On November 1, the Centers for Medicare & Medicaid Services (CMS) released its finalized 2023 Medicare Physician Fee Schedule (MPFS). Among other key updates, the 2023 MPFS includes a reduction in the fee schedule conversion factor from $34.6062 to $33.0607. The 2023 MPFS also implements updates relating to telehealth flexibilities that mirror components of the 2022 Consolidated Appropriations Act, including extension of certain telehealth flexibilities during the 151-day period following expiration of the COVID-19 Public Health Emergency. Beyond these updates, the 2023 MPFS includes details on updated coding and work RVUs/practice expense RVUs for Evaluation and Management (E/M) and other services, as well as updates to the Quality Payment Program and Medicare Shared Savings Program.
Payment Cuts
Due to payment cuts in the Fee Schedule, physician groups are asking Congress to delay a 4.4% cut to Medicare payments.
“Ninety percent of medical practices reported that the projected reduction to 2023 Medicare payment would reduce access to care,” said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, in a statementv. “This cannot wait until next Congress—there are claims processing implications for retroactively applying these policies.”
“The Medicare payment schedule released today puts Congress on notice that a nearly 4.5 percent across-the-board reduction in payment rates is an ominous reality unless lawmakers act before Jan. 1. The rate cuts would create immediate financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians,” Jack Resneck Jr., MD, president of the American Medical Association (AMA) said in a statement.
CMS was required to install the cut under budget neutrality rules, leaving groups to turn to lawmakers for help. Congress has previously stepped in to stave off Medicare cuts, and there is a bipartisan bill in the House to do just that. Groups are also hoping to get a delay to a 4% decrease to payments as part of the PAYGO law, which mandates cuts if federal spending reaches a certain threshold.
Telehealth
CMS is finalizing its proposal to implement provisions of section 1834(m) of the Social Security Act, including the amendments made by the Consolidated Appropriations Act (CAA) 2021, and provisions of the CAA 2022, that extend certain Medicare telehealth flexibilities adopted during the PHE for at least 151 days after the end of the PHE. CMS confirmed that it will implement certain telehealth provisions via program instruction or other sub-regulatory guidance, including policies to allow the furnishing of telehealth services in any geographic area and originating site setting; specified services to be delivered via audio-only telecommunications systems; and physical therapists, occupational therapists, speech-language pathologists, and audiologists to provide telehealth services. These flexibilities will remain in place for 151 days post-PHE. Additionally, under the final rule, the in-person visit requirements for mental health services delivered via telehealth are delayed until 152 days after the end of the PHE.
CME Industry
In a previous article, we discussed the CMS request for feedback on whether to allow continual medical education organizations (CMS definition) to directly submit improvement activities for Quality Payment Program MVPs, which would, subsequently, require creating a new type of third-party intermediary. In addition, the RFI sought feedback on the value of the implementation of policies to approve CME Organizations or accreditation entities as third-party intermediaries.
CMS only provided a brief update on this text from the proposed rule. CMS writes: “We thank the commenters for their input on these issues and will use the information gathered in consideration for future rulemaking.”
Quality Payment Program (QPP)
In the final rule, CMS continues to move the QPP forward by focusing on measurement efforts, refining how clinicians participate via MIPS MVPs, and the encouragement of participation in APMs. The final rule will continue CMS’ work to develop new MVPs and refine the subgroup participation option. CMS finalized changes in traditional MIPS to provide clinicians continuity and consistency while they gain familiarity with MVPs. As such, CMS finalized the proposal to remove duplicative and topped out measures, as well as those with limited adoption, in order to continue streamlining and strengthening quality measure and improvement activity inventories.
To reduce burden and facilitate participation in APMs, CMS is finalizing its proposal to establish the eight percent minimum applicable nominal risk standard for Advanced APMs, which was previously set to expire in 2024. Previously, CMS had set a limit of 50 for the number of clinicians in an organization that participates in Advanced APM through a Medical Home Model, using the Medical Home Model nominal financial risk criteria. In this final rule, CMS is applying the 50 eligible clinician limit to the APM Entity participating in the Medical Home Model based on the TIN/NPs on the APM Entity’s participation list. Additionally, CMS is finalizing conforming changes to the Other Payer Advanced APM policies in these areas.
MSSP
CMS believes that its proposals in the final rule will reverse recent trends as well as advance equity within the Shared Savings Program. Specifically, CMS is finalizing its proposed health equity adjustment for up to a 10 bonus point bump to ACO MIPS scores based on high-quality performance and servicing a high portion of dually eligible beneficiaries. Specifically, ACOs will benefit from these additional bonus points if the organization scores in the top or middle third of performance for each quality measure. CMS explicitly stated that the policy will not run the risk of negatively impacting an ACO’s MIPS quality performance score and is only intended to positively impact ACOs.
In the final rule, CMS will provide advanced shared savings payments, referred to as advanced investment payments (AIP), to low revenue ACOs which meet the following criteria: (1) a first-time member in the Program; (2) “inexperienced” with performance-based risk Medicare ACO initiatives; and (3) serve an underserved population(s).
CMS is also finalizing its proposed changes to certain aspects of its benchmarking methodologies aimed at improving participation amongst providers who treat a high percentage of beneficiaries with substantial clinical risk factors and dually eligible beneficiaries.
Remote Therapeutic Monitoring (RTM) Services
In the proposed rule, CMS elected to postpone developing a generic remote therapeutic monitoring (RTM) device code and instead sought comments related to existing RTM devices that meet the “reasonable and necessary” definition, including: (1) types of data collected; (2) how the data solves specific health conditions; (3) associated costs; (4) length of episode of care; and (5) number of potential beneficiaries. The agency, in this final rule, suggests that it will continue to weigh the tradeoffs required to further reduce the complexity of coding and billing for RTM, whilst increasing flexibility in care delivery and retaining proper access to RTM services.
E/M Visits
CMS is finalizing the adoption of the revised CPT E/M Guidelines for Other Evaluation/Management (E/M) visits with the exception of prolonged services. These revised guidelines were developed jointly with the American Medical Association. Additionally, the final rule adopts the general Current Procedural Terminology (CPT) framework for “Other E/M” visits, such that practitioner time or medical decision-making (MDM) will be used to select the E/M visit level. This includes the listing of qualifying activities by the physician or NPP that count toward the time spent when time used is required to select the visit level.