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San Francisco Marin Medical Society Blog

CMS Releases Final Rules for FY 2015 Medicare Physician Payments



CMS released finalized payment rules for different Medicare providers and services for 2015. Among other rules, CMS created new payments for chronic care management programs, launched efforts to streamline payments for individuals’ hospital care and expanded the agency’s Physician Compare website.

Rules on Physician Compare Website, Open Payments System

CMS said the rules expanding the Physician Compare website would significantly bolster “the quality measures available on this website by making group practice and individual physician-level measures available for public reporting, including patient experience measures”.

Separately, the rules also eliminate a reporting exemption under the Sunshine Act that excluded payments to physicians associated with accredited continuing medical education from the payments that have to be shared on the Open Payments System. CMS said the rule would now require group purchasing organizations and affected manufacturers to report compensation given to physician speakers at continuing education events in most cases.

Changes to Medicare Shared Savings Program

The rules also broaden quality performance penalties for all physicians and include additional quality criteria for the Medicare Shared Savings Program. Specifically, Medicare physician payments beginning in 2015 will be adjusted based on quality performance measures and penalties will no longer apply solely to larger physician practices.

CMS Increases Hospital Outpatient, Surgery Center Payments

In addition, CMS in the rules said it will increase Medicare payments for hospital outpatient services and ambulatory surgical centers in 2015.

Hospital outpatient departments will receive a 2.2% bump in reimbursement rates, while ambulatory surgical centers' payment rates will increase by 1.4%, effective January 1, 2015. The increase will affect more than 5,300 ambulatory surgical centers and 4,000 hospitals.

Further, CMS created comprehensive ambulatory payment classifications, which will provide lump sum payments to the centers for 25 particular outpatient services, such as hip replacements or pacemaker procedures.

CMS Cautions on SGR

In the rules, CMS noted that providers could see payment cuts around 21% in April 2014 if action is not taken on Medicare's sustainable growth rate formula.

Click here to view the 2015 Medicare Physician Payment Final Rules.

Source: California Healthline, November 3, 2014.



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