CMS proposes improved E/M payments, additional price transparency for hospitals


The Centers for Medicare & Medicaid Services is proposing improvements to physician payments and an overhaul of the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program.

In a separate proposal also released on July 29, the agency proposed that hospitals be required to make more pricing information publicly available.

The Medicare Outpatient Prospective Payment System proposed rule for the 2020 annual update would require hospitals to not only publish their gross charges, but also the negotiated price by specific payer for select services that can be scheduled by a patient in advance.

The proposal states “that hospitals make public their standard changes (both gross charges and payer-specific negotiated charges) for all items and services online in a machine-readable format” which would allow them to be included in price transparency tools and electronic health records.

“Hospitals would be required to post all their payer-specific negotiated rates, which are the prices actually paid by insurers,” CMS Administrator Seema Verma said during a July 29 conference call with reporters.

As “deductibles rise and with 29 million uninsured, patients have the right to know the price of health care services so they can shop around for the best deal,” she said.

The rule also comes with new enforcement tools so that CMS can ensure hospitals are complying with the rule, should it be finalized.

Hospitals would need to start publishing list prices and payer-specific negotiated prices beginning Jan. 1, 2020.

In a separate proposal to update the physician fee schedule for 2020, CMS is looking to increase Medicare payments in 2021 for evaluation and management (E/M) visits based on recommendations from the American Medical Association’s Relative Value Scale Update Committee (AMA-RUC). In fact, CMS is walking back the recently proposed plans to collapse E/M levels. The CPT code changes recommended by the AMA allow clinicians to choose the E/M visit level based on either medical decision making or time.

With this update, the agency will be “rewarding the time that doctors spend with patients,” Administrator Verma said.

In a joint statement, the American Gastroenterological Association, the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy welcomed the news as the GI societies opposed CMS’ proposal when it was announced last year. “We worked with the AMA and a coalition of specialty societies in an effort to get CMS to rethink collapsing payment for E/M code levels, and subsequently decided to support the AMA’s proposed E/M changes as they moved through the CPT and RUC processes. In the rule, CMS abandons its proposal and adopts the AMA CPT changes and RUC valuation.”

The fact sheet on the proposed update to the physician fee schedule also highlights improvements to case management payments, allowing physicians to get paid for case management services if the patient only has one high-risk condition.

“For 2021, we are overhauling the Merit-based Incentive Payment System, or MIPS, to reduce reporting burden, making sure the measures are relevant to clinicians as they move toward value-based care,” she said, noting that clinicians would be reporting on fewer, more meaningful measures that are aligned to their specialty or practice area, “making it easier to participate in MIPS.” CMS proposed removal of 2 colonoscopy measures from MIPS performance year 2022 because they do not align with MIPS scoring methodology.

The American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy are currently reviewing the details of the proposed rules and will be providing joint comments. CMS will accept comments until Sept. 27, 2019.

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