The Medicare Physician Fee Schedule (PFS) proposed rule for calendar year (CY) 2017, which the Centers for Medicare & Medicaid Services (CMS) released July 7, includes physician payment and quality program changes among provisions of interest to essential hospitals:
- Payment update – CMS proposed to adjust the annual physician payment rate by negative 0.08 percent.
- Telehealth services – For CY 2017, CMS proposed adding these services to the list of telehealth services for which Medicare providers may be reimbursed: end-stage renal disease related services for home dialysis (CPT codes 90967-90970), advance care planning (CPT codes 99497 and 99498), and telehealth consultations for a patient requiring critical care services (GTTT1 and GTTT2). The agency also proposed adding a place of service code that a telehealth service provider would report on Medicare claims, indicating that the provider receives the Medicare PFS facility rate.
- Primary care, care management, and patient-centered services – CMS proposed to add billing codes to more appropriately reimburse practitioners who provide these types of services.
- Expansion of Diabetes Prevention Program (DPP) model – Administered by the Centers for Disease Control and Prevention, the DPP is aimed at preventing the onset of diabetes in pre-diabetic individuals through the use of a clinical intervention consisting of increased physical activity, dietary changes, and other behavior changes. The Center for Medicare & Medicaid Innovation previously tested this model, and CMS now proposes to permanently expand it to the full Medicare population. Medicare would reimburse Medicare suppliers for providing Medicare DPP services to beneficiaries beginning Jan. 1, 2018.
- Medicare Advantage (MA) provider enrollment – CMS proposed requiring health care providers and suppliers that contract with MA plans to go through screening and enrollment, similar to requirements for Medicare fee-for-service providers and suppliers.
- Medicare Shared Savings Program (MSSP) – CMS proposed numerous changes to the MSSP, including changes to the measure set, resulting in a total of 31 MSSP quality measures, and numerous technical changes to quality reporting requirements. The proposed rule also would allow Medicare beneficiaries to provide a voluntary attestation identifying their main physician for purposes of determining beneficiary assignment to an accountable care organization (ACO). Finally, CMS proposed allowing individual eligible professionals in an MSSP ACO to separately report in the Physician Quality Reporting System to avoid reduced payments in CYs 2017 and 2018.
Comments are due to CMS by Sept. 6. Contact Director of Policy Erin O’Malley at firstname.lastname@example.org or 202.585.0127 with questions.