CMS releases final 2018 Physician Fee Schedule rule

Additional cuts to what CMS pays to hospital-owned off-campus facilities were finalized in the Physician Fee Schedule rule for 2018, though the reductions were lower than what the agency had originally proposed.

CMS had proposed to cut payment rates for “certain items and services furnished by certain off-campus hospital outpatient provider-based departments” by 50 percent, on top of cuts which had already been considered harmful by stakeholders in the 2017 rule. The final rule for 2018 softens the blow by making only a 20 percent cut—specifically going from the 2017 level of paying 50 percent of the Outpatient Prospective Payment System (OPPS) rate to 40 percent of the OPPS rate in 2018.

CMS said “this adjustment will provide a more level playing field for competition between hospitals and physician practices by promoting greater payment alignment.” To America’s Essential Hospitals, however, the cut in payment works against the agency’s goal of “integrated, coordinated healthcare,” particularly for lower-income patients.

“In these healthcare deserts, essential hospitals work to overcome practitioner shortages by extending primary and specialty care services to off-campus clinics in their communities,” said the group’s president and CEO, Bruce Siegel, MD, MPH. “But today’s final rule puts expansion of services further out of reach for these communities and threatens access to care where access is needed most.”

The final rule did slightly increase the payment update over the proposed rule. Payments to physicians treating Medicare beneficiaries will increase by 0.41 percent in 2018. The final conversion factor, which reflects how relative value units in Medicare are multiplied to calculate reimbursement, will jump from $35.89 in 2017 to $35.99 in 2018.

Telehealth reimbursement will also be expanded thanks to the rule. CMS finalized adding several codes the list of covered telehealth services:

• CPT code 90785: Interactive complexity
• CPT codes 96160 and 96161: Health risk assessment
• CPT codes 90839 and 90840: Psychotherapy for crisis
• HCPCS code G0506: Care planning for chronic care management
• HCPCS code G0296: Visit to determine low dose computed tomography eligibility

The final rule also delayed the start date for Medicare’s Appropriate Use Criteria (AUC) Program for Advanced Diagnostic Imaging. The program was supposed to begin with an “educational and operations testing year” in 2019, but that year will now be pushed to 2020. A voluntary participation period for the program will begin in the middle of next year and run through 2019, during which “CMS will collect limited information on Medicare claims to identify advanced imaging services for which consultation with appropriate use criteria took place.”

The American College of Radiology had argued against any further delay in the AUC, saying concerns the policy would burden providers already working to meet requirements larger Quality Payment Program (QPP) and the Merit-based Incentive Payment System (MIPS) were “unfounded.”