Medicare Updates: 2011 OPPS Final Rule, Physician Payments and the SGR
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Earlier this month, the Centers for Medicare and Medicaid (CMS) issued final rules updating Medicare policies and rates for 2011, including several changes relating to physician supervision that impact rural providers. Read more about these changes as well as other components of the final rule. Some of the highlights include:
- Delayed the enforcement of supervision requirements for outpatient therapeutic services in both critical access hospitals (CAHs) and small rural hospitals through calendar year 2011
- Changed definition of “immediately available”
- Finalized a proposal for 16 services requiring direct supervision by a physician or non-physician practitioner during an initiation period, followed by ‘general’ supervision for the reminder of the service
- Announcement that CMS will convene a panel in 2012 to review supervision requirements for all outpatient services
While we’re on the topic of Medicare, as Rural Voice readers recall from last week’s post, Medicare physician payments will be cut by 23% beginning December 1 without congressional action. Why so high? In very oversimplified terms, the formula used to determine Medicare payments, the Sustainable Growth Rate (SGR), ties Medicare physician payments to factors related to the overall national economy. Put another way, SGR says the growth in payments per Medicare beneficiary cannot grow more than the economy as a whole…and slower economic growth requires lowering physician payments to control Medicare costs. Reimbursements were cut in 2002 but since that time payment reductions have been postponed (and been accumulating) while SGR remains in place. Many organizations and individuals will be calling on Congress next week to take action to avert these cuts and create a more stable, sustainable method for determining physician payments. Stay tuned for opportunities to contact your congressperson next week to share your concerns about potential Medicare cuts and what they will mean for rural communities and providers.
Want to learn more about SGR and how Medicare pays physicians? Check out this policy brief by Health Affairs that summarizes the issues and possible solutions.
