In a move away from the traditional visit-based payment system, officials at the Centers for Medicare and Medicaid Services are considering paying physicians for their non-face-to-face work in chronic disease management.
The proposal, which would be a boon for primary care physicians, would create two new G-codes for the non-–face-to-face care management services for Medicare patients with two or more significant chronic conditions.
The services would include physician development and revision of a care plan, communication with other treating physicians and health providers, as well as medication management. CMS is proposing to establish two G-codes for establishing a plan of care and for providing care management over 90-day periods.
Physicians could use the codes if their patients have had either Medicare’s Annual Wellness Visit or an Initial Preventive Physician Examination. CMS also plans to establish some practice standards to go along with the codes, such as requiring the use an electronic health record at the time of service.
The new codes would go into effect Jan. 1, 2015.
Currently, Medicare only pays for primary care management that occurs during an office visit. However, last year the agency established codes for transitional care management services for patients moving from a hospital or a skilled nursing facility to home, which included some non–face-to-face activities. The transitional care codes went into effect in January 2013.
The new codes are one of several policy changes being floated as part of the proposed 2014 Medicare Physician Fee Schedule. The proposed rule will be published in the Federal Register on July 19. CMS will accept public comment on the proposal until Sept. 6 and a final rule is expected in November.
The rule also serves as a reminder that in addition to payment changes proposed by CMS, physicians currently face a 24.4% across-the-board pay cut in 2015 due to the Sustainable Growth Rate (SGR) formula. Congressional action is required to avoid the steep pay cut. Members of Congress are currently drafting legislation that would permanently eliminate the SGR formula but it is unclear if the bill would be voted on this year.
Dr. Jeffrey Cain, president of the American Academy of Family Physicians, praised the CMS proposal for complex chronic care management, but said the agency can only make so much progress on payment reform within the current system.
"In light of the SGR’s mandate that CMS slash Medicare physician payment by 24.4%, these incremental increases do nothing to sustain primary medical care, much less build the primary care physician workforce," he said in a statement. "The SGR-required payment cut shines a bright light on the need for Congress to replace this dysfunctional system."
The fee schedule proposal also offers more specifics for rolling out the physician value-based payment modifier, an Affordable Care Act program to will pay physicians based on both the quality and cost of the care they provide to Medicare beneficiaries. The program is being phased in over time but will apply to all physicians by Jan. 1, 2017.
Since the program is "budget neutral," higher payments for some physicians mean pay cuts for others. Under the program, physician groups could see a payment cut of between 1% and 2% in 2016 based on their performance on quality and cost.
The latest fee schedule proposal sets out an implementation schedule for the value modifier program. Physician groups with 100 or more eligible professionals will be subject to the modifier starting in 2015. In 2016, the program will apply to physician groups of 10 or more. However, Medicare officials will begin measuring their performance on cost and quality in 2014 to determine the payments in 2016. The expansion of the program to groups of 10 or more will mean that nearly 60% of physicians will be affected by the modifier in 2016, according to CMS.
The remainder of physicians will see their payments affected by the modifier in 2017, based on performance during 2015.
Physicians can see how they are performing on cost and quality through annual Quality and Resource Use Reports produced by CMS. The agency will be providing these reports to groups of 25 or more eligible professionals in September. CMS said they expect to provide the reports to physician groups of all sizes in 2014.