The Centers for Medicare and Medicaid Services (CMS) July 7 released the calendar year (CY) 2017 Physician Fee Schedule (PFS) proposed rule that updates payment rates, and other payment policies for services provided by physicians and other health care professionals paid under the physician fee schedule. Key provisions include: expansion of the Diabetes Prevention Program Model, modifications to the Medicare Shared Savings Program (MSSP), collection of data on resources used in furnishing global services, and identification of misvalued codes.
CMS proposes to expand the Diabetes Prevention Program into Medicare beginning Jan. 1, 2018. CMS proposes coding and payment changes to better value primary care, care management and cognitive services, such as making separate payments for certain non-face-to face prolonged evaluation and management services, separate payments for comprehensive assessment and care planning, and chronic care management for patients with greater complexity.
The Diabetes Prevention Program is a clinical and educational lifestyle intervention that includes physical, dietary, and overall lifestyle changes to prevent the onset of diabetes in individuals who are pre-diabetic. The program consists of 15 intensive “core” sessions in a group-based, classroom-style setting that provides changes that an individual can sustain long-term. The primary goal of the intervention is at least 5 percent average weight loss among participants.
Regarding the MSSP, the CY 2016 PFS proposed rule updates quality reporting requirements for Accountable Care Organizations (ACOs) to better align with the proposed Quality Payment Program (QPP) under the Medicare Access CHIP Reauthorization Act (MACRA). CMS also proposes to modify the attribution methodology to assign beneficiaries to an ACO when a beneficiary has designated an ACO professional for their overall care. Additional changes were proposed to account for the merged and acquired physician group practices and for reconciliation of ACOs that fall below 5,000 beneficiaries.
Furthermore, CMS proposes a data collection strategy, including claims-based data collection and a survey of 5,000 practitioners, to gather data on the activities and resources involved in furnishing global services. The data collection will be used to revalue surgical services.
Finally, CMS has proposed misvalued code changes that would achieve .51 percent in net expenditure reductions. These changes would meet the misvalued code target of .5 percent, therefore avoiding broad overall reduction to PFS services. CMS also proposes to add on several codes to the list of services eligible to be furnished via telehealth and an additional code to account for mammography services.
Comments are due by 5 p.m. ET on Sept. 6, 2016. The AAMC will be hosting a webinar on the proposed rule, and will be providing members with additional information and will be seeking feedback as we prepare our comment letter.