On July 2, 2007, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would revise the Medicare Physician Fee Schedule (MFPS) for calendar year 2008. The proposed rule was published in the Federal Register (Adobe PDF, 1.8M, 275 pages) on July 12, 2007. The agency will accept public comments until August 31, 2007, and anticipates publishing a final rule by November 1, 2007. Once finalized, the ruling would be applicable to services rendered on or after January 1, 2008.

While the proposed rule primarily addresses payments to the MFPS, it also includes an important new initiative to encourage the use of electronic prescribing to improve the speed and accuracy of care furnished to beneficiaries, as well as proposals for additional quality measures for use in the Physician Quality Reporting Initiative (PQRI) in 2008. This HRS memorandum (Adobe PDF, 353K) summarizes the proposal, focusing on changes that would impact upon cardiology-related services. Additional downloads related to PQRI:

• Table 17 re: 2008 Quality Measures in Physician Fee Schedule (Adobe PDF, 455K)
• Continued PQRI Funding in Physician Fee Schedule (Adobe PDF, 303K)
• Registry Based Reporting in Phyician Fee Schedule (Adobe PDF, 614K)

Highlights of the Proposed Rule

• CMS projects that it will pay approximately $58.9 billion to 900,000 physicians and other health care professionals in calendar year (CY) 2008.
• The estimated annual update to the MFPS for CY 2008 is – 9.9%. This means an across-the-board cut in reimbursement rates under the fee schedule, unless Congress acts to reverse this reduction.
• CMS estimates that total Medicare payments to cardiologists under the fee schedule in CY 2008 will decrease by 11%. Of this decrease, 10% percent is due to the estimated negative annual update affecting all services and specialties; the remaining 1% is due to changes in work and practice expense RVUs for cardiology services.
• CMS is proposing to adopt the recommendations of the RUC with regard to more than 50 procedures, which were included in the 2007 5-year review of physician Work values, but for which a decision was deferred until the 2008 proposed rule.
• CMS will continue with implementation of the change in methodology for calculating Practice Expense (PE) relative value units (RVUs) over a 4-year period with full implementation in 2010.
• CMS is proposing to modify enrollment standards for Independent Diagnostic Testing Facilities (IDTFs)
• CMS outlines measures from seven categories for inclusion in the 2008 PQRI, provided that the measures are either endorsed by the National Quality Forum (NQF) or adopted by the AQA Alliance.
• CMS is proposing to use the Physician Assistance and Quality Initiative Fund (PAQI), created by Tax Relief and Health Care Act (TRHCA) that provides $1.35 billion for physician payment and quality improvement initiative, to extend voluntary quality reporting bonus payments into 2008.

Comments on the proposed rule are due by August 31, 2007. Please submit your feedback to Lisa Miller-Jones, Director of Reimbursement or Regulatory Affairs at lmiller-jones@hrsonline.org for inclusion in HRS comments to CMS.

Comments or questions specific to PQRI should be directed to Joel Harder, Manager of Quality Improvement and Outcomes, jharder@hrsonline.org.