Could Last Week’s Proposed-Rule Release Represent an Inflection Point for CMS and for Value-Based Federal Payment? | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

Could Last Week’s Proposed-Rule Release Represent an Inflection Point for CMS and for Value-Based Federal Payment?

July 18, 2018
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Industry leaders’ responses to the release of CMS’s proposed rule reveals a fascinating policy landscape

The release last Thursday of a proposed rule involving the Physician Fee Schedule and the Quality Payment Program under the Medicare program, by senior officials at the Centers for Medicare and Medicaid Services, was a very important development for physicians, hospitals, healthcare IT leaders, and others. As Managing Editor Rajiv Leventhal wrote in his breaking-news report on Thursday evening, “The Centers for Medicare & Medicaid Services (CMS) today proposed changes that the agency believes 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, part of the Physician Fee Schedule (PFS) and the Quality Payment Program (QPP), would also modernize Medicare payment policies to promote access to virtual care, CMS said in a July 12 announcement.”

Leventhal further noted that “Such changes would establish Medicare payment for when beneficiaries connect with their doctor virtually using telemedicine to determine whether they need an in-person visit. Additionally, the QPP proposal, set to take place in year three of the program, in 2019, would make changes to quality reporting requirements to focus on measures that most significantly impact health outcomes, CMS said.”

Among other elements, “The proposed changes would also encourage information sharing among healthcare providers electronically. And, the QPP proposal would make changes to the Merit-based Incentive Payment System (MIPS) “Promoting Interoperability” performance category to support greater EHR interoperability and patient access to their health information, as well as to align this clinician program with the proposed new “Promoting Interoperability” program for hospitals, according to the announcement,” Leventhal noted. And he quoted CMS Administrator Seema Verma’s statement upon the release of the proposed rule that “Today’s proposals deliver on the pledge to put patients over paperwork by enabling doctors to spend more time with their patients. Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care. This Administration has listened and is taking action. The proposed changes to the Physician Fee Schedule and Quality Payment Program address those problems head-on, by streamlining documentation requirements to focus on patient care and by modernizing payment policies so seniors and others covered by Medicare can take advantage of the latest technologies to get the quality care they need,” Verma said last week.

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.

 

Reactions from the field

Industry leaders have been quick to react. As Associate Editor Heather Landi reported in her article published this morning, “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.”

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