The 1.1 percent fee schedule update is required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which became law on July 15. The act averted a 5.4 percent reduction that would have happened if CMS had applied the physician fee schedule conversion factor projected in the proposed rule. Total Medicare spending under the 2009 Physician Fee Schedule is projected at $61.9 billion, up 4 percent from the $59.5 billion projected for 2008.
Physicians and other eligible professionals who adopt and use qualified e-prescribing systems to transmit prescriptions to pharmacies may earn an incentive payment of 2.0 percent of their total Medicare allowed charges during 2009. To participate in the e-prescribing incentive program, physicians will need to have a qualified e-prescribing system with that can
- communicate with the patients pharmacy;
- help the physician identify appropriate drugs and provide information on lower cost alternatives for the patient;
- provide information on formulary and tiered formulary medications; and
- generate alerts about possible adverse events, such as improper dosing, drug-to-drug interactions, or allergy concerns.
To earn the incentive payment, physicians must successfully report one of three codes for the e-prescribing measure when submitting claims for specified types of medical visits, indicating either that they did not prescribe any medications during the visit; they used e-prescribing for any medications prescribed during the visit; or they did not use e-prescribing for a prescription because the law prohibits electronic prescribing for the specific type of drug, such as a controlled substance.
Physicians can earn an additional 2.0 percent incentive payment for 2009 for successfully reporting measures under the updated PQRI. Among the changes for 2009 is removal of the quality measure 125 that was used to report on the use of e-prescribing, since that is now the focus of the e-prescribing incentive program. The final rule also adds 52 new quality measures (bringing the total number of measures to 153 from which eligible professionals can select from for 2009 PQRI), addressing such areas as osteoarthritis, rheumatoid arthritis, back pain, coronary artery bypass graft (CABG), chronic kidney disease (CKD), melanoma, oncology, coronary artery disease, hepatitis, and HIV/AIDS. Eighteen of the new measures are reported exclusively through registries.
The final rule with comment will appear in the Nov. 19 Federal Register. Comments on designated provisions are due by 5:00 p.m. Eastern time on Dec. 29, and a final rule responding to the comments will be published at a later date. Download the text of the final MPFS rule. For more details on the general provisions of the rule, as well as CMSs implementation of the PQRI and e-Prescribing initiative, and MIPPA changes, see the Medicare Fact Sheets.
