The CMS on Friday finalized rules that modify how physicians get paid for evaluation and management services and changes how the agency determines the financial rewards that doctors receive for improving healthcare quality and lowering costs.
The final physician fee schedule rule updates E/M codes for every specialty in 2020, but the CMS targeted its changes to encourage primary care physicians and other clinicians to spend more time coordinating care for their patients. The agency hopes these changes will help address the social determinants of health, increase patient adherence to treatment and improve the continuity of care. The final rule is virtually unchanged from the regulation proposed over the summer.
"We want to focus on the time that providers are spending with patients," CMS Administrator Seema Verma said in a call with reporters. "We know that some of these visits have become more complex."
Verma was eager to note the agency's growing desire to address social determinants of health to better coordinate care, improve health outcomes and cut spending. She thinks increased payments will help providers do that.
"Our doctors need time to spend with their patients to be able to address these issues," Verma said. "(The healthcare system relies) on a strong foundation of primary care to be the coordinator of care."
She added that the reimbursement rates outlined in the 2020 physician fee schedule wouldn't go into effect until 2021, so doctors and hospitals should consider them "preliminary."
"We'll update them on more recent data before the rule actually goes into effect," Verma said.
The rule finalized increases in the importance of cost performance under the Merit-Based Incentive Payment System, which ties Medicare Part B payments to clinician quality and cost-effectiveness. It's supposed to promote clinicians' transition to value-based payments, which reward physicians for outcomes instead of the volume of services provided.
Physician groups have complained that too many doctors are left out of MIPS and that it's too easy to get bonuses. They also worry that the penalties for not delivering on quality or cost performance aren't big enough to encourage improvement.
But the CMS is already looking forward to the next round of changes to its quality programs. The agency has asked the healthcare industry for help figuring out how to streamline reporting requirements for each specialty by reducing the number of measures and aligning them with alternative payment models. That spooked hospitals because they were worried that they wouldn't have enough time to roll out the new requirements.
Verma said that her agency understands the concerns of the industry and has clarified the language in the final rule to make it clear that the CMS will work closely with providers to make sure they get the changes right.
"We felt like we didn't do a good job of clarifying that on the front end," said Verma. "We're going to work with the specialty societies to develop (the new measures)."
