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Medicare Reform Bill Signed into Law

Monday, May 11, 2015   (0 Comments)
Posted by: Lynne Cobb
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A $200 billion Medicare bill was signed into law that reformulates how Medicare reimburses physicians and other providers. This bill prevents a 21 percent cut in payments to providers who treat Medicare patients and eliminates the need to annually pass a temporary patch to keep the payments from being dramatically cut. The bill repeals the current Medicare payment formula for providers and replaces it with a reimbursement schedule that will increase payments by 0.5 percent for providers for the next five years. Medicare will transition to a payment system designed to reward physicians and other applicable practitioners based on the quality of care provided rather than the quantity of patients seen. After five years, physicians will receive bonuses or penalties based on performance scores from the government. Existing payment incentive programs are to be combined into a new merit-based incentive payment system. The bill also establishes an ad hoc Physician-Focused Payment Technical Advisory Committee to make comments and recommendations to the Secretary on physician-focused payment models.


The bill also includes two years of funding for the Children’s Health Insurance Program, a program that provides insurance for low-income families whose children do not qualify for Medicaid, and an additional $7.2 billion for community health centers over the next two years. Additional health measures included in the bill are funding for physical and other therapy services, ambulance services and rural hospitals, and a program that will allow low-income people to keep their Medicaid coverage as they transition into employment. This bill also includes provisions for Medicare extenders, Medicare beneficiary reforms and protection of the integrity of Medicare.


Medicare Reform Bill Gives Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs) More Authority for Medicare Reimbursement

The passage of the Medicare payment reform bill improves health care delivery by identifying PAs and APRNs (nurse practitioners [NP], clinical nurse specialists [CNS], certified registered nurse anesthetists [CRNA] and certified nurse midwives [CNM]) as Medicare applicable practitioners. The reform bill authorizes payment to APRNs to document evaluations for durable medical equipment, includes NP, CNS and CRNA in the first year of the merit-based Incentive Payment System and ensures that NP, CNS and CNM-led patient centered medical homes are eligible to receive incentive payments for the management of patients with chronic disease. For PAs, the chronic medical care provision authorizes them to provide complex chronic care. Additionally, PAs and APRNs will now be able to document face-to-face encounters for durable medical equipment.


Although PAs and APRNs have been given greater authority to receive reimbursement with the passage of the reform bill, growing the health care workforce to meet a potential increased demand may be difficult. An online education program provider has projected that increased demand for chronic-disease management and a shortage of primary care physicians will create a need for more than 30,000 PAs by 2022.


The American Association of Nurse Practitioners (AANP) and the American Medical Association (AMA) are among those who congratulate the passage of the Medicare Payment Reform Bill

The AANP noted that the bill will preserve the health services of seniors and recognize the expert care of nurse practitioners. Similarly, the AMA noted that the bill will assist in building a stable and sustainable Medicare program that will secure high-quality, cost-effective health care.

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