The Centers for Medicare & Medicaid Services (CMS) released July 3 the Medicare physician fee schedule (PFS) proposed rule. This rule updates the payment policies and rates for services furnished on or after Jan. 1, 2015. Of particular interest to members of America’s Essential Hospitals, the rule also includes proposed changes to the Medicare Shared Savings Program (MSSP).
The MSSP aims to facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service beneficiaries and reduce growth in health care costs. Eligible providers participate in this program through the creation of an accountable care organization (ACO). CMS monitors the quality of care provided by ACOs through their submission of quality data. In a November 2011 final rule, CMS adopted 33 quality measures that capture patient experience, outcomes, and evidence-based care processes.
In the PFS rule, CMS proposes to increase the total number of quality measures to 37. All 37 measures would be phased in for ACOs with a 2015 start date. ACOs with start dates prior to 2015 would be responsible for the complete and accurate reporting of the measures for the 2015 performance year and then for either reporting or achieving certain performance levels according to the proposed phase-in schedule. CMS arrived at 37 measures by adding 12 measures and retiring 8 measures from the initial set of 33 measures. CMS notes that the chosen measures are more outcome-oriented and should reduce the reporting burden on ACOs, as the measures are calculated by CMS using administrative claims data or patient surveys.
Additionally, CMS proposes to establish a quality performance benchmark and update the benchmark every two years, which would allow the agency to be flexible and make adjustments if appropriate. The longer period between benchmark updates would give ACOs a more stable target for measuring quality improvement. Lastly, CMS seeks comments on alternative approaches to explicitly reward quality improvement for ACOs.
The proposed rule will be published in the Federal Register July 11, and comments are due to CMS Sept. 2. Please contact Xiaoyi Huang, director of policy, at email@example.com or 202.585.0127 with any questions.