Med Page – by David Pittman WASHINGTON — With the release of its 2014 physician fee schedule, Medicare is one step closer to paying physicians for non-face-to-face care management for beneficiaries with two or more significant chronic conditions.
The Centers for Medicare and Medicaid Services (CMS) released the finalized fee schedule late Wednesday and said it will begin paying for chronic care management services beginning in 2015.
“We believe that successful efforts to improve chronic care management for these patients could improve the quality of care while simultaneously decreasing costs, through reductions in hospitalizations, use of post-acute care services, and emergency department visits,” CMS Principal Deputy Administrator Jonathan Blum said in a statement.
Care management includes the development and implementation of a care plan, patient and caregiver communication, and medication management, CMS said. Medicare beneficiaries can receive such services from practices that meet certain standards set by Medicare.
CMS first proposed the care management payment in July. Primary care societies generally supported the idea.
But the American College of Physicians (ACP) told the agency in comments submitted in September that the 90-day reporting time may be too long to create meaningful documentation — especially since most of the care is rendered within the first 4 to 6 weeks — and overall too complex for physicians to bill for.
The ACP said it “anticipates that the CCCM [Complex Chronic Care Management] proposal, as written, could result in codes that are administratively difficult to use. Physicians would be challenged by the CCCM codes, due to the number and burden of the proposed requirements.”
The billing code also has been panned by those who advocate for a greater move away from fee-for-service.
“As long as Medicare — the big gorilla — is staying stuck in a fee-for-service world, we’re not going to get the transformation we’re looking for,” Chris Koller, president of the Milbank Memorial Fund in New York City, said at the Fall Conference of the Patient-Centered Primary Care Collaborative.
Generally, the 2014 fee schedule provides payment increases for many medical specialties, CMS said. The greatest boost will go to mental health providers, psychiatry, clinical psychologists and clinical social workers.
Last year, CMS granted family physicians up to a 7% boost in Medicare payments in 2013, and other primary care providers a 3% to 5% boost.
The 2014 fee schedule will also allow underserved areas in urban settings to bill for telehealth services.
In regard to the Physician Quality Reporting System (PQRS), CMS finalized a new option for 2014 for eligible professionals to report quality measures through qualified clinical data registries. Furthermore, CMS will align quality measures in 2014 across reporting programs so that physicians may report a measure once to receive credit for all programs.
Groups reporting PQRS measures in 2012 will have their data publicly reported on CMS’Physician Compare website in 2014.
On Wednesday, CMS also released the 2014 fee schedule for the hospital outpatient prospective payment system (OPPS) and for ambulatory surgical centers (ACS). The final rule increases overall payments for hospital outpatient departments by an estimated 1.7%.
Provisions in that fee schedule streamline outpatient services by combining payment for multiple items and services into a single payment. Items include drugs, biologics, and radio-pharmaceuticals that function as supplies.
“The final OPPS/ASC rule gives hospitals a stake in managing their resources to generate better coordinated and ultimately, more affordable outpatient care,” Blum said.
CMS was to release the fee schedules on Nov. 1, but the partial shutdown of the federal government for the first half of October delayed that until Wednesday.
Medicare has been rough on doctor payments this year. Payments to providers were cut by 2% — $11 billion — in mandatory federal spending cuts under the so-called sequester that started March 1.
Physicians face the prospect of a Medicare pay freeze for a decade under a proposal to repeal the program’s sustainable growth rate (SGR) payment formula currently pending in Congress. However, groups like the American Medical Association have vowed to fight that.
The AMA took the release of the schedule to remind Congress of the need to replace the SGR.
“Today’s release of the final Medicare payment rule serves as an urgent reminder to Congress that there are just 34 days before physicians who care for Medicare patients will face a steep payment cut of about 24% due to the short-sighted, fatally flawed Medicare payment formula — the SGR,” AMA President Ardis Hoven, MD, said in a statement.
The final 2014 physician fee schedule rule will be published in the Federal Register on Dec. 10 and take effect Jan. 1.
http://www.medpagetoday.com/PublicHealthPolicy/Medicare/43186