CMS Calls for Changes to Physician Fee Schedule

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The Centers for Medicare and Medicaid Services (CMS) is proposing changes on how Medicare pays for services provided by primary care physicians and other practitioners, focusing on care management and behavioral health.

The annual Physician Fee Schedule updates payment policies, payment rates, and quality provisions for services provided in calendar year 2017. These services include, but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services.

In addition to physicians, the fee schedule pays a variety of practitioners and entities, including nurse practitioners, physician assistants, physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities. Additional policies proposed in the 2017 payment rule include:

  • Primary Care and Care Coordination: The rule proposes revisions to payment for chronic care management, including payment for new codes and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions. This proposed change is a significant update to the Physician Fee Schedule and will support primary care when and where patients need it most.
  • Mental and Behavioral Health: CMS is proposing to pay for specific behavioral health services furnished using the Collaborative Care Model, which has demonstrated benefits in a variety of settings. In this model, patients are cared for through a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also proposing to pay more broadly for other approaches to behavioral health integration services.
  • Cognitive Impairment Care Assessment and Planning: CMS is proposing a new code to pay for cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s). This is a major step forward for care planning for these populations.
  • Care for Patients with Mobility-Related Impairments: CMS is proposing to pay physicians more accurately for furnishing services to beneficiaries with mobility-related impairments. This increase in payment will improve quality and access for this vulnerable population.

CMS has also evaluated concerns about payment adjustments to Puerto Rican clinicians based on local costs and is proposing a change that would more accurately reflect these costs and significantly increase payments in the Commonwealth. Other changes in the proposed regulation would enhance program integrity and data transparency in the Medicare Advantage program.

The rule also proposes policies to expand the Diabetes Prevention Program within Medicare starting January 1, 2018. This is the first time a preventive service model from the CMS Innovation Center would be expanded into the Medicare program.

“Through expansion of the Diabetes Prevention Program, beneficiaries across the nation will be able to access a community-based intervention that prevents diabetes and keeps people healthy. This is part of our efforts for better care, smarter spending, and healthier people,” said Patrick Conway, Acting Principal Deputy Administrator and CMS Chief Medical Officer.

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