The Election and Health Care Reform, also News on Payment Increases for 2013

If the email below is not displayed correctly on your smartphone or email viewer, click here.
To ensure that you always receive our newsletter, please add the e-mail address "" to your address book.

November 16, 2012
In this issue
» With Election in the Rearview Mirror, ACP Looks Toward Challenges Ahead

» Medicare Raises Rates for Primary Care Physicians

» Federal Government Steps in to Create Parity in Medicaid, Medicare Payments

About this newsletter

The ACP Advocate is an e-newsletter, edited by the College's Washington, DC governmental affairs division, created to provide you, our members, with succinct news about public policy issues affecting internal medicine and patient care. To learn more about ACP's Advocacy and to access the ACP Advocate archives, go to

Welcome to The ACP Advocate

As promised, our first story today updates you on how the election results will impact our health care advocacy agenda. President Obama's re-election and expansion of Democratic Senate seats removes any prospect that the Affordable Care Act will be repealed, at least for the next four years. As a result, the major expansions of coverage required by the law remain on track to be implemented on Jan. 1, 2014. Now, the focus shifts to the states--which will have to decide soon if they will agree to set up exchanges for residents to buy qualified health plans with federal subsidies and/or to accept federal dollars to expand Medicaid. Read the article to learn more about what's happening there.

Our second story today brings you very good news about the 2013 Physician Fee Schedule. The biggest change for internists is that Medicare will now begin paying for new transitional care management codes. ACP played a key advocacy role in persuading CMS to pay for the physician work described by these codes relating to care of patients who are discharged from inpatient facilities. These new codes, combined with other changes in the rule, will result in internists gaining 4-5 percent in total Medicare payments in 2014, on top of the 10 percent primary care bonus payments already in effect. However, it is important to note these increases don't take into account the 26.5 percent SGR cut that is scheduled for Jan. 1. We believe that Congress will make the fix to avert that cut as it has done other years; however with the fiscal cliff, the situation this year is a bit more complex. We'll update you in our Dec. editions about where this issue stands. In the meantime, read the story to learn more about changes to the Fee Schedule for 2013.

Finally, our third story is more good news to report to you. CMS also recently released the final rule on Medicaid primary care pay parity. The final rule lists internal medicine, family medicine and pediatricians as qualifying for the higher Medicaid payments, but in a big win for ACP, CMS decided that internal medicine subspecialists also are eligible. In our comments to CMS, we asked the agency not to accept the viewpoint offered by other physician organizations that IM subspecialists should be ineligible for the higher Medicaid payments because they are not primary care physicians. We noted that patients need access to both general internists and internal medicine subspecialists. We are very pleased that CMS heeded our advice so that all internists in almost all states will see higher Medicaid payments starting in Jan!

For more coverage of what's happening in Washington take a look at my award-winning blog, The ACP Advocate Blog by Bob Doherty. My most recent post discusses why it is better for the country to come together to seek bipartisan ways to improve the Affordable Care Act rather than urging states to resist implementation. You can also follow me on Twitter @BobDohertyACP. 

And, as always, please send your feedback and suggestions on this newsletter to:

Yours truly,

Bob Doherty
Senior Vice President
Governmental Affairs and Public Policy
American College of Physicians 


In the news
» With Election in the Rearview Mirror, ACP Looks Toward Challenges Ahead
  Decisions loom on insurance exchanges, Medicaid expansion and more

The first reaction of Dr. David Bronson, president of the American College of Physicians, to the Nov. 6 election results was one of relief -- but perhaps not for the reason you might think.

Bronson works as president for Clevela... » Click to read the full article

» Medicare Raises Rates for Primary Care Physicians
  ACP advocacy pays off in fee schedule changes that include expanded transitional care coverage

Primary care physicians should see an increase in their Medicare payments next year, according to a new fee schedule released this month by the Centers for Medicare and Medicaid Services.

However, it's what the increased payme... » Click to read the full article

» Federal Government Steps in to Create Parity in Medicaid, Medicare Payments
  Doctors who provide primary care services will see increases starting in 2013

Physicians who provide primary care services under Medicaid will receive compensation equal to that paid for Medicare services, according to a new rule adopted Nov. 1 as part of the Affordable Care Act.

For two years -- 2013 and... » Click to read the full article

In focus
Get Started with Free PQRS Webinar
PQRS is a CMS voluntary reporting program providing a financial incentive to physicians/other professionals who report data on quality measures. The 2012 reporting year is the last chance to participate in PQRS and receive an incentive payment without risk of penalty. Penalties for nonparticipation in PQRS reporting begin in 2015, but are applied to the reporting year of 2013. ACP offers discount access to the PQRIwizard, which helps guide professionals through easy steps to rapidly collect, validate and submit their results to CMS for payment. Register now for a free webinar on 11/29.

If you don't want to receive this newsletter anymore, unsubscribe here.

© Copyright 2012 American College of Physicians. All rights reserved.
Washington Office | 25 Massachusetts Ave., NW | Washington, DC 20001-7401 | Phone: (800) 338-2746

Featuring articles produced by HealthDay's Custom Content Division

Delivered by HEALTHBANKS, INC. • 15 New England Executive Park • Burlington, MA 01803