The Centers for Medicare & Medicaid Services (CMS) released the 2023 Medicare Physician Fee Schedule and Quality Payment Program (QPP) proposed rule on July 7. This proposed rule included updates to payment rates for physicians and other health care professionals, extended telehealth waivers and flexibilities, adopted evaluation and management (E/M) coding changes, made significant changes to the Shared Savings Program, revised policies for the 2023 performance year of the QPP, and included many other provisions. The AAMC will provide comments on the proposed rule, which are due to the CMS by Sept. 7.
Notably, the 2023 conversion factor would be reduced by about 4.5% from $34.61 in calendar year (CY) 2022 to $33.08 for CY 2023. This is due in part to the expiration of the 3% payment increase provided in CY 2022 by Congress and changes to E/M Codes. The rule also delayed implementation of the definition of “substantive portion” of a split (shared) service as being more than half of the total time for one year until Jan. 1, 2024. The definition of “substantive portion” is important since the practitioner who provides the substantive portion of the visit would bill for the visit. The rule adopted significant changes to several E/M code families (hospital, emergency medicine, nursing facility, and home visits) that were recommend by the American Medical Association’s Current Procedural Terminology (CPT) Editorial Panel and Relative Value Scale (RVS) Update Committees.
The rule would also implement policies in the Consolidated Appropriations Act of 2022 (P.L. 117-103) which extend certain flexibilities in place during the public health emergency for 151 days after its end, including permitting telehealth services to be furnished in any geographic area including a patient’s home; permitting audio-only technology; and allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services.
In light of the increased needs for mental health services, the rule proposed to create a new general behavioral health integration service personally performed by clinical psychologists or clinical social workers to account for monthly care integration when these practitioners are serving as the focal point of care integration. It also proposed to allow licensed professional counselors, marriage and family therapists, and other behavioral health practitioners to provide services under general (rather than direct) supervision.
The CMS proposed numerous changes to the Medicare Shared Savings Program to incentivize participation. These include allowing advanced payments to certain Accountable Care Organizations (ACOs) that are low revenue and serve underserved populations, giving more time to transition to downside risk for certain ACOs, and making adjustments to benchmarks to reduce the effect of ACO performance on ACO historical benchmarks and increase options for ACOs caring for high-risk populations. It also updated the program’s quality measurement policies, including a new health equity adjustment for ACOs serving higher proportions of underserved or dually-eligible beneficiaries.
For the QPP, the CMS proposed to add five new Merit-based Incentive Payment System Value Pathways (MIPS MVPs) and revise the seven established MVPs starting performance year 2023. The CMS also proposed refinements to the MIPS subgroup reporting process. Subgroup reporting would be voluntary for CY 2023, 2024, and 2025 performance periods. Multispecialty groups would be required to participate as subgroups when reporting MVPs in the 2026 performance period. The rule included an increase to the quality data completeness threshold and changed to scoring and requirements under the Promoting Interoperability performance category. For the 2023 performance year, eligible clinicians would no longer be eligible to earn the 5% Advanced Alternative Payment Model bonus payment or the MIPS exceptional performance bonus unless Congress passes legislation extending these bonuses.