The Centers for Medicare & Medicaid Services (CMS) on November 1, 2012 issued its 1,362-page final rule of fee schedules for 57 physician and other specialty provider groups for calendar year 2013. 

Primary care providers are the big winners with family practitioners topping the list with a 7% fee increase, geriatricians receive 5%, internal medicine specialists receive 4%, nurse practitioners receive 4%, pediatricians receive 3%, and physician assistants receive 3% fee increases for transitional care management.  CMS said it is trying to recognize "the work of community physicians and practitioners in treating a patient following discharge from a hospital or nursing facility will ensure better continuity of care for these patients and help reduce patient readmissions."

A new change for primary care is the addition of a Healthcare Common Procedure Coding System "G" billing code to cover time spent coordinating care for a patient being discharged from a hospital or skilled nursing facility. CMS is looking for better post-discharge coordination.  According to Dr. Jeffrey Cain, president of the American Academy of Family Physicians, "We've had a problem with the culture in our healthcare system (determining) who's in charge of medication, who's in charge of referrals" after a patient is discharged from the hospital.  "What Medicare is saying is that they're now recognizing there's a complexity of care that's not been valued in the past."

On a positive note, CMS has increased the number of services that will be covered when provided via an interactive telecommunication system.  As telemedicine continues to grow, this expansion will be welcomed by many physicians, although it primarily still relates to preventative care.  The rule would add codes covering several levels of assessments, screenings, and counseling for alcohol and substance abuse, depression, prevention of sexually transmitted infections, cardiovascular disease, and obesity.

Other specialty groups likely to receive fee increases include:

• Allergy/immunologists, 3%
• Anesthesiologists, 1%
• Colonand rectal surgeons, 2%
• Critical care specialists, 1%
• Endocrinologists, 1%
• General practice doctors, 1%
• Hand surgeons, 1%
• Hematology/oncologists, 2%
• Infectious disease specialists, 1%
• Interventional pain management specialists, 1%
• Otolaryngologists, 2%
• Psychiatrists, 2%
• Pulmonary disease specialists, 1%

Among those specialists likely to receive fee decreases:

• cardiac surgeons, -1%;
• cardiologists, -2%
• nuclear medicine specialists, -3%
• ophthalmologists, -3%
• pathologists, -6%
• physical medicine specialists, -4%
• thoracic surgeons, -1%
• urologists, -1%
• vascular surgeons, -2%

The groups that are already receiving proposed fee reductions are concerned that the SGR reductions will come on top of the reductions listed above.  CMS has stated that they don't think the SGR will take effect, at least not with that severe of a cut, but if you ask me, the outcome of the presidential election will be the deciding factor.  Congress has overridden the required reduction every year since 2003.