CMS Announces Cuts to Medicare Physician Fee Payment Rates in 2018

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Changes to Impact Health Care Access in Underserved Communities

Last week, the Center for Medicare and Medicaid Services (CMS) proposed a series of changes to the Medicare Physician Fee Schedule in 2018. The proposal includes a plan to slash Medicare payments by half for services provided by provider-owned, off-campus hospital departments.

The proposed changes will result in an unsustainable payment rate that will dramatically reduce access for patients and hospitals in underserved communities, referred to as “healthcare deserts.”

The proposal “is yet another blow to access to care for patients, including many vulnerable communities without other sources of healthcare,” Tom Nickels, executive vice president of the American Heart Association, told Becker’s Hospital CFO Report last week.

5 Proposed Changes to the 2018 Medicare Physician Fee Schedule

  1. Physician payment rates will increase by 0.31%, accounting for the required increase by MACRA and a negative 0.19% adjustment required under the Achieving a Better Life Experience Act of 2014.
  1. Reduce current physician fee schedule payment rates for services provided at off-campus provider-based departments by half.
  1. Physicians can claim services for advanced diagnostic imaging via CMS’ implementation of the Medicare Appropriate Use Criteria Program.
  1. CMS is proposing to pay for new telehealth services including:
  • Low dose computed tomography eligibility
  • Interactive complexity
  • Health risk assessment
  • Care planning for chronic care management
  • Psychotherapy for crisis
  1. CMS will establish payment to rural health clinics and federally qualified health clinics for chronic care management services in addition to general behavioral health integration services and psychiatric care.

All of these changes require adjustments to each department’s workflow, paperwork, and new billing codes, simultaneously increasing overhead while cutting payment rates in half -- essentially wiping out any of the proposed benefits for the communities and hospital departments that need it most.

An Unsustainable Model of Health Care Delivery

For doctors to receive reimbursement from programs like Medicaid, they shoulder the burden of intense administrative work. The reimbursement method results in additional overhead costs. The departments try to make up for the increase in overhead by ramping up patient volume.

The more patients seen each day results in deterioration of the quality of care. Proposals like these from CMS send hospital groups into an endless downward spiral, perpetuating an unsustainable model for health care delivery.

Breaking the Cycle

Oculus Health works with healthcare providers to put quality, accessible health care in the hands of more patients in the United States with solutions designed to streamline processes that reduce the impact of the Medicaid rollercoaster.

The Oculus Health electronic medical record (EMR) unit brings primary care into the 21st century by giving physicians and administrators the ability to:

  • Provide comprehensive data tracking, query options, and reporting capabilities for improved diagnosis and care, Medicaid performance benchmarking, billing, and reimbursement
  • Provide 24/7 accessibility management services through remote (telehealth) communication capabilities
  • Provide continuity of care management
  • Create, communicate, and easily follow up on comprehensive care plans

The key to improving the continuity and coordination of care in alignment with CMS’ new proposal is a provider’s ability to appropriately document, benchmark, and report on their services in order to be properly and adequately compensated. Learn more about how you can dramatically reduce administrative costs and overhead with simplified documentation from Oculus Health.

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