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CMS Proposes Changes to Quality Payment Program, Could Reduce Burden


Under the proposals, physicians would report measures that are outcome-based and more aligned to Alternative Payment Models.


Changes to the Quality Payment Program aim to reduce burden by removing unnecessary measures, making it easier for physicians to be on the path towards value-based care, according to an announcement yesterday from the Centers for Medicare & Medicaid Services (CMS).

“Clinicians are drowning in paperwork and reporting requirements caused by cumbersome government rules and regulations,” said CMS Administrator Seema Verma, MPH. “These administrative costs add to the total cost of delivering healthcare, which means physicians often have to hire extra staff and spend more time complying with requirements instead of with their patients.”

CMS proposed changes to the Quality Payment Program include a new way for physicians to participate in the agency’s pay-for-performance Merit-based Incentive Payment System. The system currently requires physicians to report on measures across performance categories, including quality, cost, promoting interoperability and improvement activities. The current system will change to one where physicians will report less. Under the new framework called the Merit-based Incentive Payment Systems Value Pathways, physicians would report measures that are specialty-specific, outcome-based and more aligned to Alternative Payment Models.

The agency claims the changes could save 2.3 million hours per year in burden reduction.

The changes also include proposals to update payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule.

CMS’ proposed changes would pay clinicians for the time they spend treating patients by increasing the value of evaluation and management codes for office and outpatient visits. The changes also provide enhanced payments for certain visits.

The changes retain five levels of coding for established patients, reduce the number of levels to four for evaluation and management services visits for new patients and revise code definitions.

The code changes would allow physicians to choose the evaluation and management visit level based on medical decision-making or time.

The agency proposed that in 2020, it will add three Healthcare Common Prodecure Coding System codes to the list of telehealth services for treatment of opioid use disorders.

“We are announcing proposals so that the government doesn’t stand in the way of patient care, by giving clinicians the support they need to spend valuable time coordinating the care of these patients to ensure their diseases are well-managed and their quality of life is preserved,” Verma said.

CMS is seeking public comments on the proposals by Sept. 27.

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