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Rules Aim To Meet Dual CMS Goals of Saving Money, Doctor Empowerment

Two rules recently issued by CMS, sought implementation of doctor goals to devote more time to patients, while also reimbursing them less for some services under the annual physician fee schedule. The finalization of the rules for the year 2019 is focused that there will be an evident improvement in the country’s healthcare system. It will enable physicians to utilize the electronic healthcare system and help to reinstate the doctor-patient relationship. “CMS is finalizing proposals to remove measures from the Hospital Outpatient Quality Reporting Program and from the Ambulatory Surgery Center Quality Reporting Program. These removals are aimed at enabling providers to focus on tracking and reporting the measures that are most impactful on patient care. This action will decrease the burden for providers by approximately $27 million over the next two years.” (Source) The proposed rules for saving money, saving goals by CMS are focused on improving the sustainability of the Medicare program and to control the frequency of unnecessary clinical visits as the clinical visit is the most common service billed. The change is intended to phase in two years. Currently, CMS and beneficiaries often pay more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting. This policy would result in lower copayments for beneficiaries and savings for the Medicare program in an estimated amount of $380 million for 2019; according to the Press Release issued by the agency. These proposed rules for saving money, saving goals would prolong the quality time that doctors and healthcare providers spend with their patients. The proposals would also revolutionize the Medicare payment guidelines to support and promote access to virtual healthcare.

Some important changes to the proposed rule are:

  • New adjustments were made in MIPS program, 34 measures of low value deleted, and 10 new measures are included an increase in the cost component calculation weight from 10 to 15 percent and doubling the performance threshold to 30 points.
  • Important reforms in the evaluation and management of payments, including combined new and established patient payment rates. A number of add-on codes to provide resources for the provision of complex data reflecting basic and non-procedural services.
  • Simplified documentation requirements, removing the need to justify the medical inevitability of a home visit instead of an office visit.
  • Decrease of quality measures from 31 to 24 under the Medicare Joint Savings Program (MSSP) and added emphasis on more results-based measures, containing patient experience in care.
  • Extend telemedicine and virtual care reimbursement, including paying for virtual check-ins and evaluating patient-submitted photos or recorded video, as well as Medicare-covered telemedicine services for extended preventive care.

The CMS declared plans to pay physicians for telehealth arrangements and correspondence with patients under yearly physicians’ payment schedule. CMS will likewise change the assessment and the management visit codes. These codes would define how doctors charge Medicare for patient appointments. CMS is pointing on activities that promote and provide care focusing solely on the patients. The updated methods exhibit that CMS listens to clinicians and perceives the doctor goals to decrease managerial responsibility by concentrating on those activities that most essentially influence patient-care and outcomes. Beginning one year from now, physicians will just need to feature what’s changed since they last observed the patient, as opposed to rehashing the entire medical history. When you consider rules for saving money, saving goals, the carrot and stick approach similar to other programs is perceived right. At the point when Medicare changes to a framework based on values, you’ll need benefits and increased incentives and penalty in case of poor performance. Under the Merit-based Incentive Payment System (MIPS), it has essentially evolved from a significant value-based transition tool to a regulatory compliance measure.

The CMS Plans –

  • Elimination of MIPS quality measures that are based on low value or low priority procedures. Physicians suggested removing the measures to focus on meaningful actions that have a greater impact on health outcomes.
  • Modification of the MIPS performance category “Promoting Interoperability” (formerly “Advancing Care Information”) to guarantee better EHR interoperability and patients’ reach to their health information, in addition to this performance category for clinicians to the offered new interoperability support program for hospitals to adapt.
  • For the “Promote Interoperability” performance category, CMS needs that MIPS-qualified clinicians must use the EHR certified technology for the MIPS performance period of 2019.

The two rules cover strategies to either execute or develop. CMS provides a 60% discount for visits to clinics or check-ups over a two-year period in hospital outpatient clinics. The purpose is to reflect the price paid for the same visits to medical practices. After complete application, the payment change is anticipating $ 610 million savings for Medicare. The rules are clearly focused on reducing the payments on the outpatient visit and a push to increase virtual visits. There are now fewer requirements to justify a home visit. However, there are concerns raised by many proclaiming that outpatient visits are sicker than other types and need more care. On the other hand, CMS is trying to diminish costs and implement the perceived doctor goals

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