Healthcare Leaders React to CMS’ 2019 QPP Proposed Rule and E&M Coding Changes | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Healthcare Leaders React to CMS’ 2019 QPP Proposed Rule and E&M Coding Changes

July 18, 2018
by Heather Landi
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Many health IT industry groups, policy experts and other industry stakeholders continue to delve into the 1,473-page proposed rule released by the Centers for Medicare and Medicaid Services (CMS) on July 12 that provides updates to the Physician Fee Schedule and Quality Payment Program (QPP), which encapsulates the Medicare Incentive-based Payment Program (MIPS) and Advanced Payment Models.

When CMS announced the proposed rule last week for CY 2019, the agency said the changes will “fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information.”

These changes, according to CMS, would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. The proposals would also modernize Medicare payment policies to promote access to virtual care, CMS said in a July 12 announcement.  

Some key changes in the proposed rule include:

  • Adjustments to the MIPS program such as the removal of 34 low-value measures, a proposal to add 10 new measures, an increase of the cost component calculation weight from 10 to 15 percent, and the doubling of the performance threshold to 30 points;
  • Major reforms to Evaluation and Management (E/M) payments including single blended payment rates for both new and established patients for office/outpatient E/M level 2 through 5 visits and a series of add-on codes to reflect resources involved in providing complex primary care and non-procedural services;
  • Streamlining documentation requirements including eliminating the requirement to justify the medical necessity of a home visit in lieu of an office visit;
  • Reduction of quality measures from 31 to 24 in the Medicare Shared Savings Program (MSSP) and additional focus on the measure set on more outcome-based measures, including patient experience of care; and
  • Expansions to telehealth and virtual care reimbursement, including payment for virtual check-ins and evaluation of patient-submitted photos or recorded video and Medicare-covered telehealth services for prolonged preventative care

Healthcare Informatics Contributing Editor David Raths interviewed telehealth advocates about expansions to telehealth and virtual care reimbursement, and his article on the telehealth provisions of the rule can be read here.

In a podcast interview with Healthcare Informatics Managing Editor Rajiv Leventhal, Jeff Smith, vice president of public policy at AMIA (the Bethesda, Md.-based American Medical Informatics Association), shared his high-level takeaways and noted that the proposed rule signals CMS’s efforts to align the MIPS Promoting Interoperability (formerly called Advancing Care Information) performance category for clinicians with the proposed new Promoting Interoperability program for hospitals, which he anticipated would be welcome news to the physician community.

According to Administration officials, the proposed changes in the PFS and QPP will streamline documentation requirements to focus on patient care and modernize payment policies, and, overall, these changes seem to be welcome news to health IT and healthcare stakeholders.

The Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) expressed support for CMS’s proposed rule. In a statement, Liz Johnson, R.N., CIO, acute hospitals and applied clinical informatics at Tenet Healthcare, who serves as the CHIME Public Policy Steering Committee Chair, said, “CMS is certainly heeding calls from the provider community to reduce administrative burdens. We support efforts to reduce these burdens on clinicians, whether they were created by paper or electronic processes, and to give physicians more time to care for patients. We also applaud the discussion of expanded telehealth reimbursement, something that has been a priority for CIOs, and we commend efforts to incent use of PDMPs (prescription drug monitoring programs) as we seek ways to leverage technology in our ongoing efforts to combat the nation’s opioid crisis.”

Gerald Maccioli, M.D., chief quality officer at Envision Healthcare, a Nashville-based physician staffing company, said in a statement that CMS is moving in the right direction by focusing on measures that will enhance the delivery of patient-centered care.The streamlined measures signify that CMS is listening to clinicians and acknowledging the need to lessen their administrative burden by focusing on the measures that will make the most tangible impact on care delivery and patient outcomes. Clinicians are the voice from the front lines of patient care so it’s imperative that we involve them in quality improvement initiatives,” he said.

Don Crane, president of America’s Physician Groups (APG), said APG staff are still reviewing the proposed rules but are “cautiously optimistic that CMS has taken real action here to advance the value movement.” “Importantly, these rules include a re-affirmation of the recently announced Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration,” he stated.


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