Telehealth, CDS provisions outlined in proposed physician fee schedule

Proposed changes to the Centers for Medicare & Medicaid Services’ Medicare Physician Fee Schedule for 2017 contain several IT provisions, including ones around the use of telehealth, clinical decision support for imaging and technology related to the Diabetes Prevention Program.

For telehealth, the agency proposes adding several codes to the list of services eligible to use such tools, including services for end-stage renal disease related to dialysis, advance care planning and critical care consultations.

For decision support, CMS points out that the Protecting Access to Medicare Act of 2014 requires providers to consult physician-developed appropriateness criteria when ordering advanced imaging studies for Medicare patients. Radiologist Matt Hawkins of Emory University in Atlanta, previously said that law will “prevent providers from being forced into the tumultuously treacherous world of pre-authorization and radiology benefit managers,” who he said could approve and deny studies without justification.

Among other things, the agency says it believes it would be in the best interest of the appropriate use criteria program to establish decision support requirements “that are not prescriptive” when it comes to specific IT standards. “The CDSM EHR and health IT environments are constantly changing and improving and we want to allow room for growth and innovation,” CMS says. “However, in the future, as more stakeholders and other entities ... come to consensus regarding standards for CDSMs, then we may consider pointing to such standards as a requirement for qualified CDSMs under this program.”

CMS, in the rule, also says it wants to expand the Diabetes Prevention Program model beginning in January 2018. The program produced promising results shared earlier this year from a demonstration involving the YMCA.

To do so, the agency says, it wants comments on requiring Centers for Disease Control and Prevention-recognized program entities to submit claims to Medicare via standard claims forms and procedures, submitted electronically. “Claims submitted would be required to be traceable to care documented by the entity’s beneficiary records, which should include the requisite amount of detail associated with participation,” according to CMS.

To learn more:
- here’s the proposed rule
- check out the CMS announcement