On November 1, CMS finalized bold proposals that address provider
burnout and provide clinicians immediate relief from excessive paperwork tied
to outdated billing practices. The final 2019 Physician Fee Schedule (PFS) and
the Quality Payment Program (QPP) rule also modernizes Medicare payment
policies to promote access to virtual care, saving Medicare beneficiaries time
and money while improving their access to high-quality services, no matter
where they live. It makes changes to ease health information exchange through
improved interoperability and updates QPP measures to focus on those that are
most meaningful to positive outcomes. The rule also updates some policies under
Medicare’s Accountable Care Organization program that streamline quality
measures to reduce burden and encourage better health outcomes. This rule is
projected to save clinicians $87 million in reduced administrative costs in
2019 and $843 million over the next decade.
“The historic reforms CMS finalized today move us closer to a
health care system that delivers better care for Americans at lower cost,” said
HHS Secretary Alex Azar. “Among other advances, improving how CMS pays for
drugs and for physician visits will help deliver on two HHS priorities:
bringing down the cost of prescription drugs and creating a value-based health
care system that empowers patients and providers.”
“Today’s rule finalizes dramatic improvements for clinicians and
patients and reflects extensive input from the medical community,” said CMS
Administrator Seema Verma. “Addressing clinician burnout is critical to keeping
doctors in the workforce to meet the growing needs of America’s seniors.
Today’s rule offers immediate relief from onerous requirements that contribute
to burnout in the medical profession and detract from patient care. It also
delays even more significant changes to give clinicians the time they need for
implementation and provides time for us to continue to work with the medical
community on this effort.”
Coding requirements for physician services known as “Evaluation
and Management” (E/M) visits have not been updated in 20 years. This final rule
addresses longstanding issues and also responds to concerns raised by
commenters on the proposed rule. CMS is finalizing several burden-reduction
proposals immediately (effective January 1, 2019), where commenters provided
overwhelming support. In response to concerns raised on the proposal, the final
rule includes revisions that preserve access to care for complex patients,
equalize certain payments for primary and specialty care, and allow for
continued stakeholder engagement by delaying implementation of E/M coding
reforms until 2021.
For the first time this rule will also provide access to “virtual”
care. Medicare will pay providers for new communication technology-based
services, such as brief check-ins between patients and practitioners and pay
separately for evaluation of remote pre-recorded images and/or video. CMS is
also expanding the list of Medicare-covered telehealth services. This will give
seniors more choice and improved access to care.
In addition, the rule continues our work to deliver on President
Trump’s commitment to lowering prescription drug costs. Effective January 1,
2019, payment amounts for new drugs under Part B will be reduced, decreasing
the amount seniors have to pay out-of-pocket, especially for drugs with high
launch prices.
CMS is also finalizing an overhaul of Electronic Health Record
(EHR) requirements in order to focus on promoting interoperability. The rule
finalized changes to help make EHR tools that actually support efficient care
instead of hindering care. Final policies for Year 3 of the QPP, part of the
agency’s implementation of MACRA, will advance the Meaningful Measures
initiative while reducing clinician burden, ensuring a focus on outcomes, and
promoting interoperability. CMS also introduced an opt-in policy so that
certain clinicians who see a low volume of Medicare patients can still
participate in the Merit-based Incentive Payment System program if they choose to
do so. In addition, CMS is providing the option for clinicians who are based at
a health care facility to use facility-based scoring to reduce the burden of
having to report separately from their facility.
For More Information:
See the full text of this excerpted CMS Press Release (November 1).
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