CMS funnels $140 million more into Medicare primary-care payments

Virgil Dickson | November 2, 2016

The CMS Wednesday announced changes to how Medicare pays for primary care that could result in an estimated $140 million in additional funding in 2017 to providers.

The agency says several coding and payment changes could eventually lead to as much as $4 billion or more being funneled into care coordination and patient-centered care. Historically, care management related activities have been “bundled” into the evaluation and management visit codes used by all specialties.

That meant payment was distributed equally among all specialties that report the visit codes, instead of being targeted toward practitioners who manage care and/or primarily provide cognitive services.

“With today’s final primary care payment policies, Medicare continues to move toward a health care system that encourages teams of clinicians to work together and collaborate in order to provide more personalized care for their patients,” said CMS Acting Administrator Andy Slavitt in a blog post announcing that and other changes to the 2017 Physician Fee Schedule.

The 1401-page rule includes other provisions that will result in $200 million in additional Medicare reimbursement to physicians over what they received in 2016, down from the $500 million the CMS initially estimated in the proposed rule.

The agency also finalizes a proposal to publicize data that inform how Medicare Advantage costs are set. The information—which would be at least five years old and exclude any proprietary information—all efforts to address payers’ concerns about stifling competition. The data, they argue would show how healthcare is used in different regions and by different populations.

Providers could use this information during future contract negotiations with MA plans, said David Schwartz, head of global policy at Cigna Federal Affairs.

In a comment letter about the draft rule, Schwartz said that would lead to “higher costs and reduced access to high quality MA plans and services for current and future beneficiaries.”

The CMS disagreed with that and similar comments from Humana. It reiterated that increased transparency was a goal for the agency and that the data will support public research that can potentially strengthen the program.

The agency did not finalize a $44 bonus for treating patients with mobility-related disabilities that doctors felt could lead to more Medicare fraud.

The American Medical Association had written to the CMS during the comment period, cautioning that doctors may not understand what justifies an eligible mobility problem and would be confused about the documentation needed to justify the bonus.

The CMS agreed that problems with the policy could arise. “We acknowledge that implementation of new or revised payments can result in unanticipated, and potentially undesirable, consequences,” the agency says in the rulemaking.

The final 2017 physician fee schedule expands a program aimed at helping people avoid diabetes. The expanded program would start in 2018 and the CMS is seeking comment whether to launch the effort nationally or in additional select markets.

The program first began in 2013 and enrolled beneficiaries in eight states: Arizona, Delaware, Florida, Indiana, Minnesota, New York, Ohio, and Texas. It is the first effort from the CMS Innovation Center, which was created by the Affordable Care Act, that proved successful enough to be rolled out as a full Medicare program. The ACA allows the CMS to expand programs that prove effective without the approval of Congress.

Beneficiaries receive coaching to prevent the onset of diabetes. People with higher than normal blood sugar levels were enrolled and attended weekly training sessions on nutrition, exercise and overall healthy living.

Those who attended at least four sessions reduced their body weight by about 5%. Medicare estimated a savings of $2,650 per participant, which is beyond the cost of the program.

Source:  Modern Healthcare