Winners And Losers In The Physician Fee Schedule

FEE SCHEDULE DROPS — CMS released its highly anticipated proposed physician fee schedule last week, and it quickly drew applause — and scorn — from industry groups.

The 1,920-page document lays out how the agency proposes to pay doctors in the Medicare system in 2024. CMS touted it as a win for health equity, price transparency and behavioral health.

Here are some of the most noteworthy proposals:

— Doctor pay cut: The Biden administration proposes cutting Medicare payments to doctors by 3.3 percent next year, which drew criticism from doctor groups. They argue it would hurt efforts to bolster primary care doctors’ pay and prospects for value-based care. Such cuts could also hurt Accountable Care Organizations.

The move underscores the bind CMS faces as it tries to balance incentivizing doctor behavior with its obligations to cutting spending. It comes as both parties in Congress eye how to improve physician pay to reverse a trend of practices closing or merging with hospitals.

Still, industry groups supported other proposals, including a new add-on payment for primary care doctors treating complex conditions and other changes to how doctors in value-based arrangements get paid.

— Hospital price transparency: The agency proposes significant changes to the way hospitals post prices for their services, so consumers can understand them and competition would increase, which could reduce costs.

Hospitals aren’t currently required to post their prices in any standardized way. CMS proposes adopting a template.

— Telehealth: CMS proposes bolstering telehealth payment rates for virtual providers caring for patients in their homes.

The agency says doctors need additional compensation because they offer a significant amount of telehealth while maintaining their physical offices. CMS doesn’t expect its costs will rise substantially despite proposing higher provider payment rates.

CMS also took further steps to facilitate telehealth access through the end of 2024 — when Congress’ extension of eased telehealth rules is set to expire — to applause from industry groups.

— Remote patient monitoring: The agency proposes allowing federally qualified health centers and rural health clinics to bill separately for remote patient monitoring, arguing it “reflect[s] the additional resources necessary” for the services. But it keeps in place regulations limiting billing for remote monitoring for “established” patients, or those using the technology before the public health emergency’s end.

Other significant proposals included:

— Paying for intensive outpatient care provided by opioid treatment programs beginning Jan. 1, implementing Congress’ will

— Creating a new benefit category for intensive outpatient care

— Permitting doctors to fulfill requirements that they supervise the provision of certain medical services virtually through 2024

What’s next: The agency is taking comments on the proposal through Sept. 11.


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