No payment changes for nephrologists in physician fee schedule

Nephrologists won’t see a difference in their monthly capitated payment for patients in 2016, but the final Medicare Physician Fee Schedule, which went into effect Jan.1, does include some new changes for physician services.

The 1,358 page rule contains changes to the calculation of payment rates, identifies potentially misvalued codes, adds procedures to the telehealth list, finalizes new policies and includes changes to several of the quality reporting initiatives. This is the first PFS final rule since the repeal of the Sustainable Growth Rate last year.

Below is a brief summary of some of the changes affecting nephrologists.

Payment for advanced care planning: For the first time, nephrologists will be able to bill Medicare under the MCP when they discuss advanced care planning with patients.

New codes for blood pressure checks: A new CPT code for central blood (arterial) pressure monitoring (93050) has been added.

New home dialysis codes added to the Telehealth Service List: CMS added CPT codes for home dialysis services (codes 90963-90966) to the list of category 1 telehealth services for 2016. CMS wrote that the home dialysis services are similar to professional consultations, office visits, and office psychiatry services that are currently on the list of telehealth services. However, CMS also wrote "a home is not an authorized originating site for telehealth.” The Renal Physicians Association was critical of this detail in their comments on the rule, saying that “an originating site policy that does not include the patient’s home (or the dialysis facility for that matter) vastly reduces the opportunities for home dialysis services to be furnished via telehealth means."

Removing two quality measures: CMS said it would remove the following two quality measures from the Physicians Quality Reporting System that relate to dialysis adequacy.

PQRS 81: Adult Kidney Disease: Hemodialysis Adequacy: Solute: Percentage of calendar months within a 12 month period during which patients aged 18 years and older receiving hemodialysis three times a week for ≥ 90 days who have a spKt/V ≥ 1.2.

PQRS 82: Adult Kidney Disease: Peritoneal Dialysis Adequacy: Solute: Percentage of patients aged 18 years and older receiving peritoneal dialysis who have a total Kt/V ≥ 1.7 per week measured once every four months.

CMS said it would remove these measures because they represent concepts that do not add clinical value to PQRS, and because eligible professionals consistently meet performance on these measures with performance rates close to 100%. The RPA disagreed with the decision, saying "Adequate dialysis dose is strongly associated with better outcomes, including decreased mortality, fewer hospitalizations, fewer days in the hospital, and decreased hospital costs. Further, there are currently very few measures upon which nephrologists can be evaluated for their ESRD patients (who for many nephrologists represent a substantial majority of the ESRD patient census), thus creating a barrier to their participation in the PQRS program, and the peritoneal dialysis measure was only recently recommended for continued endorsement by the NQF."