CMS: Proposed rule supports preventive, quality care initiatives

The proposed rule released July 6 by the Centers for Medicare & Medicaid Services (CMS) supports long term CMS goals to reward providers for administering higher quality care at lower costs, according to the speakers of a July 17 CMS open door forum.

The physician fee schedule, physician quality reporting system (PQRS) and the value-based payment modifier program represent just some of the areas within CMS’ domain that could be affected by the proposed rule.

The physician fee schedule is being adjusted to reflect the CMS’ goal to encourage patient utilization of primary care services and discourage unnecessary treatments and procedures. This is “what we consider to be the first in a multi-year proposal to move toward greater primary care in the physician fee schedule,” one CMS representative said.

One provision would allow payments to providers who coordinate patient care upon their discharge, something that the CMS hopes will support its Medicare readmission reduction program.

The proposed rule would also increase payments to medical homes administering advanced preventive care services, to providers administering preventive care with telehealth tools and extend payments to providers of certain substance abuse programs.

Meanwhile, it would decrease payments in some instances to providers for multiple surgical procedures conducted on a single patient, for certain physical therapy services, for ordering certain advanced diagnostic images, specifically for orders that are originated and performed within the same healthcare organization or physician group. Face-to-face physician and patient encounters would also become a requirement for payments made for certain durable medical equipment procedures.

CMS outlined how it could expand the physician quality reporting system and begin implementing the value-based modifier payment program on a voluntary basis in 2013, encouraging enrollment by ensuring providers that “simply by participating, they can avoid all negative downward payments.”

The proposed rule would allow providers greater choice in the PQRS by expanding reporting options and develops a method for ranking providers who participate in the value-based modifier payment program. For eligible physician groups, CMS would create a composite of care quality, a composite of care cost, combine them using a standardized score approach and compare them against the national mean.

CMS is currently soliciting public comment. The deadline to submit comments is Sept. 4 and CMS will issue a final rule on Nov. 1.