|
CENTERS FOR MEDICARE &
MEDICAID SERVICES (CMS)
 
Special
Edition – Tuesday, August 04, 2020
|
Trump
Administration Proposes to Expand Telehealth Benefits Permanently for
Medicare Beneficiaries Beyond the COVID-19 Public Health Emergency and
Advances Access to Care in Rural Areas
CMS is proposing changes to expand telehealth
permanently, consistent with the Executive Order on Improving Rural and
Telehealth Access that President Trump signed. The Executive Order and
proposed rule advance our efforts to improve access and convenience of care
for Medicare beneficiaries, particularly those living in rural areas.
Additionally, the proposed rule implements a multi-year effort to reduce
clinician burden under our Patients Over Paperwork initiative and to ensure
appropriate reimbursement for time spent with patients. This proposed rule
also takes steps to implement President Trump’s Executive Order on Protecting
and Improving Medicare for our Nation’s Seniors and continues our commitment
to ensure that the Medicare program is sustainable for future generations.
Expanding Beneficiary Access to Care through
Telehealth:
Over the last three years, as part of the
Fostering Innovation and Rethinking Rural Health strategic initiatives, CMS
has been working to modernize Medicare by unleashing private sector
innovations and improve beneficiary access to services furnished via
telecommunications technology. Starting in 2019, Medicare began paying for
virtual check-ins, meaning patients across the country can briefly connect
with doctors by phone or video chat to see whether they need to come in for a
visit. In response to the COVID-19 pandemic, CMS moved swiftly to
significantly expand payment for telehealth services and implement other
flexibilities so that Medicare beneficiaries living in all areas of the
country can get convenient and high-quality care from the comfort of their
home while avoiding unnecessary exposure to the virus. Before the Public
Health Emergency (PHE), only 14,000 beneficiaries received a Medicare
telehealth service in a week, while over 10.1 million beneficiaries have
received a Medicare telehealth service during the PHE from mid-March through
early-July. For more information on Medicare’s unprecedented increases in
telemedicine and its impact on the health care delivery system, visit the CMS Health Affairs blog.
As directed by President Trump’s Executive
Order on Improving Rural and Telehealth Access, through this rule, CMS is
taking steps to extend the availability of certain telemedicine services
after the PHE ends, giving Medicare beneficiaries more convenient ways to
access health care particularly in rural areas where access to health care
providers may otherwise be limited.
“Telemedicine can never fully replace
in-person care, but it can complement and enhance in-person care by
furnishing one more powerful clinical tool to increase access and choices for
Americas seniors,” said CMS Administrator Seema Verma. “The Trump
Administration’s unprecedented expansion of telemedicine during the pandemic
represents a revolution in health care delivery, one to which the health care
system has adapted quickly and effectively. Never one merely to tinker around
the edges when it comes to patient-centered care, President Trump will not
let this opportunity slip through our fingers.”
During the PHE, CMS added 135 services such
as emergency department visits, initial inpatient and nursing facility
visits, and discharge day management services that could be paid when
delivered by telehealth. CMS is proposing to permanently allow some of those
services to be done by telehealth, including home visits for the evaluation
and management of a patient (in the case where the law allows telehealth
services in the patient’s home) and certain types of visits for patients with
cognitive impairments. CMS is seeking public input on other services to
permanently add to the telehealth list beyond the PHE in order to give
clinicians and patients time as they get ready to provide in-person care
again. CMS is also proposing to temporarily extend payment for other
telehealth services, such as emergency department visits for a specific time
period, through the calendar year in which the PHE ends. This will also give
the community time to consider whether these services should be delivered
permanently through telehealth outside of the PHE.
Prioritizing Investment in Preventive Care
and Chronic Disease Management:
Under our Patients Over Paperwork initiative,
the Trump Administration has taken steps to eliminate burdensome billing and
coding requirements for Evaluation and Management (E/M) (for
office/outpatient visits) that make up 20 percent of the spending under the
Physician Fee Schedule. These billing and documentation requirements for E/M
codes were established 20 years ago and have been subject to longstanding
criticism from clinicians that they do not reflect current care practices and
needs. After extensive stakeholder collaboration with the American Medical
Association and others, simplified coding and billing requirements for E/M
visits will go into effect January 1, 2021, saving clinicians 2.3 million
hours per year in burden reduction. As a result of this change, clinicians
will be able to make better use of their time and restore the doctor-patient
relationship by spending less time on documenting visits and more time on
treating their patients.
Additionally, last year, the Trump
Administration finalized historic changes to increase payment rates for
office/outpatient E/M visits beginning in 2021. The higher payment for E/M
visits takes into account the changes in the practice of medicine,
recognizing that additional resources are required of clinicians to take care
of their Medicare patients, of which two-thirds have multiple chronic
conditions. The prevalence of certain chronic conditions in the Medicare
population is growing. For example, as of 2018, 68.9% of beneficiaries have 2
or more chronic conditions. In addition, between 2014 and 2018, the percent
of beneficiaries with 6 or more chronic conditions has grown from 14.3% to
17.7%.
In this rule, CMS is proposing to similarly
increase the value of many services that are comparable to or include
office/outpatient E/M visits, such as maternity care bundles, emergency
department visits, end-stage renal disease capitated payment bundles, physical
and occupational therapy evaluation services, and others. The proposed
adjustments, which implement recommendations from the American Medical
Association, help to ensure that CMS is appropriately recognizing the kind of
care where clinicians need to spend more face-to-face time with patients,
like primary care and complex or chronic disease management.
Bolstering the Health Care Workforce/Patients
Over Paperwork:
CMS is also taking steps to ensure that
health care professionals can practice at the top of their professional
training. During the COVID-19 public health emergency, CMS announced several
temporary changes to expand workforce capacity and reduce clinician burden so
that staffing levels remain high in response to the pandemic. As part of its
Patients over Paperwork initiative to reduce regulatory burden for providers,
CMS is proposing to make some of these temporary changes permanent following
the PHE. Such proposed changes include:
For More Information:
Trump
Administration Proposes Policies to Provide Seniors with More Choices and
Lower Costs for Surgeries
Outpatient Prospective Payment System (OPPS)
& Ambulatory Surgical Center (ASC) proposed rule advances CMS’ commitment
to increasing competition
As directed by President Trump’s Executive
Order on Protecting and Improving Medicare for Our Nation’s Seniors, CMS is
proposing several policies that would give Medicare beneficiaries more
choices in where they seek care and lower their out-of-pocket costs for
surgeries. The proposed rule takes steps that would allow hospitals and
ambulatory surgical centers to operate with better flexibility and patients
to have what they need to make informed decisions on where they receive care.
“President Trump’s mandate is to put patients
and doctors back in charge of health care,” said CMS Administrator Seema
Verma. “Following through on that mandate entails loosening the stranglehold
of government control that has accumulated over decades. Surgeries can be
expensive. Patients should have as many options as possible for lowering
their costs while getting quality care. These proposed changes, if finalized,
would do exactly that, help put patients and doctors back in the driver’s
seat and in a position to make decisions about their own care."
For patients having surgery, hospital
outpatient departments are subject to the same quality and safety standards
as inpatient settings under Medicare rules. With this in mind, for 2021, CMS
proposes to expand the number of procedures that Medicare would pay for in
the hospital outpatient setting by eliminating the “Inpatient Only list,”
which includes procedures for which Medicare will only make payment when
performed in the hospital inpatient setting. This proposed change would remove
regulatory barriers to give beneficiaries the choice to receive these
services in a lower cost setting and convenience to go home as early as the
same day after a procedure, when their clinician decides such a setting is
appropriate. CMS would phase-in this proposal over three years and would
gradually allow over 1,700 additional services to be paid when furnished in
the hospital outpatient setting. In 2021, approximately 300 musculoskeletal
services (such as certain joint replacement procedures) would be newly
payable in the hospital outpatient setting. The proposed change would be the
largest one-time reduction to the Inpatient Only list by far; from 2017
through 2020, approximately 30 services total were removed from the Inpatient
Only list.
Medicare pays for most services furnished in
ASCs at a lower rate than hospital outpatient departments. As a result, when
receiving care in an ASC rather than a hospital outpatient department,
patients can potentially lower their out-of-pocket costs for certain services.
For example, for one of the most common cataract surgeries, currently, on
average, a Medicare beneficiary pays $101 if the procedure is done in a
hospital outpatient department compared to $51 if done in a surgery center.
CMS proposes to expand the number of
procedures that Medicare would pay for when performed in an ASC, which would
give patients more choices in where they receive care and ensure CMS does not
favor one type of care setting over another. For CY 2021, we propose to add
eleven procedures that Medicare would pay for when provided in an ASC,
including total hip arthroplasty. Since 2018, CMS has added 28 procedures to
the list of surgical services that can be paid under Medicare when performed
in ASCs.
Additionally, we propose two alternatives
that would further expand our goals of increasing access to care at a lower
cost. Under the first alternative, CMS would establish a process where the
public could nominate additional services that could be performed in ASCs
based on certain quality and safety parameters. Under the other proposed
alternative, we would revise the criteria used to determine the procedures
that Medicare would pay for in an ASC, potentially adding approximately 270
procedures that are already payable when performed in the hospital outpatient
setting to the ASC list. Under this alternative, we solicit comment on
whether the ASC conditions for coverage (the baseline health and safety
requirements for Medicare-participating ASCs) should be revised given the
potential for a significant expansion in the nature of services that would be
added under this alternative proposal.
As part of the Trump Administration’s
commitment to lowering drug prices, CMS is proposing a change that would
lower beneficiaries’ out-of-pocket drug costs for certain hospital outpatient
drugs. In 2018 and 2019, CMS implemented a payment policy to help
beneficiaries save on coinsurance for drugs that were administered at
hospital outpatient departments and acquired through the 340B program, which
allows certain hospitals to buy outpatient drugs at lower costs. Due to CMS’
policy change, which was recently upheld by the United States Court of
Appeals for the D.C Circuit, Medicare beneficiaries now benefit from the
steep discounts that 340B-enrolled hospitals receive when they purchase drugs
through the 340B program.
For 2021, CMS would provide even larger
discounts for beneficiaries by proposing to further reduce the payment rate
for drugs purchased through the 340B Program based on hospital survey data on
drug acquisition costs. CMS is proposing to pay for 340B acquired drugs at
average sales price minus 28.7 percent. With this proposed change, CMS
estimates that, in 2021, Medicare beneficiaries would save an additional $85
million on out-of-pocket payments for these drugs and that OPPS payments for
340B drugs would be reduced by approximately $427 million. The savings from
this change would be reallocated on an equal percentage basis to all
hospitals paid under the OPPS. We propose that children’s hospitals, certain
cancer hospitals, and rural sole community hospitals would continue be
excepted from these drug payment reductions. In the alternative, and in light
of the court’s recent decision, we propose to continue our current policy of
paying ASP minus 22.5% for 340B drugs.
In continuing the agency’s Patients Over
Paperwork Initiative to reduce burden for health care providers, CMS is
proposing to establish, update, and simplify the methodology to calculate the
Overall Hospital Quality Star Rating (Overall Star Rating) beginning with CY
2021. The Overall Star Rating summarizes a variety of quality measures
published on the Medicare.gov Hospital Compare tool for common conditions
that hospitals treat, such as heart attacks or pneumonia. Along with publicly
reported data on Hospital Compare, the Overall Star Rating helps patients
make better informed health care decisions.
Responding to stakeholder feedback about the
current methodology used to calculate the Overall Star Rating, CMS is
proposing revisions on how to calculate the ratings and grouping hospitals in
the Readmission measure group by the hospital’s percentage of patients who
are dually enrolled in Medicare and Medicaid, which would help provide better
insight on health disparities. These and other proposed changes are intended
to reduce provider burden, improve the predictability of the star ratings,
and make it easier to compare ratings between similar hospitals.
As part of the agency’s Rethinking Rural
Health Initiative, in the FY 2020 Inpatient Prospective Payment System (IPPS)
final rule, CMS increased the wage index for certain low wage index hospitals
for at least four years, beginning in FY 2020. In the CY 2020 OPPS/ASC
Payment System final rule, CMS adopted changes to the wage index for outpatient
hospitals as were finalized in the FY 2020 IPPS final rule, including the
increase in wage index for certain low wage index hospitals. The OPPS wage
index adjusts hospital outpatient payment rates to account for local
differences in wages that hospitals face in their respective labor markets.
For 2021, under the OPPS, CMS proposes to continue to adopt the IPPS
post-reclassified wage index, including the wage index increase for certain
low wage index hospitals. The increase would address a common concern that
the current wage index system contributes to disparities between high and low
wage index hospitals. Overall, CMS estimates that payment for outpatient
services in rural hospitals across the country would increase by 3 percent,
which is 0.5 percent higher than the national average increase of 2.5
percent.
For More Information:
CMS
Updates Medicare Payment Policies for IRFs
On August 4, CMS finalized a Medicare payment
rule that further advances our efforts to strengthen the Medicare program by
better aligning payments for Inpatient Rehabilitation Facilities (IRFs). The
final rule updates Medicare payment policies and rates for facilities under
the IRF Prospective Payment System (PPS) for FY 2021. This final rule also
includes making permanent the regulatory change to eliminate the requirement
for physicians to conduct a post admission visit since much of the
information is included in the pre-admission visit. This flexibility was
offered during the Coronavirus Disease 2019 (COVID-19) Public Health
Emergency (PHE), and the rule would make this flexibility permanent beyond
the expiration of the PHE. In recognition of the interdisciplinary role that
non-physician practitioners are currently performing with patients in the
IRF, CMS is also finalizing that a non-physician practitioner may perform one
of the three required visits in lieu of the physician in the second and later
weeks of a patient’s care when consistent with the non-physician
practitioner’s state scope of practice. Additionally, for FY 2021, CMS is
updating the IRF PPS payment rates by 2.4 percent.
For More Information:
Like our newsletter? Have
suggestions? Please let us know!
|
No comments:
Post a Comment