Mixed reactions to CMS 2015 Medicare Physician Fee Schedule proposed rule

Centers for Medicare & Medicaid Services issued a proposed update to the Medicare Physician Fee Schedule for the 2015 calendar year late Thursday afternoon, which doesn't include changes to the sustainable growth rate (SGR) formula, but revises the Medicare Shared Savings Program (MSSP).

CMS plans to up the number of quality measures in the MSSP and put a greater emphasis on outcomes, a move praised by leaders at the purchasing cooperative, Premier, Inc.

Blair Childs, senior vice president of public affairs, Premier, Inc., in an email statement to FierceHealthcare commended CMS for proposing bonus points for accountable care organization (ACO) improvement to reach the MSSP quality goals. He also praised the agency for proposing to reduce the reporting burden on ACOs and move toward electronic submission.

"We also support CMS's efforts to create more realistic benchmarks for 'topped out' measures with overall high-performance. We look forward to working with CMS to identify new areas of measure to further the goals of the program," he said.

Other provisions in the proposed rule include changes to:

  • Value-based payment modifers, which would affect payments to physicians and physician groups, as well as other eligible professionals, based on the quality and cost of care they provide beneficiaries enrolled in the traditional Medicare fee-for-service program, according to a CMS fact sheet

  • Chronic care management: CMS proposes a payment rate of $41.92 for the code, which cannot be billed more than once a month per qualified patient; greater flexibility in the supervision of clinical staff providing chronic care management services; and CMS will not propose separate standards that practitioners furnishing services would have to meet.

  • Telehealth services: The proposed rule would add annual wellness visits, psychoanalysis, psychotherapy and prolonged evaluation and management services to the list of items Medicare beneficiaries can receive under the telehealth benefit.

  • Off-campus provider-based departments: CMS wants to start collecting data on services offered in off-campus provider-based departments, requiring hospitals and physicians to report a modifier for those services on both hospital and physician claims.

  • Global surgery code: CMS wants to transform all 10- and 90-day global codes to 0-day global codes beginning in 2017. The Office of Inspector General identified a number of surgical procedures that include more visits in the global period than are provided, according to the fact sheet. The agency plans to have one code for services provided on the day of surgery, and pay separately for postsurgical services.

  • Physician Payment Sunshine Act: Also known as the Open Payment program, this requires pharmaceutical and medical device manufacturers and group purchasing organizations to register with and submit to CMS data on their financial relationships with physicians and teaching hospitals. CMS proposes deleting the definition of "covered device" as duplicative of the definition of "covered drug, device, biological or medical supply," as well as deleting the reporting exclusion for payments made to speakers at accredited continuing medical education events when certain requirements are met.

Additionally, it proposes changes to the ambulance fee schedule regulations, the Physician Compare Website, the Physician Quality Reporting System and the Physician Feedback Program, FierceHealthcare reported. The agency will accept comments on the proposal through Sept. 2.

Physician groups are disappointed the proposed rule doesn't address the SGR repeal.

"We again call on Congress to repeal the flawed sustainable growth rate formula reflected in the 2015 proposed Medicare physician fee schedule," Reid Blackwelder, M.D., president of the American Academy of Family Physicians said in statement. "Temporary fixes do nothing to solve one of the most chronic and fundamental challenges in the Medicare program, nor do they establish a stable environment in which physicians can plan for their practice's stability."

To learn more:
- here's the proposed rule (pdf)
- read the CMS fact sheet 
- check out the AAFP statement

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