CMS mulls payment policy changes on chronic care, telehealth

In an important first, the CMS is considering paying primary-care physicians for complex chronic care management services of Medicare patients without an in-person patient visit.

The change would start in 2015. It's just one of several policy changes included in the CMS-proposed Medicare Physician Fee Schedule for 2014 (PDF).

Other proposed changes include adjustments to some 200 “misvalued” fee-schedule codes and expanded payment for telehealth services—particularly for identified rural “health professional shortage areas.”

Payment for services rendered in non-face-to-face visits has long been advocated by physician groups. Under the CMS proposal, payments would be made for development and revision of care plans, and could include monitoring of patients' medical and functional needs.

To be eligible, the CMS is proposing that patients would need to have an annual, in-person wellness visit and consent to receiving a doctor's management plan for one year.

“We believe that successful efforts to improve chronic-care management for these patients could improve the quality of care while simultaneously decreasing costs (for example, through reductions in hospitalizations, use of post-acute care services, and emergency department visits),” the CMS stated in its proposal. “One of the primary reasons for our proposed 2015 implementation date is to provide sufficient time to develop and obtain public input on the standards necessary to demonstrate the capability to provide these services.”

In its proposal, the CMS also sought comment on whether third-party patient-centered medical home recognition by an entity such as the National Committee for Quality Assurance would demonstrate this capability.

Similarly, the CMS is proposing expanding payment for telehealth visits. This proposal includes refining the definition of “rural” to avoid disruption of services if an area's geographic designation is changed. In seeking comment for other possible expansions, the CMS stated that it was looking for evidence to “demonstrate the service furnished by telehealth to a Medicare beneficiary improves the diagnosis or treatment of an illness or injury” or improves patient function.

The proposed fee schedule also contains consideration for adjusting some 200 DRG codes involving services that had been misvalued due to fast growth of a service, have experienced substantial changes in expense and services recently established with new technology.

Many of the payments set by the CMS fee schedule are based on recommendations of the American Medical Association Specialty Society Relative Value Scaled Update Committee, commonly referred to as “the RUC.” The RUC has come under fire lately by critics who say it tilts the scales too heavily toward specialists and away from primary care. These critics include Rep. Jim McDermott (D-Wash.), who recently introduced legislation to address “the lack of transparency and fairness” in setting the Medicare fee schedule.

In its proposed schedule, however, the CMS noted that it also depends on the Physician Practice Expense Information Survey to set fees. It said the survey includes information from 3,656 respondents from 51 physician specialty and healthcare professionals groups and described it as “the most comprehensive source of (physician expense) survey information available.”

The proposed rule will be published in the July 19 Federal Register. Comments will be taken until Sept. 6, and the final rule will be published around Nov. 1.

Follow Andis Robeznieks on Twitter: @MHARobeznieks