CMS Releases 2015 Medicare Physician Fee Schedule Final Rule

StethoscopeIt’s highly unlikely that you have read through the thousand-plus pages of the 2015 Medicare Physician Fee Schedule (MPFS) final rule, but have no fear because we have you covered. Listed below are the top items of particular concern to neurosurgeons.

Reimbursement-related Provisions:

  • The Sustainable Growth Rate (SGR). Absent congressional action, the SGR formula calls for a 21.2 percent cut to physician payments, effective April 1, 2015.
  • Surgical Global Packages Eliminated. CMS intends to implement a far-reaching plan to transition all global surgery services to 0-day global periods, beginning with 10-day global services in 2017 and following with 90-day global service in 2018.
  • New Timeline for Publication of CMS Proposed Values for New and Revalued Codes. CMS will change its schedule for publishing and implementing proposed values for new and revalued codes to include them in the MPFS proposed rule released annually in July.
  • Relative Values Maintained for Lumbar Laminectomy. CMS confirmed 63047 and 63048 as final at their current values and maintained the current values for 63045 and 63046 as interim for FY 2015.
  • Five Year Review of Professional Liability Insurance RVUs. CMS conducted its five year review of malpractice RVUs. Overall neurosurgery PLI RVUs will increase by 1 percent in 2015.

Quality-related Provisions:

  • Physician Quality Reporting System (PQRS) Program Transitions to Penalties and Increases Barriers to Participation. CMS is removing 50 measures from the PQRS in 2015, including many that neurosurgeons have relied on, such as the perioperative and back pain measures groups.
  • Value-based Payment Modifier (VM) Applies to All Physicians, with Penalties Doubling for Some. The VM will apply to all physicians in 2017, based on 2015 reporting. CMS will double penalties to -4 percent for group practices with 10 or more eligible professionals and will apply a -2 percent penalty to smaller practices and solo practitioners who do not satisfy reporting requirements.
  • Continued Expansion of Public Reporting. CMS will publicly report in 2016 the performance rates of all PQRS measures reported by physicians in 2015. Physicians also will be given 30 days to preview data and request corrections before it is posted.

Open Payment Continuing Medical Education (CME) Exemption:

  • Elimination of CME Exemption from Open Payment (Physician Sunshine) Reporting. CMS intends to eliminate the bright line exception for accredited Continuing Medical Education (CME) activities that are currently afforded to physicians through CMS’ existing regulations.

Click here, to view a detailed side-by-side analysis of the key provisions of the fee schedule affecting neurosurgery.

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