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MSA News - CMS Announces Payment Rules

Last week the Centers for Medicare and Medicaid Services (CMS) announced several payment rules to reward higher quality and lower cost programs, including Medicare Set Asides.

The final rules include Medicare payments to physicians and non-physician practitioners, hospital outpatient departments, ambulatory surgical centers, home health agencies and dialysis facilities that treat patients with end-stage renal disease.

The new CMS rules are an attempt to gain greater value for the healthcare expenses of the system, and are welcomed by the provider and payer communities. Some of the highlights include:

•  Better coordination of care for beneficiaries with multiple chronic conditions. Beginning in 2015, the Medicare Physician Fee Schedule will include a new chronic care management fee. This separate payment for chronic care management will support physician practices in their efforts to coordinate care for Medicare beneficiaries with multiple chronic conditions. Presumably, this should help improve the coordination of care for patients outside of regular office visits.

•  Rewarding value rather than volume. In 2015 Medicare is continuing to phase in the Value-based Payment Modifier, which adjusts traditional Medicare payments to physicians and other eligible professionals based on the quality and cost of care they furnish to beneficiaries. The adjustments translate into payment increases for providers who deliver higher quality care at a better value, while providers who underperform may be subject to a payment reduction.

•  Providing incentives to hospital outpatient departments and facilities to deliver efficient, high-quality care. The Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS) rule includes opportunities to promote greater packaging of payments for items and services rather than making separate payments for each individual service.

•  Better information for providers and beneficiaries to understand the total scope, cost, and quality of care. To assist physicians in improving quality of care for their Medicare beneficiaries, CMS recently made Quality and Resource Use Reports available. The reports include information about the scope, cost and quality of care that is delivered to the Medicare beneficiaries they serve, both inside and outside of their practices. These reports should improve care coordination and reduce unnecessary services. Also, the Physician Compare website allows consumers to search for information about physicians and other health care professionals who provide Medicare services so they can make informed decisions about who delivers their care.

•  New quality and performance measures for dialysis facilities. The End-Stage Renal Disease (ESRD) Prospective Payment System rule introduces new quality and performance measures for outpatient dialysis facilities. In 2017, a Standardized Readmission Ratio, which assesses the rate at which ESRD dialysis patients return to an acute care hospital within 30 days of discharge from an acute care hospital, will attempt to reduce unnecessary hospital readmissions.

Blackburn Robert  

By Robert J. Blackburn, Managing Principal, Blackburn Group, Inc.                                       Contact Bob at This email address is being protected from spambots. You need JavaScript enabled to view it..

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