently, Lewis says, post-discharge care is either uncompensated or billed at lower rates using existing evaluation and management (E/M) codes.

    As important as the additional compensation itself is the way the new code would be implemented, says the AAFP's Stream. Although two new codes covering similar services are under review by the American Medical Association/Specialty Society Relative Value Scale Update Committee, Medicare's main adviser on physician reimbursement, CMS chose to create and value its own code so that it could be implemented sooner. "It's important to know they were willing to recognize the value that care coordination brings to the healthcare system and to pay for it," Stream says.

    The precise G codes are expected to be announced as part of the final fee schedule later this year.

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