• Medicare releases proposed rule on 2020 physician fee schedule

    The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule on the 2020 Medicare physician fee schedule and Quality Payment Program (QPP) performance period. In addition to proposals on the fee schedule and QPP, the rule includes proposals on Medicare payments to support opioid treatment programs (OTPs).

    On the fee schedule side, CMS proposes to increase the conversion factor (i.e., the amount paid per relative value unit under the fee schedule) by a nickel to $36.09. CMS also proposes to increase payment for transitional care management while creating a set of Medicare-developed “G codes” for certain chronic care management services. CMS also proposes creating new codes for “principal care management” services, which would pay physicians for providing care management for patients with a single serious and high-risk condition.

    For the Merit-based Incentive Payment System (MIPS) portion of the QPP, CMS proposes to:

    •    Increase the performance threshold (the minimum number of points a physician must attain to avoid a negative payment adjustment) from 30 points in 2019 to 45 points in 2020.
    •    Increase the threshold for exceptional performance to 80 points in 2020.
    •    Reduce the Quality performance category weight to 40 percent in 2020.
    •    Increase the Cost performance category weight to 20 percent in 2020.

    CMS also proposes a new way for physicians to participate in the MIPS. The MIPS Value Pathways (MVPs), beginning in the 2021 performance period, would require physicians to report a smaller set of measures than the regular MIPS that are specialty-specific, outcome-based, and more closely aligned to Alternative Payment Models. CMS said it anticipates MVPs participants would receive data and feedback faster and in greater amounts.

    Lastly, CMS proposes that Medicare begin paying treatment programs that deliver Medication-Assisted Treatment (MAT) to Medicare recipients suffering from Opioid Use Disorder (OUD). OTPs must be accredited by the Substance Abuse and Mental Health Services Administration. CMS proposes to pay physicians monthly for management and counseling involving MAT for patients with OUD. This bundled payment would cover care activities such as overall patient management, care coordination, individual and group psychotherapy, and substance-use counseling, increasing patient access to evidence-based services that support OUD recovery.

    Comments on the proposed rule are due to CMS by Sept. 27. In addition to the proposed rule, CMS issued fact sheets on both the fee schedule and QPP provisions.

    The AAFP has issued its own summary of the physician fee schedule here: https://www.aafp.org/news/government-medicine/20190802mpfssummary.html.

    – Kent Moore, Senior Strategist for Physician Payment at the American Academy of Family Physicians

    Posted on Jul 30, 2019 by Kent Moore

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