CMS announces physician payment proposals for 2018

The Centers for Medicare & Medicaid Services (CMS) is seeking comments on a proposed rule for physician payments in 2018. The Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2018 contains a number of changes and requests for input. Some of the changes, as described in the CMS Fact Sheet, include:

Overall Payment Update and Misvalued Code Target:  The overall update to payments under the PFS based on the proposed CY 2018 rates would be +0.31 percent.

Care Management Services:  CMS is continuing efforts to improve payment within traditional fee-for-service Medicare for chronic care management and similar care management services to accommodate the changing needs of the Medicare patient population. CMS is proposing to adopt Current Procedural Terminology (CPT) codes for CY 2018 for reporting several care management services currently reported using Medicare G-codes.

Physician Quality Reporting System (PQRS):  Under the PQRS, individual eligible professionals and group practices who did not satisfactorily report data on quality measures in 2016 are subject to a downward payment adjustment of 2.0 percent in 2018 to their PFS services. PQRS is being replaced by the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program (QPP). The first MIPS performance period is January through December 2017.

2018 Value Modifier: In order to better align incentives and provide a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program, CMS is proposing the following changes to previously-finalized policies for the 2018 Value Modifier:

  • Reducing the automatic downward payment adjustment for not meeting minimum quality reporting requirements from negative two percent to negative one percent (-1.0 percent) for physician and non-physician solo practitioners and groups of two to nine clinicians;
  • Holding harmless all physician groups and solo practitioners who met minimum quality reporting requirements from downward payment adjustments for performance under quality-tiering for the last year of the program; and
  • Aligning the maximum upward adjustment amount to 2 times the adjustment factor for all physician groups and solo practitioners.

Elation Health will continue to monitor and report on CMS updates regarding physician payments. We remain committed to bridging the enormous chasm between the world of policy and payers, and the world of the front-line physician.

The deadline for submitting comments on the proposed rule is 5 p.m. on September 11, 2017.