Tucked Centers for Medicare and Medicaid Services (CMS) recently published the final Medicare Physician Fee Schedule for 2018. In a statement, the California Medical Association (CMA) announced that it is pleased, overall, to see many positive changes in the final rule, “including the reduction of penalties under the flawed Value Modifier (VM) program, the expansion of coverage for telehealth services, the delay in implementation of the Appropriate Use Criteria (AUC) for imaging, and the reduction of documentation requirements for Medicare Shared Savings Program accountable care organizations.”

CMA also announced that it supports the continued expansion of the Medicare Diabetes Prevention Program and the transition to the new geographic payment regions in California.

In the proposed rule released this summer, CMS announced its “Patients before Paperwork” initiative and invited physicians to submit ideas for regulatory, policy, practice and procedural changes to improve the health care system to reduce unnecessary burdens for clinicians, patients and their families. CMA submitted its “Top 10 List for Regulatory Relief” to CMS and strongly urged CMS to provide immediate relief because it is causing a significant and disturbing trend in physician burnout.

HIGHLIGHTS OF THE 2018 FINAL MEDICARE PHYSICIAN FEE SCHEDULE:

Quality Reporting

In response to advocacy from CMA and AMA, CMS revised the 2016 Physician Quality Reporting System (PQRS) and Meaningful Use reporting requirements to only require physicians to report six measures with no domain or cross-cutting measures. This change aligns the 2016 requirements with the new MACRA requirements. CMS estimates this change alone will reduce physician penalties by $22 million. Also, the CAHPS survey for group practices of 100+ physicians will be optional in for the Group Practice Reporting Option.

Value Modifier

CMS made significant changes to the problematic value modifier program, which rewards or penalizes physicians on their Medicare expenditures compared to their peers. (CMA has heavily criticized this program.) Physicians who met the 2016 PQRS reporting requirements will not receive a VM penalty in 2018. Penalties were cut in half for physician groups and small practices who did not meet the PQRS requirements. The proposal to publicly report 2016 VM physician expenditure data on its Physician Compare website was eliminated.

Diabetes Prevention Program

CMA and AMA strongly support the Medicare Diabetes Prevention Program. CMS is allowing a maximum payment per beneficiary of $670 over three years for core and maintenance services. CMS is also shifting a higher percent of the payment resources to the first six months of the DPP services period. CMS delayed the start date of the program until April 1, 2018, and finalized new HCPCS G-codes for reporting DPP services. Unfortunately, CMS declined to approve payment for virtual DPP services.

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