July 21, 2017
Area(s) of Interest: Payor Issues and Reimbursement Practice Management Public Payors
The Centers for Medicare & Medicaid Services (CMS) recently released the proposed 2018 Medicare Physician Fee Schedule. The California Medical Association (CMA) is pleased to note that there are a number of positive proposed changes that would help physicians improve patient care. CMS is also soliciting ideas from physicians to reduce Medicare and Medicaid regulatory hassles.
Highlights of the proposed rule include:
Request for information on regulatory relief: CMA applauds CMS’ invitation for physicians to submit ideas for regulatory, policy, practice and procedural changes to improve the health care system to reduce unnecessary burdens for clinicians, patients and their families. CMA has met with CMS on several occasions this year to urge the agency to reduce regulatory burdens on physicians.
CMA is compiling a list of regulatory reforms and will provide comments urging CMS to make it a top priority to provide regulatory relief to physicians in the Medicare and Medicaid programs. CMA’s list of reforms includes: reduced electronic health record (EHR) reporting; more EHR vendor accountability and assistance with usability; Medicare RAC and prepayment audit reforms; and requiring states and health plans to arrange and pay for Medicaid interpreter services.
Expansion of the Diabetes Prevention Program (DPP): The proposal would expand coverage of the Medicare DPP model to all Medicare patients at risk of developing type 2 diabetes. This expansion will ensure at-risk seniors and people with disabilities have access to evidence-based DPPs that can help them lower their risk factors and prevent or delay the progression to type 2 diabetes. The new proposal provides more flexibility to DPP providers in supporting patient engagement and attendance, and by making performance-based payments available if patients meet weight-loss targets over a longer period of time.
The Medicare DPP pilot program projected an estimated savings of $1.3 billion, prompting CMS to conclude last year that the expanded coverage would result in significant cost savings. This is a groundbreaking policy decision to cover and provide additional payment for evidenced-based prevention activities that improve patient health and reduce total health expenditures.
Delayed implementation of appropriate use criteria: The proposal would delay implementation of a program created under the Protecting Access to Medicare Act that would have denied payment for advanced imaging services unless the physician ordering the service documented that they had consulted the appropriate use criteria. CMS has decided to postpone the implementation of this requirement until 2019 and to make the first year an opportunity for testing and education, where consultation would not be required as a condition of payment for imaging services.
California Geographic Practice Cost Index: This year also marks the second year of the CMA-sponsored California Geographic Practice Cost Index (GPCI) fix. The GPCI fix updated California’s Medicare physician payment regions in 2017 and will transition payment levels upwards for 14 urban California counties misclassified as rural, while holding the remaining rural counties permanently harmless from cuts.
For more information, see the CMS Fact Sheet or read the full rule.
CMA is currently reviewing the proposed rule and will provide more information at a later date. CMS is accepting comments on the proposed rule through September 11, 2017. The final rule is expected to be released in early November.