CMS Announces Several New Medicare Regulations

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CMS on Friday confirmed details of an electronic prescribing incentive program for physicians, scheduled to begin on Jan. 1, 2009, which would increase Medicare payments for doctors who use the technology, the Dallas Morning News reports. Under the new program, which was included in the new Medicare law in July, physicians who use e-prescribing technology to deliver medication prescriptions to pharmacies will be eligible for a 2% increase in their Medicare payments (Roberson, Dallas Morning News, 11/1).

According to CQ HealthBeat, physicians who participate in the agency's Physician Quality Reporting Initiative also would qualify for a 2% payment increase in addition to the scheduled 1.1% payment increase for all physicians in 2009. Physicians who participate in both the e-prescribing and PQRI initiatives would receive a 5.1% bonus in Medicare payments next year. CMS acting Administrator Kerry Weems in a news release said, "The Institute of Medicine says more than 1.5 million Americans are injured every year by drug errors," adding, "E-prescribing lets providers know -- up front -- their patients' medication history and the risk of dangerous infections" (Carey, CQ HealthBeat, 10/31).

Other Payment Changes

In related news, CMS on Thursday announced that it will increase payments to outpatient departments by 3.6% beginning Jan. 1, 2009, but that the agency eventually will eliminate payments for illnesses or injuries caused by poor quality outpatient care, CQ HealthBeat reports.


In a news release, Weems said agency officials are considering ways "to make sure beneficiaries who come in for treatment of one complaint don't leave with two as a result of adverse events during their outpatient visits." Weems added that a policy on the issue would be proposed "in the future" (Reichard, CQ HealthBeat, 10/31). CongressDaily reports that a similar policy is being considered for hospital inpatient departments (CongressDaily, 10/31).

The payments that are being increased cover the costs of facilities, equipment, supplies and staffing, but do not reimburse physicians or other practitioners for care. CMS expects to make $30.1 billion in payments under the rule in 2009, an increase from $28.5 billion this year.

Medicare currently requires outpatient facilities to meet certain quality measures or face having the annual payment reduced by 2%. The new rule adds four new quality measures to the seven measures on which physicians already must submit data to qualify for Medicare payments. The new measures include a provision that is intended to increase the efficiency of medical imaging by altering the payment when physicians use more than two imaging procedures during the same session.

In addition, the agency expects to make $3.9 billion in payments to about 5,100 ambulatory surgery centers, an increase from $3.5 billion this year. To receive the new payments, the centers must meet new conditions, such as bolstering the requirements for assessing patients' conditions to ensure that surgery is appropriate and safe in an ambulatory surgery setting (Reichard, CQ HealthBeat, 10/31).

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