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Regs & Eggs - November 7, 2019

eggs

CMS Releases Major Final Reg: 2020 Medicare Physician Fee Schedule

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Last Friday, the Centers for Medicare & Medicaid Services (CMS), released its final 2020 Medicare Physician Fee Schedule (PFS) reg, which includes changes that will affect Medicare physician payments and the Merit-based Incentive Payment System (MIPS) starting on January 1, 2020.

ACEP, along with other external stakeholders, weighed in when CMS issued the proposed reg in July. There are several policies in the final reg that will have a major impact on emergency medicine, specifically a few that specifically affect payment for emergency department (ED) evaluation and management (E/M) services—the most commonly billed services for emergency physicians.

In recognition of the critical value of these services, CMS finalized an increase in these payments in line with the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) recommendation for 2020. However, CMS also finalized a proposal to increase the office and outpatient E/M services in 2021. As you may know, Medicare requires that overall changes to Medicare physician payments be budget neutral, so this adjustment to the office and outpatient E/M codes is likely to reduce reimbursement to emergency medicine. So, while emergency physician services will be more appropriately valued in 2020, payments for these same services may be significantly reduced the following year. Fortunately, CMS is leaving the door open to re-evaluating this policy in next year’s reg, and ACEP will be working hard to ensure that these payment reductions do not become a reality in 2021.

While payment for E/M services is the most critical issue in the final reg, there are other policies you should be aware of.

  • Reducing documentation burden: CMS finalized a proposal to eliminate duplicative documentation requirements in medical record—a potential time and money savings.
    • ACEP Reaction: ACEP supports this final policy as we believe that this broad flexibility will significantly reduce burden for teaching physicians.
  • Adding a new benefit for Opioid Use Disorder Coverage: CMS finalized a new Medicare benefit for treatment services delivered by an opioid treatment program which allows physicians and other clinicians to dispense certain drugs and provide counseling, therapy, and toxicology testing. CMS is establishing bundled payments for the overall treatment of opioid use disorder.
    • ACEP Reaction: ACEP is extremely supportive of these policies. In the proposed rule, CMS had sought comment on possibly reimbursing medication-assisted treatment (MAT) in the ED. We continue to be optimistic about a future policy that would pay separately for MAT initiated in the ED.
  • Developing MIPS Value Pathways (MVPs), a new framework for MIPS: CMS finalized the concept of MVPs, which the agency believes will reduce the burden of reporting for physicians and link elements of the program into one cohesive function. CMS will begin transitioning clinicians into MVPs in 2021.
    • ACEP Reaction: ACEP had submitted robust comments on the proposed concept of MVPs and had strongly recommended that CMS slow down implementation, to provide CMS time to flesh out the details, receive additional public input, and propose and develop the first cohort of MVPs. However, CMS decided to move forward with the 2021 start date. CMS recognizes stakeholder concerns about this timeline and says it’s committed to a smooth transition to the MVPs that does not immediately eliminate the current MIPS program.
  • Changing the definition of “hospital-based” for groups to be eligible for hardship exemptions for the Promoting Interoperability category of MIPS: Currently, clinicians who are considered “hospital-based” as individuals are exempt from the Promoting Interoperability (EHR) category of MIPS. However, if individual clinicians decide to report as part of a group, they lose the exemption status if even a single group member does not meet the definition of “hospital-based.” ACEP has repeatedly argued that this is unfair as it penalizes hospital-based clinicians who work in multi-specialty groups. CMS is modifying this policy by exempting groups from the Promoting Interoperability category of MIPS as long as 75 percent of individuals in the group meet the definition of hospital-based.
    • ACEP Reaction: This is a major win for ACEP. We are extremely appreciative that CMS has agreed to modify this policy and not penalize some emergency physicians who participate in multi-specialty groups.
  • Increasing the performance thresholds under the MIPS program: CMS is increasing the threshold—which a clinician must exceed to be eligible for a payment bonus—from 30 points in 2019 to 45 points in 2020 and 60 points in 2021. CMS also has an exceptional bonus for high performers and is increasing the threshold for receiving this additional bonus from 75 points in 2019 to 85 points in 2020 and 2021.
    • ACEP Reaction: ACEP is disappointed that CMS is finalized such a high threshold for exceptional performance as we have previously objected to increasing it above 80 points.
  • Increasing data completeness requirements for quality performance: CMS increased the percentage of data required to be submitted from 60 percent in 2019 to 70 percent in 2020.
    • ACEP Reaction: ACEP does not support the increase in the data completeness threshold to 70 percent, as we believe 60 percent is appropriate.
  • Adding new Qualified Clinical Data Registries (QCDR) requirements: CMS finalized numerous new requirements for both 2020 and 2021 for QCDRs, which will have a direct impact on ACEP’s own QCDR, the Clinical Emergency Data Registry.
    • ACEP Reaction: ACEP is concerned that some of the policies may make it more challenging and burdensome for QCDRs like CEDR to participate in MIPS successfully.

This reg is dense and complicated, but it’s important to understand the key policies and how they may affect you and the patients you serve. You can find ACEP’s full summary of the reg here. If you have any questions about the reg, please feel free to email me.

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!

jeff headshot.PNGIf you have any questions or want to weigh in on other regulatory items, feel free to email me: jdavis@acep.org.

Jeffrey Davis is the Director of Regulatory Affairs at the American College of Emergency Physicians (ACEP). He manages ACEP’s formal response to federal policies and works with federal agencies and other stakeholders to help advance ACEP’s federal affairs agenda. Prior to that, Jeffrey worked in the Budget Office at the U.S. Department of Health and Human Services for nearly eight years. Jeffrey came to the Government as a Presidential Management Fellow, and in his position in the Budget Office, he advised top level officials on major budgetary and policy considerations within Medicare and prepared detailed analyses of Medicare regulations and legislation. Jeffrey has a Masters of Science in Health Policy and Management from the Harvard T.H. Chan School of Public Health and a Bachelors of Arts degree from Duke University.

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