Starting in 2015, primary care physicians will get paid for some of the chronic care management work they do outside of office visits.
As part of the 2014 Medicare physician fee schedule final rule, officials at the Centers for Medicare and Medicaid Services (CMS) finalized plans to begin paying physicians separately for services such as development and revision of a care plan, communication with other treating providers, review of lab results, and adjustment of medications.
The agency established a new G-code that physicians can use to bill for non-face-to-face care management services for Medicare patients with two or more significant chronic conditions. The code, which will apply to 20 minutes or more of chronic care management services during a 30-day period, takes effect on Jan. 1, 2015.
Dr. Reid Blackwelder
Physicians who wish to use the new code will have to meet a series of requirements laid out by the CMS, including providing 24-7 access, coordination with home- and community-based service providers, and patient access to the practice through secure messaging or patient portals.
The new codes are part of a recent move by Medicare officials to emphasize primary care and to pay for services that happen outside of the traditional office visit. In 2012, the CMS established codes for transitional care management services for patients moving from a hospital or skilled nursing facility to home. Those codes, which took effect this year, included payment for some non-face-to-face activities.
The news was greeted as a step in the right direction by the American Academy of Family Physicians.
"Elderly and disabled patients have complex, multiple, and chronic health conditions that require the whole-person medical attention available only through primary care physicians," Dr. Reid Blackwelder, AAFP president, said in a statement. "Placing appropriate value on the primary care services these patients require and establishing codes for chronic care management are important steps in meeting their needs."
The final fee schedule rule also provides a new estimate for how deep the Sustainable Growth Rate (SGR) formula cut will be in 2014. The across-the-board cut, which will take effect on Jan. 1 unless Congress takes action to avert it, will be 20.1%, down from an earlier estimate of 24.4%.
The somewhat smaller cut was not seen as good news by physician groups, which are increasingly fed up with the SGR formula.
The American Medical Association urged Congress to act quickly, not on a temporary patch, but on a permanent repeal of the SGR formula.
"The clock is ticking," Dr. Ardis Dee Hoven, AMA president, said in a statement. "At stake are innovations that would make Medicare more cost effective for current and future generations of seniors. These innovations are not possible if physicians are worried about drastic cuts to Medicare rates that have remained almost flat since 2001, while the cost of caring for patients has gone up by 25 percent."
The 2014 fee schedule also continues to phase in the Physician Value-Based Payment Modifier program. The program links Medicare payments to performance on cost and quality of care. The first payment adjustments will come in January 2015 for practices of 100 or more providers. In January 2016, the program will extend to groups with 10 or more eligible professionals. The CMS estimates that nearly 60% of physicians will be paid under the value-based payment modifier program in 2016. The remainder of physicians will be included in the program starting in January 2017.
But the CMS urged physicians to plan ahead. While payments won’t be affected until those dates, the performance measurement will occur earlier. For instance, for small group practices that will enter the program in 2017, the performance year is 2015. Physicians in small practices should use 2014 as a "practice year" and report to the Physician Quality Reporting System (PQRS) program so that they will be ready in 2015, according to the CMS.
The fee schedule will be published in the Federal Register on Dec. 10. The deadline for public comments on the rule is Jan. 27, 2014.