CMS proposed changes to the Physician Fee Schedule and MACRA

CMS proposed changes to the Physician Fee Schedule and MACRA August 14, 2018

Independent physicians often face daunting challenges when it comes to Medicare and Medicaid paperwork. Providers want to spend more time with patients and less time filling out required forms and completing reports. The Centers for Medicare & Medicaid Services (CMS) is beginning to recognize the importance of this situation and, in fact, has announced proposed changes that would ease the administrative burden on independent physicians.

CMS states that its new proposed rules “would fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information, instead of information that is only for billing purposes.”

Provisions in the proposed CY 2019 Physician Fee Schedule, developed in response to stakeholder concerns, “would help to free EHRs to be powerful tools that would actually support efficient care while giving physicians more time to spend with their patients, especially those with complex needs, rather than on paperwork. Specifically, this proposal would:

• Simplify, streamline and offer flexibility in documentation requirements for Evaluation and Management office visits — which make up about 20 percent of allowed charges under the Physician Fee Schedule and consume much of clinicians’ time;
• Reduce unnecessary physician supervision of radiologist assistants for diagnostic tests; and
• Remove burdensome and overly complex functional status reporting requirements for outpatient therapy.”

CMS Administrator Seema Verma has reassured physicians that the organization is listening to their concerns. She says that the proposed changes to the Physician Fee Schedule and MACRA address their challenges by “streamlining documentation requirements to focus on patient care and by modernizing payment policies so seniors and others covered by Medicare can take advantage of the latest technologies to get the quality care they need.”

In addition, the proposed Physician Fee Schedule changes would reinforce the concepts in the Patients Over Paperwork initiative, which is “focused on reducing administrative burden while improving care coordination, health outcomes, and patients’ ability to make decisions about their own care.”

Some physicians and healthcare groups have concerns about some of the proposed MACRA changes. For example, many argue that the cut to physician reimbursement for Part B drugs could actually raise prices for prescription medications. Another proposed MACRA change is the payment reduction for the “critical evaluation and management of more complex cancer cases from $172 to $135 (a 22% payment cut) for a new patient and from $148 to $93 (a 37% payment cut) for an existing patient,” which greatly concerns groups such as the American Society of Clinical Oncology.

Additional MACRA changes proposed by CMS include continuing “its policy requiring physicians to document a full 365 days of quality measures rather than 90 consecutive days” and a requirement to upgrade to 2015 Edition Certified Electronic Health Record Technology beginning in 2019.

Public comments on the proposed rules are due by September 10, 2018.

CMS has made available the following documents for physicians to review:

Fact sheet on the CY 2019 Physician Fee Schedule proposed rule

CY 2019 Physician Fee Schedule proposed rule

Fact sheet on the CY 2019 Quality Payment Program proposed rule

CY 2019 Quality Payment Program proposed rule

Fact sheet on the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration