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CMS issues proposed rules impacting payment rates

Over the last week, the Centers for Medicare & Medicaid Services (CMS) has issued proposed changes that will update payment policies and rates for physicians, dialysis facilities and for services to Medicare beneficiaries in hospital outpatient departments and decrease Medicare payments to home health agencies.

CMS' proposed rule for Medicare payments to physicians and non-physician practitioners includes a 29.5 percent payment rate reduction in 2012. "This payment cut would have serious consequences and we cannot and will not allow it to happen," said CMS Administrator Donald M. Berwick in a statement. "We need a permanent (Sustainable Growth Rate) 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."

[See also: Congress wrestles with the future of SGR.]

The proposed rule impacting physicians also calls for a number of policy changes, including expansion of the billing code initiative to make sure there is appropriate valuation; payment adjustments accounting for geographic variation in cost of practice; expansion of the multiple procedure payment reduction to include the professional interpretation of advance imaging services; an update of the number of physician incentive programs; and quality and cost measures that would be used in establishing a new value-based modifier to reward physicians for providing higher quality and more efficient care.

In separate filings, CMS also proposed a 3.35 percent decrease in Medicare payments to home health agencies for 2012; a 1.8 percent increase in payment rates for dialysis treatments; a 1.5 percent increase in hospital outpatient rates; and a 0.9 percent increase in ambulatory surgical center payments.

Additionally, CMS aims to strengthen the hospital value-based purchasing program for inpatient stays by adding a clinical process care measure to guard against infections from urinary catheters.

CMS is accepting comments through Aug. 30 and plans on issuing its final rules by Nov. 1.