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CMS proposes changes to Medicare payment for coordinated care
CMS recently proposed changes to the Physician Fee Schedule to modify how Medicare pays for primary care, focusing on care management and behavioral health.
“Today's proposals are intended to give a significant lift to the practice of primary care and to boost the time a physician can spend with their patients listening, advising and coordinating their care — both for physical and mental health,” CMS Acting Administrator Andrew Slavitt, said in a press release. “If this rule is finalized, it will put our nation's money where its mouth is by continuing to recognize the importance of prevention, wellness, and mental health and chronic disease management.”
Andrew Slavitt
The proposed changes aim to improve how Medicare pays for services provided by primary care physicians and other clinicians caring for individuals with multiple chronic conditions, mental and behavioral health issues, cognitive impairment or mobility-related impairments.
The rule also proposes expanding the Diabetes Prevention Program within Medicare, beginning Jan. 1, 2018.
“Through expansion of the Diabetes Prevention Program, beneficiaries across the nation will be able to access a community-based intervention that prevents diabetes and keeps people healthy. This is part of our efforts for better care, smarter spending, and healthier people,” Patrick Conway, acting principal deputy administrator and CMS chief medical officer, said in the release.
Patrick Conway
The proposal would allow Medicare Diabetes Prevention Program suppliers to submit claims to Medicare for providing diabetes prevention services.
Additional policies proposed to the 2017 Physician Fee Schedule include:
- Revisions to payment for chronic care management, including new codes for extra care management from a clinician following an initial visit for individuals with multiple chronic conditions;
- CMS payment for specific behavioral health services within the collaborative care model and broader payment for other behavioral health integration approaches;
- A new code to pay for cognitive and functional assessment and care planning for individuals with cognitive impairment; and
- More accurate payment for clinicians treating individuals with mobility-related impairments.
Nitin S. Damle
Further, CMS is proposing payment adjustments for clinicians in Puerto Rico to more accurately reflect local costs and significantly increase payments.
Other changes may increase program integrity and data transparency of the Medicare Advantage program.
“As a practicing primary care internist myself, I am greatly encouraged that CMS is proposing substantial improvements to help me and my colleagues provide coordinated, patient-centered, high value and team-based care to our patients” Nitin S. Damle, MD, MS, FACP, president of the American College of Physicians, said in a press release. “We look forward to providing CMS with detailed comments to support these improvements while recommending other changes to strengthen primary care.”
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