American Society of Hematology

2013 Physician Payment Advocacy Highlights

Published on: January 30, 2014

Over the past year, ASH has been very active on physician payment issues. Following the passage of the Affordable Care Act, there is a recognition that the delivery of healthcare services is changing and the reimbursement system must change with it. ASH, along with the American Medical Association and other medical specialty societies, has advocated repeatedly for the elimination of the archaic formula known as the Sustainable Growth Rate (SGR) that subjects physicians to potential cuts in reimbursement on an annual basis. In addition, ASH has advocated that cognitive specialists, such as hematologists, should be provided enhanced payments similar to those provided to primary care physicians as they often serve as the principle if not primary care provider of patients with rare bleeding disorders. ASH continues to provide input to the Centers for Medicare and Medicaid Serviceds (CMS) both nationally and locally on coverage policies related to the treatment of patients with bleeding disorders.

Medicare Reimbursement for Physician Services

While Medicare annually updates payment rates for inflation for most provider services, physician services are updated by a formula mandated in legislation known as the SGR. "Patching" the SGR has become an annual exercise in Congress, and with each "patch," the potential cuts facing physicians continue to grow.  On December 26, President Obama signed the Bipartisan Budget Act of 2013 (BBA). This agreement included the Pathway for SGR Reform Act of 2013, a provision of the budget framework which prevented the scheduled 24 percent Medicare payment reduction from taking effect on January 1, and provided for a 0.5 percent increase for Medicare payments for services performed from January 1 through March 31, 2014. In 2013, the three Congressional Committees with jurisdiction over the Medicare program—the House Energy and Commerce Committee, House Ways and Means Committee, and Senate Finance Committee—have passed bills to repeal the SGR and replace it with a quality-based payment system.  At this time it is impossible to predict whether a permanent repeal of the SGR will be enacted in 2014, but the recent Congressional action makes the outlook favorable. 

ASH has been a leading advocate over the past year urging Congress to repeal the SGR and replace it with a predictable, stable, and quality-based payment system for updating fees that fully and realistically account for the costs of operating a medical practice. ASH submitted comment letters to Congress in response to legislative proposals. Read the most recent letters ASH submitted to the Energy and Commerce Committee, as well as the Senate Finance Committee and House Ways and Means Committee. ASH also developed an on-line advocacy campaign for the Society's members to join ASH's advocacy efforts and the ASH Committee on Practice members and Advocacy Leadership Institute participants also echoed the Society's key message during their 2013 Capitol Hill Days.

Coding, RUC, and Medicare Payment Policies for Hematology-Specific Services

ASH is an active participant in the AMA's Current Procedural Terminology (CPT) Coding and Relative Value Update Committee (RUC). Samuel Silver, MD, PhD, MACP, and Robert Weinstein, MD, ASH's CPT and RUC representatives along with ASH staff and consultants have successfully advocated for improvements in coding and payment for hematology services.

Medicare Coverage Policies

As Medicare continues to seek an evidence-basis for coverage of new services and treatments, ASH will respond to CMS requests for public comment on national coverage decisions. ASH also assists members directly with local coverage problems. On June 20-21, ASH co-hosted the Annual Meeting of the Hematology and Oncology Carrier Advisory Committee (CAC) Network, which provided hematology and oncology Medicare CAC representatives, leaders from hematology and oncology state societies and Medicare Contractor Medical Directors with an opportunity to strengthen and create more effective CACs in order to achieve appropriate reimbursement. ASH is planning to co-host this year’s meeting on July 24-25.

Analysis of Medicare and Medicaid Regulations and Legislation Impacting Practice

ASH staff and its consultants prepare and disseminate detailed analyses of the major regulations and legislation impacting hematologists.

Hospital Inpatient, Hospital Outpatient, and Physician Payment Rules

On June 24, ASH submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed rule for FY 2014 updating the hospital inpatient prospective payment system. ASH's advocacy was successful and CMS approved Kcentra for the new technology add-on payment for non-hemophilia patients in the final IPPS rule – the Society's primary recommendation.

On September 6, ASH submitted comments to CMS on the 2014 Medicare proposed rules impacting payment for physician and hospital outpatient services. ASH also released a comprehensive analysis on the final 2014 Medicare Physician Fee Schedule and the Hospital Outpatient Prospective Payment System rules.

In 2013, ASH hosted a webinar series to educate ASH's practice-based members about Medicare regulations impacting practice.  The first webinar focused on the items in the proposed physician payment and hospital outpatient rules that would impact hematology; the second webinar detailed the use of the Society's new PQRS Pro registry system and presented information on the 2013 reporting year, including how to avoid the 2015 PQRS penalty; the third webinar highlighted the key issues and impact the final rules will have on hematology, and also provided an update on Congressional action to repeal and reform the SGR.

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