New Chronic Care Management Payment Included in Proposed 2015 Medicare Fee Schedule

CMS Proposal Also Calls for SGR-mandated Cut, Changes to Open Payments Program

July 09, 2014 03:26 pm News Staff

The good news: CMS' recently released proposed Medicare physician fee schedule for 2015( includes a new code for chronic care management (CCM). The not-so-good news: The proposal also includes projected pay cuts required by the sustainable growth rate (SGR) formula used to determine physician payment.

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In a statement issued July 3, AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., expressed the Academy's longstanding frustration that existing legislation continues to require that CMS publish an annual physician fee schedule that slashes Medicare payments to physicians -- this time, by 20.9 percent.

"If Congress had any question about the urgency of repealing the sustainable growth rate formula that determines Medicare physician payments, (it) need look no further than the proposed 2015 Medicare physician fee schedule," said Blackwelder. "For the 12th consecutive year, the annual proposed schedule reflects an SGR-mandated payment cut that ultimately threatens the health security of elderly and disabled Medicare beneficiaries and the military families who depend on TRICARE for their health coverage."

Blackwelder called on Congress to pass the SGR Repeal and Medicare Provider Payment Modernization Act and, thus, end the recurring cycle of last-minute, temporary patches Congress passes each year to avert the scheduled cuts.

Story Highlights
  • The proposed 2015 Medicare physician fee schedule CMS released last week includes a 20.9 percent cut in physician payments called for by the sustainable growth rate (SGR) formula.
  • The fee schedule proposal also includes a per patient, per month payment for chronic care management (CCM) services for patients with two or more chronic conditions.
  • The AAFP said in a statement that it welcomes the CCM payment but calls on Congress to repeal the SGR to finally eliminate the annual cycle of threatened cuts in physician payment.

"Temporary fixes do nothing to solve one of the most chronic and fundamental challenges in the Medicare program, nor do they establish a stable environment in which physicians can plan for their practice's stability," Blackwelder said.

On the positive side of the ledger, starting in 2015, CMS proposes that Medicare make a separate payment to physicians for CCM services they provide to patients. Specifically, the agency proposes a per patient payment of $41.92 that can be billed no more than once per month for patients with two or more chronic conditions. The agency also proposes allowing greater flexibility in the supervision of clinical staff who provide CCM services.

Elderly and disabled patients have complex, chronic health conditions that require whole-person medical attention that can only be obtained from primary care physicians, according to Blackwelder. The new code "recognizes the value of additional cognitive and administrative work that occurs outside the exam room but that is essential to comprehensive, coordinated care," he stated.

"The AAFP welcomes the new code, but we also look to a day when policies designed to strengthen primary medical care are not undermined by drastic cuts to the underlying foundation on which all payment is based," said Blackwelder.

Another change CMS proposes in the fee schedule is the addition of several services that can be provided to Medicare patients as part of the program's telehealth benefit, including annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services.

In addition, CMS unexpectedly included in the fee schedule a number of proposed changes to the agency's Open Payments transparency program, one of which has already drawn considerable attention. Specifically, the agency proposes eliminating the CME reporting exclusion from the program, which requires drug and device companies to disclose payments and other transfers of value to physicians. The AAFP will address that change when it prepares comments on the proposed schedule.

The Academy is preparing a summary of the 2015 proposed fee schedule for members and will submit its comments on the schedule to CMS before the Sept. 2 deadline.

Additional Resource
CMS Fact Sheet: Proposed policy and payment changes to the Medicare Physician Fee Schedule for Calendar Year 2015(