Doctors will be paid for Medicare care coordination, wellness and behavioral health telehealth visits. But, under final rules issued by the CMS late Friday, physicians also could see all Medicare payments cut by roughly 21% in April if the Medicare sustainable growth rate formula cuts are allowed to take effect.
In addition, the rule eliminates a controversial reporting exemption under the Physician Payments Sunshine Act for indirect financial ties between industry and physicians. It expands quality-performance penalties to all doctors. And it contains new quality criteria for the Medicare Shared Savings Program, a test of the accountable care payment and delivery model that now includes more than 300 accountable care organizations.
As proposed earlier this year, Medicare will cover wellness and behavioral health telehealth visits starting in January, according to the final rule for Medicare's physician fees. Doctors also will be able to bill Medicare $42.60 per patient per month for care coordination for patients with multiple chronic conditions. The new payments are for non-face-to-face services.
Under the rule, the Medicare sustainable growth rate formula —a payment policy that has forced Congress to repeatedly intercede to avoid major cuts to physician payment—would slash reimbursement to doctors by 21.1% as of April 1.
The rule also affects reporting of manufacturers' payments to physicians under the Sunshine Act. The CMS originally had proposed exempting payments to physicians associated with accredited continuing medical education from payments that must be reported to the CMS' Open Payments website. That reporting is intended to inform the public about physicians' possible conflicts of interest.
But the CMS reversed course in July and proposed to eliminate that exemption and require reporting of these payments. Friday's rule finalized the elimination of the exemption for reporting indirect manufacturers' payments to physicians for continuing medical education participation.
According to the CMS, applicable manufacturers and group purchasing organizations now will be required to report compensation provided to physician speakers at continuing education events, unless the payment or other transfer of value is specifically excluded.
“Eliminating the exemption for payments to speakers at certain accredited or certifying continuing medical education events will create a more consistent reporting requirement, and will also be more consistent for consumers who will ultimately have access to the reported data,” the CMS said in an overview of the rule changes.
The Sunshine Act-related rule provision also clarifies which indirect subsidies must be reported when the industry underwrites CME for doctors. Underwriting by drug and medical-device makers won't be considered indirect payments as long as the grants meet established criteria, including that recipients of the underwriting, not the manufacturers, have control over content of events and which doctors receive subsidies.
Andrew Rosenberg, senior adviser for the CME Coalition, a lobbying group for accredited CME providers, called this CMS clarification a victory for his members. “This clarification by CMS addresses the chief concerns of the CME Coalition and over 98% of the commenters to the public record who called on the agency to maintain a strong CME exemption to the reporting requirements,” he said in an e-mail.
The rule also included significant changes to Medicare payments tied to quality under the health reform law. Next year, Medicare payment to all physicians will be adjusted by quality performance under value-based payment modifiers. The quality-performance penalties were previously limited to larger groups and excluded small practices.
The rule also contained new quality criteria for the Medicare Shared Savings Program, a test of the accountable care payment and delivery model that now includes more than 300 accountable care organizations.
The proposed rule would have increased quality measures to 37 from 33. The final rule will limit the quality measures to 33, but with changes. The CMS will add new measures for stewardship of patient resources; 30-day, all-cause skilled nursing facility readmissions; and all-cause unplanned admissions for patients with diabetes, heart failure and multiple chronic conditions. The rule also will add new measures for diabetic foot exams and three coronary-artery disease quality measures and remove six measures, including reconciliation of medications after patients leave the hospital.
In addition, the rule includes a bonus for Medicare Shared Savings ACOs that improve their quality performance. The current criteria award bonuses based on quality scores, not quality improvement.
CMS representatives were not available for comment on deadline Friday.
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