Summer proposals for independent practice policy updates

In July, the Centers for Medicare and Medicaid Services (CMS) announced their Calendar Year (CY) 2023 Medicare Physician Fee Schedule Proposed Rule. Comments on the proposed changes will be accepted through September 6, 2022. The final rule will then be released around November 1 and the changes will take effect on January 1, 2023. There are a number of policy update proposals that will affect your independent practice.

In their fact sheet, CMS emphasizes that they are seeking input as they “develop a more consistent, predictable approach to incorporating new data in setting PFS rates.” The organization states that it hopes to “implement changes that will promote transparency and predictability in payment amounts.”

In particular, the organization is proposing to “rebase and revise” the Medicare Economic Index (MEI) cost share weights for CY 2023. The MEI measures the input price pressures of providing physician services. CMS says they are proposing a new methodology for estimating base year expenses that relies on publicly available data from the US Census Bureau NAICS 6211 Offices of Physicians.

Using the new MEI cost weights to set Physician Fee Schedule (PFS) rates would not change overall spending on PFS services but would likely result in significant changes to payments among PFS services. In consideration of ongoing efforts to update the PFS payment rates with more predictability and transparency, and in the interest in ensuring payment stability, CMS is proposing not to use the proposed updated MEI cost share weights to set PFS payment rates for CY 2023. However, they are soliciting comments on the potential use of the proposed updated MEI cost share weights to calibrate payment rates and update the GPCI under the PFS in the future.

Elation Health is here to support your independent practice as you navigate the changes. Our electronic health record (EHR) solution handles your clinical documentation, practice operations, and reimbursement from a single, intuitive platform so you can provide great care while sustaining a successful practice.

Other significant aspects of the proposed policy updates for independent practices include:

  •  Adopting CPT changes in coding and documenting other evaluation and management (E/M) visits, including hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment 
  • Making several temporarily available telehealth services during the public health emergency (PHE) covered through CY 2023 on a Category 3 basis; extending the time these services are temporarily included on the telehealth services list following the end of the PHE.
  • New HCPCS codes and valuation for chronic pain management and treatment services (CPM) for CY 2023. CMS believes the proposed CPM HCPCS codes would, if finalized, facilitate payment for medically necessary services, prompt more practitioners to welcome Medicare beneficiaries with chronic pain into their practices, and encourage practitioners already treating Medicare beneficiaries who have pain to spend the time to help them manage their condition within a trusting, supportive, and ongoing care partnership.
  • Expanding access to Accountable Care Organizations (ACOs) by incorporating advance shared savings payments to certain ACOs; allowing smaller ACOs more time to transition to downside risk; and creating a health equity adjustment to reward excellent care delivered to underserved populations.

The organization is seeking input and comments regarding the changes proposed for ACOs. They are proposing changes to the quality reporting and the quality performance requirements that are responsive to interested parties’ feedback and designed to support transition of ACOs to all payer quality measure reporting. These proposals include reinstitution of a sliding scale reflecting an ACO’s quality performance for use in determining shared savings for ACOs, regardless of how they report quality data, and to revise the approach for determining shared losses for ENHANCED track ACOs.

CMS is also proposing:

  • To extend the incentive for reporting eCQMs/MIPS CQMs through performance year 2024 to align with the sunsetting of the CMS Web Interface reporting option.
  • To implement a health equity adjustment to an ACO’s quality performance category score to recognize high quality performance by ACOs with high underserved populations.
  • Benchmarking policies to establish quality measure benchmarks and minimum attainment level for the CMS Web Interface measures for performance years 2022, 2023 and 2024 under the Shared Savings Program.

Comments can be submitted before September 6, 2022, at: https://www.regulations.gov/.