HHS and the CMS released its proposed changes to the 2019 physician fee schedule in a 1,473-page proposed rule on July 12. The modifications included some indications of where the agencies are headed with future Medicare regulations. Here, Modern Healthcare highlights seven ways the physician fee schedule could change.

1) Targeting high-cost procedures

Some CPT code procedures are in line for a possible drop in reimbursement. The CMS identified seven procedures that appear to be over-reimbursed and asked for a review.

  • Total hip arthroplasty
  • Total knee arthroplasty
  • Esophagogastroduodenoscopy biopsy single and multiple
  • Colonoscopy with lesion removal
  • CT imaging of head without contrast
  • Electrocardiogram, complete
  • Transthoracic echocardiogram with doppler, complete

2) Considering opioid bundles

The rule says it all: “We are seeking comment on creating a bundled episode of care for management and counseling treatment for substance use disorders. We are also seeking comment for regulatory and subregulatory changes to help prevent opioid use disorder and improve access to treatment under the Medicare program. We seek comment on methods for identifying non-opioid alternatives for pain treatment and management, along with identifying barriers that may inhibit access to these non-opioid alternatives including barriers related to payment or coverage.”

3) Changing MIPS measures drastically

CMS proposed 10 new quality measures, four of which are patient reported, seven are high-priority and one that replaces an existing measure. The agency would like to remove 34 measures.

4) Allowing small reimbursement for e-visits

But that reimbursement is meager. The rule says: “Medicare would pay $14 per visit in the first year for these communication technology-based services, compared with $92 per visit for the corresponding established patient visits.” In addition, the CMS expects the change to increase payments to the industry by 0.2%, so it reduced the total payments in the physician fee schedule by that amount.

5) Adding EHRs to the Physician Compare tool

The CMS wants to know how they might add EHR utilization performance to the Physician Compare tool on the CMS website

6) Eliminating chargemasters

Amid concerns about insufficient price transparency, which includes the surprise billing from anesthesiologists and radiologists that hospitals are becoming known for, the rule says the agency would like input on how to potentially overhaul and maybe standardize the often-maligned, yet still unchanged chargemaster pricing system.

7) Encouraging more price transparency

Also in the transparency section, one of the questions the agency asks in the rule is, “Can we require providers and suppliers to provide patients with information on what Medicare pays for a particular service performed by that provider or supplier?” Hospital industry executives are likely to respond to this query.

Bonus note: Among v. amongst

Is there a U.K. native on the CMS’ rule-writing staff? After zero appearances in the 2018 physician fee schedule final rule, the word “amongst” shows up five times in the current proposed rule, though still far behind the 110 uses of “among.”


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