The Physician Quality Reporting Initiative (PQRI) will continue to pay bonuses for participation in its reporting program, with a 1% bonus in 2011 and 0.5% bonus in each of the years 2012–2014. There will be a 1.5% penalty in 2015 for unsuccessful participation, which will increase to 2.0% in subsequent years. Essentially, physicians will be forced to participate in PQRI by 2015 or they will see a reduction in reimbursement. With this mandate, I urge rheumatologists to start using the ACR Rheumatology Clinical Registry today because it can be used to satisfy the PQRI requirements.
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Explore This IssueMay 2010
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Fraud and Abuse
One of the ways Congress and President Obama have said that the law will save money is by cracking down on fraud and abuse in the Medicare system. The law now extends the Recovery Audit Contractor (RAC) program to Medicaid and Medicare Parts C (Medicare Advantage) and D (Prescription Drug). The ACR has expressed to legislators and CMS our serious concern over the reimbursement of RACs, which have been tasked to recover revenue through detecting waste, fraud, and abuse in the Medicare system. Presently the RACs are paid a percentage of what they recover from the physicians and hospitals they audit. This methodology is unethical and dangerous, and could foster potentially overzealous reviews in hopes of greater revenue for the contractors. We will continue to closely monitor this process and how it affects rheumatology healthcare professionals.
Three Changes for Patients
Many patients with rheumatic disease have difficulty acquiring insurance in the individual market because some rheumatic diseases were considered pre-existing conditions. With the new law, patients will no longer be excluded because of a pre-existing condition. In addition, patients will no longer have lifetime or annual limits on their health insurance, which will eliminate many out-of-pocket expenses for individuals. Finally, for those on Medicare, the new law will slowly fill the Medicare Part D prescription drug coverage donut hole. Currently, patients who spend over $2,700 enter a coverage gap until their out-of-pocket costs exceed $6,150. This gap will slowly close until it is eliminated in 2020.
Creation of New Government Programs
The new law introduces a variety of new government programs, including the Independent Payment Advisory Board, which will annually determine if the projected per capita growth rate under Medicare exceeds the target rate. With this information, recommendations will be made to reduce the Medicare per capita growth rate. The ACR opposes the creation of an independent commission that has the authority to mandate physician payment cuts, and will work with other medical specialties to include the removal of this commission in a corrections bill.