Providers mostly applaud CMS over fee schedule, but some specialists fear cuts

By | October 2, 2019

Dive Brief:

  • Lobbying groups for the country’s physicians and hospitals applauded CMS for its 2020 physician fee schedule rule largely due to the agency walking back a previous proposal that aimed to significantly alter how office visits, or evaluation and management (E/M) services, were coded and ultimately reimbursed.
  • Still, the American Medical Association and American Hospital Association were more critical of CMS’ proposal to better streamline multiple programs that tie Medicare reimbursement to quality or value. AHA said considerable revisions are needed to ensure that providers are assessed fairly and accurately in order to receive the appropriate payment.
  • The proposed rule garnered more than 33,000 comments, which were due Friday. Many psychologists slammed the agency over proposed cuts.

Dive Insight:

CMS received significant pushback from providers after previously signaling it wanted to change office visit reimbursement. The main fear for doctors was the change would result in a flat fee that failed to take the complexity of a patient into account, a chief concern for specialists.

“CMS recognized that its earlier plan for E/M visits would have disrupted care patterns and may have created other unintended consequences,” American Medical Group Association CEO Jerry Penso said in a statement. “Having the separate codes helps acknowledge the difference in resources in treating patients with more complex care needs.”

Some say CMS’s move has already given the green light to insurers to rethink some office visit reimbursements. In some states, Anthem is now denying payment for certain follow-up office visits the same day a procedure is performed, which has irked providers.

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But as CMS has walked back the E/M issue for some providers, it is causing worry among others such as psychologists who say they will have to shoulder cuts to make room for increases in some E/M payments.

“This would be devastating for psychology practices, and we unfortunately predict a mass exodus of psychologists who currently provide important care for Medicare beneficiaries such as neuropsychological testing for dementia and behavioral pain management for opiate addicted peoples,” the American Psychological Association said in its comments criticizing the proposed rule.

CMS is also trying to streamline its value-based programs. The agency is attempting to align the scoring methodology for the Medicare Shared Savings Program for accountable care organizations with the Merit-based Incentive Payment System (MIPS) quality performance scoring methodology.

AHA said “especially the increase in the number and weight of cost measures, and the proposed MIPS Value Pathways (MVP) framework — require considerable revisions to ensure they assess providers fairly and accurately.”

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