Clinical Geriatrics

Recently the House and Senate passed the Medicare Improvements for Patients and Providers Act of 2008. This Act affects Medicare providers and their patients in 10 major areas:

1. Increase provider reimbursement
2. Promote technology – ePrescribing and telehealth services
3. Promote coordination/transitions of care
4. Promote preventive services
5. Education
6. Coverage of drugs
7. Clinical effectiveness studies
8. Assist low-income individuals
9. Decrease reimbursement and increase regulations for Medicare Advantage Plans
10. Durable medical equipment coverage

Despite a planned Presidential veto because of the cuts this act imposes on Medicare management care plans, that veto threat was overridden by the House and Senate, who passed this legislation with enough votes to overcome a Presidential veto. As a result, the only questions left at this time are exactly when and how one’s specific practice will be affected. That will be dependent on the preparation one lays now to be ready to take advantage and to minimize the impact of this legislation.

Increase Provider Reimbursement
Perhaps the most scrutinized area of this legislation is provider reimbursement. Medicare had been scheduled to cut provider reimbursement by more than 10% starting January 1, 2008. This cut was placed on hold for six months until July 1, 2008, but like a bad student given an extension, once again Congress waited until the last minute to address this matter, and actually left for the July 4th holiday without a resolution. Upon return after the holiday, the legislation passed.

Section 131 - Physician payment, efficiency, quality incentives blocks the pending cuts scheduled under the sustainable growth rate (SGR) formula through December 31, 2009. In place of the cuts in reimbursement, providers will receive 1.1% update for 2009. In addition, there is an extension to the physician quality reporting initiative (PQRI) through December 31, 2010. The PQRI will also see an increase in the PQRI bonus to 2.0% for 2009 and 2010. The Act also makes improvements to the PQRI, including a requirement for the endorsement of measures by a consensus-based, standard-setting entity and permits group practices to report, using a sampling methodology, on measures targeting high-cost, chronic conditions. The focus on cost-cutting and pay for performance continues with a requirement for the Secretary to provide confidential feedback to providers regarding their resource use, and to submit a plan to Congress on transition to a value-based purchasing program for physicians. Despite this focus in the first year of the PQRI program, the Centers for Medicare & Medicaid Services (CMS) paid out just $36 million to 56,700 providers, which accounted for only $634.92 per provider on average.

Providers delivering psychotherapy and related services will see restoration of a portion of cuts recently applied in these areas as addressed in Section 138 - Adjustment for Medicare mental health services.