CMS Releases Final Rules for FY 2015 Medicare Physician Payments
Among other rules, CMS created new payments for chronic care management programs, launched efforts to streamline payments for individuals' hospital care and expanded the agency's Physician Compare website. CMS Administrator Marilyn Tavenner said the "rules are a part of a broader strategy driving greater value in health care."
Rules on Physician Compare Website, Open Payments System
CMS said the rules expanding the Physician Compare website would significantly bolster "the quality measures available on this website by making group practice and individual physician-level measures available for public reporting, including patient experience measures" (Viebeck, The Hill, 10/31).
Separately, the rules also eliminate a reporting exemption under the Sunshine Act that excluded payments to physicians associated with accredited continuing medical education from the payments that have to be shared on the Open Payments System. CMS said the rule would now require group purchasing organizations and affected manufacturers to report compensation given to physician speakers at continuing education events in most cases.
Changes to Medicare Shared Savings Program
The rules also broaden quality performance penalties for all physicians and include additional quality criteria for the Medicare Shared Savings Program. Specifically, Medicare physician payments beginning in 2015 will be adjusted based on quality performance measures and penalties will no longer apply solely to larger physician practices.
Meanwhile, the accountable care organizations taking part in the Medicare Shared Savings Program will be subject to 33 adjusted quality requirements, including:
- Measures for patient stewardship resources;
- Readmissions to 30-day, all-cause skilled nursing facilities; and
- Unplanned, all-cause admissions for individuals with diabetes, heart failure and more than one chronic condition (Evans, Modern Healthcare, 10/31).
CMS Increases Hospital Outpatient, Surgery Center Payments
In addition, CMS in the rules said it will increase Medicare payments for hospital outpatient services and ambulatory surgical centers in 2015, Modern Healthcare reports.
Hospital outpatient departments will receive a 2.2% bump in reimbursement rates, while ambulatory surgical centers' payment rates will increase by 1.4%, effective Jan. 1, 2015. The increase will affect more than 5,300 ambulatory surgical centers and 4,000 hospitals, according to Modern Healthcare. The increases are higher than those proposed by CMS earlier this year (Herman, Modern Healthcare, 10/31). The agency did not include estimates of how much the increases are expected to cost (Young , CQ HealthBeat, 10/31).
Further, CMS created comprehensive ambulatory payment classifications, which will provide lump sum payments to the centers for 25 particular outpatient services, such as hip replacements or pacemaker procedures (Herman, Modern Healthcare, 10/31).
CMS also finalized rules that, beginning in January, will:
- Establish new quality and performance care standards for patients undergoing dialysis treatments;
- Require Medicare to use competitive bidding rates to purchase durable medical equipment (Young , CQ HealthBeat, 10/31);
- Allow physicians bill Medicare $40.39 per month for each patient with more than one chronic condition to improve care quality (Morgan, Reuters, 10/31);
- Expand coverage for telehealth physician visits by requiring Medicare to reimburse physicians for wellness and behavioral health visits (Evans, Modern Healthcare, 10/31); and
- Eliminate a "narrative" requirement that requires physicians to submit written descriptions explaining why home health services are necessary (Young , CQ HealthBeat, 10/31).
CMS also announced in the regulations that it will consider whether to reimburse providers for end-of-life care counseling, AP/Modern Healthcare reports. The potential payment changes would take effect in 2016 and would apply to voluntary end-of-life care counseling (AP/Modern Healthcare, 11/1).
CMS Cautions on SGR
In the rules, CMS noted that providers could see payment cuts around 21% in April 2014 if action is not taken on Medicare's sustainable growth rate formula, CQ HealthBeat reports (Young , CQ HealthBeat, 10/31).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.