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CMS Finalizes Medicare Physician Fee Schedule Rule, Delays E&M Coding Reforms


The agency claims the rule will promote innovation and limit physician paperwork burnout. Critics have managed to put off the most controversial part of the change.

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The Centers for Medicare & Medicaid Services (CMS) today finalized changes to Medicare’s Physician Fee Schedule and Quality Payment Programs — which it said will reduce physician burden — but the agency delayed the implementation of controversial evaluation and management (E&M) coding reforms for another two years after pushback from providers.

CMS officials said the finalized rule will fight physician burnout and promote innovation by requiring less time spent on documentation. The agency claims this piece of its Patients Over Paperwork initiative could help healthcare save $87 million in administrative costs next year alone.

Critics of the rule — including the American Medical Association, which in August authored an objection letter alongside 170 other medical entities — have said it could harm some providers’ bottom line and reap unintended consequences. In response, CMS has equalized certain payments for primary and specialty care, added measures to maintain access to care for complex patients and instituted the E&M delay.

>> READ: Battle Brews as AMA, 150 Health Groups Oppose CMS Payment Rate Proposal

“The historic reforms CMS finalized today move us closer to a healthcare system that delivers better care for Americans at lower cost,” U.S. Department of Health and Human Services Secretary Alex Azar said in a statement.

A major component of the rule centers on E&M billing, which make up about 40 percent of Medicare payments under the Physician Fee Schedule, touching about 75,000 doctors. The proposed rule would have collapsed tiered office visit reimbursement rates from eight to two each, meaning physicians would be more likely to receive a single payment rate, beginning next year, in 2019.

CMS claims the arrangement would result in less paperwork and lower expenses for providers.

The AMA and its co-signers said the rule would hit specialties and services like chemotherapy administration and other especially hard, but the organization applauded CMS for the two-year delay.

“A two-year window for implementation of the proposal will give the AMA-convened work group — comprised of physicians and other health professionals — time to make recommendations on this complicated topic,” AMA President Barbara L. McAneny, M.D., said in a statement. “The group is analyzing these issues and plans to offer solutions to be provided to CMS for future implementation.”

CMS said the finalized rule boosts patient access to virtual care and improves interoperability and quality measures.

The AMA also applauded CMS for making other paperwork-related revisions to the rule since it was proposed this past summer.

“Today’s rule offers immediate relief from onerous requirements that contribute to burnout in the medical profession and detract from patient care,” CMS Administrator Seema Verma, M.P.H., said in a statement. “It also delays even more significant changes to give clinicians the time they need for implementation and provides time for us to continue to work with the medical community on this effort.”

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