Docs to receive slightly better Medicare pay bump than originally proposed

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Comment by Dr. Mike Nelson, MD, FCCP

Mike Nelson, MD, FCCP, comments: One need not “google” too long to find that the United States performs quite poorly in overall health care when compared with other nations, despite spending more than any of the comparators…we’re 37th this year. This information from Avalere Health portends a further drop in our ranking next year. The privilege of good health is a responsibility of the individual, but the right to affordable health care is a responsibility of the government. It is time for our legislators to stop playing partisan politics and start communicating to propose a workable and affordable solution.

Dr. Michael Nelson


Physicians will see a 0.41% increase to their payments under the Medicare physician fee schedule in 2018, a slight increase from the proposed 0.31% uptick but still short of the 0.5% increase promised under the Medicare Access and CHIP Reauthorization Act (MACRA).

Officials at the Centers for Medicare & Medicaid Services were unable to find adequate funding in so-called misvalued codes to back the larger increase, as required by law, according to the final version of the 2018 physician fee schedule, released Nov. 2 and scheduled for publication in the Federal Register on Nov. 15.

The agency finalized a number of other provisions, including the rollback of reporting requirements for the recently completed Physician Quality Reporting System to better align those reporting requirements with the Merit-based Incentive Payment System requirements of the Quality Payment Program created by MACRA. Similar changes were make to the reporting requirements under the Medicare Electronic Health Record Incentive Program.

“We finalized these changes based on stakeholder feedback and to better align with the MIPS data submission requirements for the quality performance category,” CMS said in a fact sheet detailing the provisions of the final rule.

CMS also is delaying the start of the appropriate use criteria (AUC) for imaging services, a program that would deny payments for imaging services unless the ordering physician consulted appropriate use criteria. The program will begin with an educational and operational testing year in 2020. Physicians will be required to start using AUCs and reporting this information on claims, but CMS will pay claims regardless of whether they correctly contain the required AUC data.

“This allows both clinicians and the agency to prepare for this new program,” the agency said in the fact sheet, CMS had proposed 2019 be the educational and operational testing year.

In response to comments submitted to the agency, CMS is changing its policy on billing codes for biosimilars administered under Medicare Part B.

“Effective January 1, 2018, newly approved biosimilar products with a common reference product will no longer be grouped in the same billing code,” the agency said in the fact sheet. “By encouraging innovation and greater manufacturer participation in the marketplace, we believe that this policy change will result in the licensing of more biosimilar products, thus creating a stable and robust market, driving market competition, and decreasing uncertainty about access and payment.”

The final rule implements proposed expansion of the Medicare Diabetes Prevention Program from a demonstration project to a nationwide program in 2018, however the implementation will be delayed for three months until April 1, 2018, rather than at the beginning of the year. The program provides payments to physicians based on performance goals being met by patients, including meeting certain numbers of service and maintenance sessions with the program and achieving specific weight loss goals.

CMS also finalized a number of new telemedicine payment codes.

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