AMA Backs CMS Diabetes, Legacy Value-Based Purchasing Changes
CMS proposals to expand the Diabetes Prevention Program alternative payment model and reduce legacy value-based purchasing reporting earned AMA support.
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By - The American Medical Association (AMA) recently commended CMS for several recommendations outlined in the recently proposed 2018 Physician Fee Schedule rule. The industry group particularly welcomed a potential Medicare Diabetes Prevention Program expansion and legacy value-based purchasing program flexibilities.
CMS released the proposed rule last week to update the Medicare Physician Fee Schedule for 2018. In addition to the annual Medicare reimbursement update, the federal agency also included the following major changes in the proposed rule:
• Request for information on how CMS can better achieve healthcare transparency, flexibility, program simplification, and innovation
• Medicare reimbursement reductions by one-half to off-campus provider-based hospital outpatient departments under site-neutral payment rules
• Addition of five Medicare telehealth codes, including care planning for chronic disease management, psychotherapy for crisis, and health risk assessments
• Delayed implementation of the Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging and new qualified provider-led entities and clinical decision support mechanisms to support the program
• Expansion of the Medicare Diabetes Prevention Program in 2018
“The annual physician fee schedule update is a chance for CMS to modify Medicare policy to ensure the best possible treatment options for patients,” stated David O. Barbe, MD, AMA President. “The AMA is encouraged by many of the proposed changes and applauds the Administration for working with the AMA to address physician concerns.”
The industry group specifically applauded CMS for proposing to extend the Medicare Diabetes Prevention Program starting in 2018. The three-year demonstration of the program is slated to save about $1.3 billion in healthcare cost savings and proposed expansion rules should extend the benefits to more beneficiaries, the AMA stated.
Under the proposed rule, CMS would establish additional policies for program providers to furnish services nationally, earn reimbursement under a value-based purchasing model based on beneficiary attendance and/or weight loss, and offer patient engagement incentives to beneficiaries.
The AMA anticipates that the expanded model will “ensure at-risk seniors and people with disabilities have access to an evidence-based DPP [Diabetes Prevention Program] that can help them lower their risk factors and prevent or delay the progression to type 2 diabetes.”
The organization also voiced support for value-based purchasing structures proposed in the rule.
“The AMA is pleased that CMS has made an effort to address AMA’s concerns that the proposed payment model was too restrictive in linking payments to patient adherence in attending sessions and health outcomes as measured by weight loss in a short period of time,” the organization wrote. “The new proposal provides more flexibility to DPP providers in supporting patient engagement and attendance and by making performance-based payments available if patients meet weight-loss targets over a longer period of time.”
In addition, the AMA backed proposals to consolidate and streamline value-based purchasing programs that ended with MACRA implementation, including the Physician Quality Reporting System (PQRS), Medicare EHR Incentive Program, and Value-Based Payment Modifier.
While the value-based purchasing programs ended when the Quality Payment Program launched in January 2017, eligible professionals must still submit 2016 data to the programs to avoid a negative Medicare reimbursement adjustment in 2018.
CMS proposed to reduce PQRS reporting requirements from 9 measures across 3 National Quality Strategy domains to only 6 measures. The federal agency also included similar changes to the clinical reporting requirements under the Medicare EHR Incentive Program.
Similarly, the Value-Based Payment Modifier initiative would see modifications under the proposed rule, including a decreased automatic downward payment adjustment for not meeting reporting requirements.
Reduced reporting requirements to legacy value-based purchasing programs should help providers transition to MACRA’s Merit-Based Incentive Payment System (MIPS), which replaced the legacy programs at the start of the year, AMA stated.
Additionally, the AMA backed the delayed implementation of the Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging.
CMS introduced program implementation rules in the 2016 Physician Fee Schedule final rule. The program aims to reduce inappropriate imaging use and overuse in outpatient settings, ambulatory surgical centers, and provider-led outpatient facilities with the use of clinical decision support mechanisms.
The federal agency intended to implement a policy in January 2017 that required providers to document qualifying decision support consultation to qualify for federal healthcare reimbursement for advanced imaging.
However, the recently proposed rule states that 2019 would act as an “educational and operations testing year.” CMS would pay claims for advanced imaging services regardless of whether they included information on required Appropriate Use Criteria consultation.
The AMA also noted that the call for public comment regarding how CMS can better achieve healthcare transparency, flexibility, program simplification, and innovation is a positive step for the federal agency.
The industry group expects to submit formal comments to CMS on the proposed rule. CMS will accept all comments until Sept. 11, 2017.
