Even After Positive Steps, a Medicare Pay Cut Still Looms


On October 31st, the Center for Medicare and Medicaid Services (CMS) issued a final rule that includes Medicare’s 2015 physician fee schedule, and revises its policies on telehealth and paying different rates for the same service in different locations. However, these revisions could lead to a 21.2% cut in physician payments due to Medicare’s sustainable growth-rate payment formula beginning April 1st.

Anders Gilberg, Medical Group Management Association’s senior vice president for government affairs, says they are still analyzing the new ruling, but one of the benefits is the implementation of monthly care-management fee of $42.50 for patients with 2 or more chronic conditions. The original proposed requirement was that only physicians using 2014 edition- certified software would be able to collect the fee, but now doctors using 2011 edition electronic health records can also collect the fee.

In addition, the rule set a fee of $56.92 for remote monitoring of patients with chronic conditions. The CMS also issued new payments for annual wellness visits and psychotherapy sessions delivered via telehealth. It also confirmed that it will maintain current payments for gastrointestinal procedures and hip- and –knee replacements.

The 481 practices involved in CMS Comprehensive Primary Care Initiative are not eligible to collect the fee because they receive a per-member, per-month fee as part of the government’s mega medical home demonstration.

Physicians are worried about the administrative problems that will come as a result of documenting non face-to-face management services could outweigh the benefits of the new payment. Some believe that the care-coordination fee payment should be higher because of the level of work involved. The CMS responded to concerns by saying that it will monitor the new ruling to assess whether the service targets the right population, and if they payment is appropriate for the services that are being provided.

Furthermore, Gilberg is worried about the CMS’s plan to phase out bundled 10-day and 90-day global payments for post-surgical services. The CMS wants to instead have separate billing for different services like treating complications, managing and removing sutures, wires, tubes, etc. The agency claims there are challenges in establishing appropriate values for global payments for post- surgical care.

Medicare Payment Advisory Commission wants to make rates the same whether the patient is seen in a hospital or a physician’s office, and consequently it is advocating site-neutral reimbursement. As a result, the CMS is studying this issue by creating new codes to designate whether services were provided outside or inside a hospital.

Gilberg believes that the issue of site neutrality has been popular because it may be a method for paying for the repeal of the sustainable growth-rate formula. The Medical Group Management Association advocates putting a bipartisan, bicameral bill to replace the sustainable growth rate. Gilberg does not believe it is possible for a new Congress to implement a new legislation before cuts take place on April 1st.

Summary by MedicalGroups.com

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