CMS released finalized payment rules for different Medicare providers and services for 2015. Among other rules, CMS created new payments for chronic care management programs, launched efforts to streamline payments for individuals’ hospital care and expanded the agency’s Physician Compare website.
CMS said the rules expanding the Physician Compare website would significantly bolster “the quality measures available on this website by making group practice and individual physician-level measures available for public reporting, including patient experience measures”.
Separately, the rules also eliminate a reporting exemption under the Sunshine Act that excluded payments to physicians associated with accredited continuing medical education from the payments that have to be shared on the Open Payments System. CMS said the rule would now require group purchasing organizations and affected manufacturers to report compensation given to physician speakers at continuing education events in most cases.
The rules also broaden quality performance penalties for all physicians and include additional quality criteria for the Medicare Shared Savings Program. Specifically, Medicare physician payments beginning in 2015 will be adjusted based on quality performance measures and penalties will no longer apply solely to larger physician practices.
In addition, CMS in the rules said it will increase Medicare payments for hospital outpatient services and ambulatory surgical centers in 2015.
Hospital outpatient departments will receive a 2.2% bump in reimbursement rates, while ambulatory surgical centers' payment rates will increase by 1.4%, effective January 1, 2015. The increase will affect more than 5,300 ambulatory surgical centers and 4,000 hospitals.
Further, CMS created comprehensive ambulatory payment classifications, which will provide lump sum payments to the centers for 25 particular outpatient services, such as hip replacements or pacemaker procedures.
In the rules, CMS noted that providers could see payment cuts around 21% in April 2014 if action is not taken on Medicare's sustainable growth rate formula.
Click here to view the 2015 Medicare Physician Payment Final Rules.
Source: California Healthline, November 3, 2014.
Thank you to all SFMS members who participated in this year's SFMS election. We are proud to announce the SFMS leadership for 2015.
President: Roger S. Eng, MD, MPH, FACR (2014 President-Elect automatically succeeds to the office of President)
President-Elect: Richard A. Podolin, MD, FACC
Secretary: Kimberly L. Newell, MD
Treasurer: Man-Kit Leung, MD
Editor: Gordon L. Fung, MD, PhD, FACC, FACP
Immediate Past President: Lawrence Cheung, MD, FAAD, FASDS (2014 President automatically succeeds to the office of Immediate Past President)
Steven H. Fugaro, MD
Brian Grady, MD
John Maa, MD
Todd A. May, MD
Stephanie Oltmann, MD
William T. Prey, MD
Michael C. Schrader, MD, PhD, FACP
Konstantin Bukov, MD
Lawrence Cheung, MD, FAAD, FASDS
Mihal L. Emberton, MD, MPH, MS
Gordon L. Fung, MD, PhD, FACC, FACP (Delegation Chair)
Richard A. Podolin, MD, FACC (serves automatically as President-Elect)
Andrea M. Wagner, MD
Pratima Gupta, MD
Jerry Y. Jew, MD, MBA
Robert J. Margolin, MD
Amy E. Whittle, MD
On November 4, the voters of California spoke loudly and definitively, sending the trial lawyers’ Proposition 46 to defeat by a 2 to 1 margin. The message is clear—Californians simply don’t want to increase health care costs and reduce health access so trial attorneys can file more lawsuits.
An increase in the Medical Injury Compensation Reform Act (MICRA) cap on non-economic damages has been rejected in California again and again: 10 times in court, 5 times in the Legislature and now overwhelmingly by voters. This idea now has its own dedicated spot in California’s political trash heap.
But this time, we energized the membership of SFMS and CMA as a whole to fight the fight together, as one unified voice of medicine, representing the patients we so deeply care about and the care that we have committed to provide them.
Despite the trial attorney proponents’ attempt to sweeten the deal by adding provisions that polled well—physician drug testing and mandatory checking of a prescription database—voters said NO on Election Night. As people throughout the state heard from physicians and No on 46 coalition members about the real intentions of the measure’s proponents, there was resounding opposition.
One of the secret weapons of this effort was the size and diversity of our coalition. We helped amass one of the largest and most diverse campaigns in California history. The breadth of the coalition—which includes labor, business, local government, health providers, community clinics, Planned Parenthood, ACLU, NAACP, taxpayers, teachers, firefighters and more—underscores just how important affordable, accessible health care is to every Californian.
In addition to the groups on the ground talking to voters about the deception and trickery behind Prop. 46, every major editorial board in California opposed the initiative.
The Los Angeles Times said, “As worthwhile as [Proposition 46’s] goals may be, the methods the measure would use to achieve them are too flawed to be enacted into law.”
The San Francisco Chronicle decried Prop. 46 saying that the measure, “overreached in a decidedly cynical way.”
The efforts of the San Francisco Medical Society and the California Medical Association across the state is a tremendous showing of what organized medicine can do for the future of health care, the quality of medicine and the dedication to patients everywhere. This was one of the most contentious and high-stakes ballot fights in California history and we rose to the occasion.
Please join SFMS/CMA as we work to make health care available to all Californians and to keep the practice of medicine in the hands of physicians.
In an effort to expand its Medi-Cal managed care provider network across the state, Anthem Blue Cross is reaching out to San Francisco Medical Society (SFMS) and California Medical Association (CMA) member physicians who may be interested in joining the insurer's network.
While some of Anthem’s Medi-Cal managed care network is delegated to medical groups and IPAs, most of their provider networks in the rural areas are still through direct contracting with physicians. They also still have direct contracts with physicians outside of their delegated business in other areas of the state. Anthem is interested in expanding their provider network to ensure adequate access to care.
Physicians who would like to learn more about the opportunity to join Anthem's provider network are being asked to provide CMA with some basic information by filling out this brief form. Anthem will then follow up with physicians who have expressed interest with additional details.
References cited in Meat and the Microbiome: From Farm to Fork to Gut by David Wallinga, MD
References cited in Climate Action and Health: The New Deal for Our Health and Our Children’s Health by Génon K. Jensen and Peter van den Hazel, MD, MPH, PhD
References cited in A New Era: Climate Change and Human Health by Ross Bowling, PhD; Nyron Rouse; John Balbus, MD, MPH
References cited in Exposure to Toxic Chemicals: Reproductive Health Professionals Speak about the First 1,000 Days by Patrice Sutton, MPH; Tracey J. Woodruff, PhD, MPH; Jeanne A. Conry, MD, PhD; Linda C. Giudice, MD, PhD, MSc
References cited in The First 1,000 Days: A Healthy Return on Investment by Elise Miller, MEd, and Ted Schettler, MD, MPH