Physician Payment Rule: CMS Proposes 3.75% Cut in Doctors’ Pay

Physician Payment Rule

In a recent move, the Centers for Medicare & Medicaid Services proposed 2022 Medicare Physician Fee Schedule & Quality Payment Program rules. The recently proposed changes stir debate around the United States. Because physicians are likely to witness a 3.75% reduction in the conversion factor in 2022. That is utilized to calculate reimbursements for the medical care providers. If the recommended cuts get approved without changes, they will go into effect on Jan. 1, 2022.

According to the official document issued by the federal agency. The initiative of cutting physicians’ pays and changes in quality payment programs, is taken to keep the Medicare budget neutral. CMS Administrator Chiquita Brooks-LaSure in her official statement said that: the public health emergency (caused due to the ongoing pandemic) has highlighted the discrepancies in the United States.

However, CMS is committed to take the lessons learned during the crisis and move forward towards a balanced system. Where no patient is overlooked and everyone has access to affordable and quality healthcare services. Moreover, the recently proposed changes will address the widening gap in health equity, especially in the unprivileged areas. The recommended steps aimed to:

  • Promote health equity.
  • Expand access to healthcare services through medical billing services i.e. telehealth, for behavioural health care.
  • Improve CMS’s quality programs to ensure quality care for Medicare beneficiaries.
  • Provide equal opportunities for doctors, regardless of whether they are associated with small or large-scale healthcare practices.

Other Proposed Policies:

Other details about the proposed policies in Physician Payment Rule are included;

1. Advancing the Quality Payment Program

In order to improve the quality of value-based care, CMS has proposed changes in the Quality Payment Program (QPP). According to which clinicians are required to meet a higher performance threshold to be eligible for incentives. As per details, CMS is moving forward with the next evolution of QPP and proposing its first seven MIPS Value Pathways (MVPs). The initial set of proposed MVP clinical areas include; rheumatology, stroke care, and prevention, heart disease, chronic disease management, lower extremity joint repair (e.g., knee replacement), emergency medicine, and anaesthesia.

In addition to this, CMS has recommended revisions in the current eligible clinician definition to include clinical social workers & certified nurse-midwives. Because these professionals are often on the front lines serving communities with acute health care needs. Furthermore, for the first time, physician assistants would be able to bill Medicare directly.

2. Expanding Telehealth

In order to ensure access to behavioural health care and reduce barriers to treatment. CMS has proposed the removal of certain statutory restrictions. Which will enable patients to get telehealth services for diagnosis, evaluation, and treatment of mental health disorders. Additionally, eligible healthcare providers are likely to get payments. When they provide certain mental and behavioural health services to patients via audio-only telephone calls from their homes when certain conditions are met.

The recent recommendations are meant to help those living in areas with poor broadband infrastructure. And among people with Medicare who are not capable of and aren’t properly familiar with the use of devices. That allows them a two-way, audio/video interaction for their health care visits.

3. Updating Vaccine Payment Rates

The ongoing pandemic has highlighted the significance of getting vaccinated. However, the Biden-Harris administration has been taking action to make sure that a large number of Americans get access to the COVID-19 vaccination. And more importantly to reach the people where they are. In order to increase the number of vaccinated people, CMS is asking for feedback. That will help to update payment rates for the administration of preventive vaccines covered under Part B.

In addition to seeking information on the types of doctors, who provide vaccines & their costs. The federal agency is also looking for feedback on its recently adopted payment add-on of $35 for immunizers who vaccinate certain underserved patients in the patient’s home.

4. Boosting Participation in Diabetes Prevention Program

To widen the reach of the Medicare Diabetes Prevention Program (MDPP), CMS has been waiving the Medicare enrollment fee for new MDPP suppliers. All the organizations that submit an application to get enrolled in Medicare as an MDPP supplier on or after January 1, 2022, will take advantage of this rule.

Nationally. CMS is proposing changes to make delivery of MDPP services more feasible and to work on persistent access by making it simpler for local suppliers. “We believe that granting a waiver of the fee for MDPP suppliers to extend beyond the COVID-19 Emergency Declaration Blanket Waiver may increase MDPP supplier enrollment, which will ultimately improve beneficiary access.” The agency also is proposing to increase performance payments when patients in the program achieve a 5% weight loss goal and also meet program attendance requirements.

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