CMS Finalizes 2015 Payment Schedule

This past Friday, the Centers for Medicare and Medicaid Services (CMS) released nearly 3000 pages of regulations finalizing 2015 payment rates for various providers and services in the Medicare program, including physicians.

“These rules are a part of the broader strategy driving greater value in health care," said CMS Administrator Marilyn Tavenner in a statement.

CMS highlighted the creation of a new payment to support chronic care management, efforts to combine and streamline payments related to a single patient's hospital care, and the expansion of the Physician Compare website.

"CMS has finalized policies to significantly expand the quality measures available on this website by making group practice and individual physician-level measures available for public reporting, including patient experience measures," the agency said in a memo.

The policies reflect the Administration’s strategy that values quality over quantity and finds better ways to deliver care, pay providers, and distribute information.

• Better coordination of care for beneficiaries with multiple chronic conditions. Often, seniors with multiple conditions see a number of specialists. In those cases, extra physician effort is required to coordinate a care regimen that prevents over-treatment or duplicative tests. Also, under the new fee schedule, chronic care management will be covered beginning next year.
• Expect Medicare to continue phasing in the Value-based Payment Modifier, which adjusts traditional Medicare payments to physicians and other eligible professionals based on the quality and cost of care they furnish to beneficiaries. Those adjustments translate into payment increases for providers who deliver higher quality care at a better value, while providers who underperform may be subject to a payment reduction.
• Providing incentives to hospital outpatient departments and facilities to deliver efficient, high-quality care. The Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS) rule includes provisions that promote greater packaging of payments for items and services rather than making separate payments for each individual service.
• Better information for providers to understand the total scope, cost, and quality of care that the Medicare beneficiaries they serve receive. To assist physician groups and physicians in improving quality of care for their Medicare beneficiaries, CMS recently made Quality and Resource Use Reports available. The reports include information about the scope, cost and quality of care that is delivered to the Medicare beneficiaries they serve, both inside and outside of their practices. Solo practitioners and group practices can use the reports to implement action steps that can improve care coordination and reduce the provision of unnecessary services, improving the quality, effectiveness, and efficiency of care delivered to Medicare beneficiaries.
• Expand and add new measures to the Physician Compare website. The Physician Compare website allows consumers to search for reliable information about physicians and other health care professionals who provide. By making all of these measures available for public reporting, CMS can work to include a diversity of quality measures on the website while including only those measures that are most beneficial to consumers and best aid decision making.