HHS Releases 2015 Final Physician Fee Schedule Rule
The new HHS Physician Fee Schedule rule aims to improve healthcare by making it more effective.
- The Department of Health and Human Service, in conjunction with the Centers for Medicare and Medicaid Services, announced a final rule to the payment policies under the physician fee schedule. The revision also includes clinical laboratory fee schedule, access to identifiable data for CMS innovation models and other aspects of Part B for the calendar year of 2015. The provisions of this final rule will be effective on January 1, 2015.
“This major final rule with comment period addresses changes to the physician fee schedule, and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute,” the report reads.
The final rule includes an Interim Final Rule with a request for public comment (IFC) related to the Electronic Health Records (EHR) Incentive Programs. It adopts changes to the regulatory language about hardship exceptions from the Medicare payment adjustment in the programs.
This Medicare physician fee schedule final rule is a collection of several rules that reflect a broader Administration-wide strategy to deliver better care at a lower cost by finding better ways to deliver care, pay providers and distribute information.
“Provisions in these rules are helping to move our health-care system to one that values quality over quantity and focuses on reforms such as measuring for better health outcomes, focusing on disease prevention, helping patients return home after the hospital, helping manage and improve chronic diseases, and fostering a more-efficient and coordinated health care system,” a contributing fact sheet reads.
The over 1,100 page document focuses covers all of the changes that are going to take place. These include:
Physician Quality Reporting System (PQRS)
PQRS is a pay-for-reporting program that combines incentive payments with downward payment adjustments to promote quality. The new rule adds 20 new individual measures and two measures groups to fill existing measure gaps. This brings the PQRD individual measures set to 225 total.
Medicare EHR Incentive Program
Payment adjustments under Medicare for eligible hospitals, professionals and critical access hospitals that are not meaningful users of certified EHR technology is handled as part of the American Recovery and Reinvestment Act of 2009 (ARRA). ARRA allows the secretary to consider hardship exceptions on an individual basis to avoid payment adjustments.
Medicare Shared Savings Program
The new rule adds a quality scoring strategy to recognize and reward ACOs that make year-to-year improvements in quality performance scores on individual measures by adding a quality improvement measures that adds bonus points to each of the four quality measure domains based on improvement. It also creates revisions to quality measure benchmarks and modifications to the quality measures that make up the quality reporting stands.
Physician compare website
The rule also continues the phased approach for public reporting on Physician Compare. This includes a proposal to expand public reporting of group-level measures by making all 2015 PGRS GPRO web interface.
