Key Provisions of Proposed Medicare Physician Fee Schedule for 2015
CMS published its proposed rule on Medicare’s payment schedule and policies on July 11. Comments on the proposal are due on September 2. Key changes in the proposal include:
• Doubling the value-based modifier (VBM) penalties to 4% and subjecting all physicians to 2017 VBM adjustments based on performance in 2015;
• Extending the VBM to ACOs and other alternate payment models;
• Eliminating global surgical services by 2018;
• Reducing the opportunity for comment, review time, and implementation for changes in local coverage determinations (LCDs) for clinical laboratory tests;
• Expanding reimbursement for telehealth services under certain circumstances to include psychotherapy services, prolonged services, and annual wellness visits in 2016;
• Reimbursing for chronic care management services on a per patient per month basis when certain conditions are met; among other things, beneficiaries must have two or more serious chronic conditions;
• Expanding public reporting of group-level measures in Physician Compare in 2016 and, if feasible, expanding measures for individuals making all 2015 PQRS individual measure collected via registries, EHR, or claims available on Physician compare in late 2016;
• Increasing the requirements for successful PQRS reporting and imposing a 2% penalty in 2017 for those eligible professionals who do not report satisfactorily in 2015. Read more details in AMA’s Summary of Key Provisions.
Note that CMS supports legislation to permanently address the SGR, but rates are only protected from payment cuts through March 2015 at which time payments will be reduced by over 20% if Congress does not act.