CMS promises to relieve ‘regulatory burden’ in 2018 Medicare physician fee schedule

The Centers for Medicare & Medicaid Services issued a proposed rule yesterday to update the Medicare physician fee schedule, with changes intended to relieve the regulatory burden on doctors and other clinicians in 2018.

The agency said the proposed rule and other Medicare payment rules for 2018 reflect a broader strategy to relieve regulatory burdens on providers, support the patient-doctor relationship, and promote transparency, flexibility and innovation in care delivery.

“Doctors want to spend less time on burdensome regulations from Washington … and more time with their patients,” CMS Administrator Seema Verma said in an announcement. “We believe this new approach will improve quality of care and result in better health outcomes. CMS is committed to giving providers and beneficiaries alike more flexibility and choice in healthcare and is eager to hear comments on our proposed rule.”

The rule will be published July 21 in the Federal Register, with comments on the proposal due Sept. 11. The proposals update Medicare payment and policies for doctors and clinicians who treat Medicare patients and take effect for 2018.

In addition to the payment and policy proposals, CMS said it is requesting feedback on ways to improve the healthcare delivery system.

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CMS provided details about the proposed fee schedule in a fact sheet. Here are some of the highlights:

  • CMS estimates a 0.31% increase in physician payment rates for 2018. The update reflects a 0.5% payment increased established by the Medicare Access and CHIP Reauthorization Act (MACRA) and a misvalued code adjustment of 0.19% required under the Achieving a Better Life Experience Act of 2014.
  • CMS makes changes to its payment rates for nonexempted off-campus provider-based hospital departments, further reducing payments by 50%. CMS said the adjustment will encourage fairer competition between hospitals and physician practices by promoting greater payment alignment.
  • CMS proposes to pay for new telehealth services, including psychotherapy for crisis, health risk assessments and care planning for chronic care management.
  • The rule would make additional proposals to implement the Medicare Diabetes Prevention Program expanded model starting in 2018, with more details available in a fact sheet.
  • The proposed rule would delay until Jan. 1, 2019, the appropriate use criteria program for advanced diagnostic imaging services.
  • The rule would establish payments to rural health clinics and federally qualified health centers for regular and complex chronic care management services, general behavioral health integration services, and psychiatric collaborative care model services using two new billing codes.
  • The agency would retroactively lower the number of required measures for the 2018 Physician Quality Reporting System from nine to six to more closely align the program with the new Merit-based Incentive Payment System that will affect payments starting in 2019.
  • CMS will improve payment for office-based behavioral health services that are often the therapy and counseling services used to treat opioid addiction and other substance use disorders.