Getting paid has never been so complicated for primary care doctors.
An uncertain policy landscape, ever-changing regulatory requirements, and evolving practice and reimbursement models mean that physicians must constantly stay on top of how they are being paid to ensure they receive what they are owed.
In recent weeks, CMS officials have released a bevy of proposals that will affect how Medicare will pay physicians in 2019. The regulations cover value-based payments, level of care changes that will impact reimbursement rates, and continued efforts to equalize payments between office- and hospital-based doctors.
Physicians should remember these proposals could change after federal officials consider comments from the public and stakeholders. Final determination on all these issues is expected in late 2018.
Here are the proposed changes physicians should monitor:
- streamlining the Quality Payment Program (QPP), Medicare’s value-based payment initiative;
- restructuring the evaluation and management (E/M) level-of-care coding system as part of the 2019 Medicare Physician Fee Schedule (PFS), which sets out reimbursement rates for fee-for-service payments;
- making brief patient check-ins via phone, text message, or video a reimbursable service; and
- taking additional steps towards site-neutral payments for outpatient visits.
No. 1: The QPP and value-based care are here to stay
While doctors will find some beneficial changes, physician groups say the QPP needs to become more physician-friendly.
CMS is proposing changes to eligibility requirements, coding, some documentation requirements, and how certain categories are weighted, among others, with goals of streamlining billing and expanding access to care.
“Internists are excited to see that CMS is proposing long overdue improvements in the physician fee schedule and the QPP that will help physicians provide the highest quality care to patients,” says Ana Maria Lopez, MD, MPH, president of the American College of Physicians, in a statement.
The proposed changes to the 2019 rule governing the QPP include:
- Expanded exemptions. A third low-volume threshold has been proposed: providing 200 or fewer covered professional services under the PFS. Any doctor who meets this requirement, or one of the previous two—$90,000 or less in Part B charges or caring for 200 or fewer Medicare beneficiaries—would be exempt from program participation.
- Ability to opt in to the Merit-based Incentive Payment System (MIPS). Any clinician or group that does not meet the low-volume exemptions could choose to opt in to MIPS. However, the decision to do so is irrevocable.
- Changes to general performance category weights used to calculate MIPS scores. Quality would decrease from 50 percent of the total to 45 percent, while cost increases from 10 percent to 15 percent. Promoting interoperability (formerly called advancing care information) and improvement activities remain at 25 percent and 15 percent of the total score, respectively.
- Removal of 34 quality measures deemed by CMS to be of low value.
- Requiring the use of 2015 Edition Certified EHR Technology in 2019. This was originally proposed for 2018, but CMS backtracked to allow 2014 Edition certification because EHR vendors were not ready.