Input from the Society Reflected in Final Rule

The Center for Medicare and Medicaid Services (CMS) released their Final Rule for the 2011 Medicare Physician Fee Schedule (MPFS) on Tuesday, November 2, 2010 for public viewing. There is a 60-day comment period ending on January 3, 2011. The official version of this regulation will be published in the November 30, 2010 edition of the Federal Register.

This Rule applies to calendar year 2011, beginning January 1, 2011. The rule was released in proposed form for comments in June with many initiatives that demonstrated a new standard of tying physician payments with quality outcomes, and the Society commented extensively at that time in order to ensure the Final Rule would better conform to the needs of the Society’s membership. (View Final Rule, PDF, 6.9M)

The Physician Quality Reporting Initiative (PQRI), which was originally a voluntary program to report data on quality measures for covered professional services furnished to Medicare beneficiaries by physicians in order to receive an incentive payment, is now a permanent program which will penalize eligible professionals for not participating in the program beginning in 2015. Now that the program is permanent, CMS has changed the name to the Physician Quality Reporting System (PQRS).

Other changes in the proposed rule included changes to physicians' reimbursement and changes to the structure and form of the PQRS. The Society commented on all these changes in order to assure the Final Rule would better conform to the needs of the Society's membership.

The Society sought clarification and confirmation that the PQRI would be helpful to electrophysiologists on several fronts. The Society:

1. Urged CMS to consider measures for subspecialties (especially those relevant to electrophysiologists) by both suggesting specific measures from the AMA-PCPI for adoption within PQRI and by creating an atrial fibrillation measures group. By incorporating these measures, the Society highlighted the belief that eligible professionals should not be denied an incentive payment if the available quality measures are not applicable to their specialty
2. Recommended that CMS delay any financial penalties relating to physicians not participating in the 2011 electronic prescribing program
3. Finally, the Society asked CMS to coordinate all provider and physician-based reporting, meaningful use requirements and electronic prescribing requirements.

Within the Final Rule of the 2011 Physicians Fee Schedule, the following changes resulted from the Heart Rhythm Society's input:

• While the Final Rule for 2011 has set the categories and standards the PQRI will accept, the Secretary of Health and Human Services will leave the door open to additional or specialized reporting requirements to better measure physician performance but held firm that such measures must be endorsed by the National Quality Forum, not just endorsed by the AMA-PCPI. Additional reporting measures should be submitted for consideration in 2012. Should HHS and CMS adopt additional requirements in the future, these will be open to a public comment period like the 2011 Proposed Rule.
• While both the Society and CMS agree that the penalties for non-compliance with PQRS requirements are mandated by the Affordable Care Act and, therefore, cannot be altered by the regulation, CMS showed a willingness to assess whether additional improvements to the PQRS could be implemented to encourage greater participation prior to implementation of the payment adjustments in 2015.
• CMS is willing to better coordinate and align all-provider-based and physician-based reporting to include meaningful-use requirements and electronic health records requirements, but must also adhere to statutory requirements which may hamper such coordination and alignment.