$140 million boost to primary care reimbursement in final 2017 Medicare PFS

The final version of the Medicare Physician Fee Schedule (PFS) released by CMS could direct an extra $140 million to primary care physicians in 2017, though it’s receiving some mixed reviews from major medical groups.

In a blog post from CMS Acting Administrator Andy Slavitt, he promoted the rule’s changes in several area, like clinicians being able to bill and be paid more when they spend more time with patients and coordinate care outside of an office visit.

“These changes are designed to improve health outcomes,” Slavitt wrote. “With today’s final primary care payment policies, Medicare continues to move toward a health care system that encourages teams of clinicians to work together and collaborate in order to provide more personalized care for their patients.”

The PFS also includes several new billing codes for:

• Assessing and planning care for patients with cognitive impairments.
• Chronic care management.
• Collaboration with mental health specialists.
• Telehealth consultations for end-stage renal disease-related services, advanced care planning, and critical care using new Medicare G-codes.

The American Medical Association appeared pleased with the final rule’s “enhanced coverage of care management and care collaboration.”

“This annual policy fine-tuning is an opportunity for CMS to improve treatment options for patients and streamline bureaucratic demands on physicians”  AMA President Andrew W.  Gurman, MD, said in a statement. “By expanding coverage of the Medicare Diabetes Prevention Program (DPP) and revising data collection efforts, CMS is ensuring that patients and physicians will benefit from better care and more rational directives.”

The American Academy of Family Physicians, however, criticized the rule’s code changes for being “misvalued.” The changes achieve 0.32 percent in net reductions for expenditures, which AAFP said falls below the Medicare Access and CHIP Reauthorization Act’s (MACRA) positive 0.5 percent update for 2017.

“The AAFP is growing increasingly concerned that CMS is adding regulatory burdens to primary care physicians such as consulting appropriate use criteria for advanced diagnostic imaging,” AAFP said in its statement. “This troubling program will divert resources from patient care and is unproven in efficacy. The AAFP has ongoing, significant concerns about the disproportional burden primary care physicians will face when trying to comply with appropriate use criteria requirements. We believe these requirements will place more burdens on primary care physicians than on other providers and add an unnecessary level of complexity that severely overtaxes our members.”

Both the AAFP and AMA applauded the expansion of Medicare’s diabetes prevention program as finalized in the PFS. Beginning in 2018, recognized suppliers will be able to offer prevention services to eligible beneficiaries at risk of developing type 2 diabetes.

The core benefit will be a 12-month intervention of at least 16 weekly and six monthly sessions, furnished regardless of weight loss, along with ongoing maintenance sessions after the 12 month period at three-month intervals, if beneficiaries maintain the required 5 percent weight loss minimum.

Enrollment will begin in 2017 after additional rulemaking, with the expanded diabetes prevention program going into effect on Jan. 1, 2018.