CMS Proposes Primary Care Raises Funded With Specialist Cuts

July 06, 2012

July 6, 2012 — Medicare would reduce reimbursement for many types of specialists to fund sizable raises for primary care physicians in 2013, according to a proposed fee schedule that the Centers for Medicare and Medicaid Services (CMS) released today.

These reductions and raises are apart from the huge pay cut — now put at 27% — set for January 1, 2013, that is triggered by Medicare's sustainable growth rate formula, and likely to be postponed by Congress.

Under today's CMS proposal, Medicare pay would increase by 7% for family physicians, 5% for internists, and 4% for geriatricians. Most of this increased reimbursement would result from a separate payment that Medicare would make to physicians for coordinating a patient's care for the first 30 days after discharge from a hospital, skilled nursing facility, or certain outpatient services. The fee, which will have its own procedure code, reflects the Obama administration's push to reduce hospital readmissions caused by sloppy follow-up care. At the same time, the administration has made it an overall priority to improve reimbursement for primary care services, according to CMS.

To give raises to primary care physicians as well as nurse practitioners and physician assistants, CMS said that it has to lower reimbursement for other clinicians to achieve budget neutrality. The biggest losers in the proposed 2013 fee schedule would be radiation oncologists, who would take a hit of roughly 15%. Most reductions, however, are less than 5%, as illustrated by the following selected specialties.

Specialty Fee Change*
Anesthesiology -3%
Cardiology -3%
Interventional radiology -3%
Neurosurgery -1%
Pathology -2%
Radiology -4%
Urology -2%
Vascular Surgery -3%

* Change in total allowed charges under proposed 2013 Medicare fee schedule.

A number of other specialties, such as allergy/immunology, gastroenterology, general surgery, plastic surgery, and rheumatology, are slated for no change in Medicare reimbursement.

The proposed Medicare fee schedule will be published in the Federal Register on July 20. CMS will accept comments on the proposal until September 4, and the agency will issue a final fee schedule by November 1. The proposal explains the various ways in which comments can be submitted.

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