CMS Proposes Health IT Changes in 2015 Physician Fee Schedule

July 7, 2014 in News

On Thursday, CMS released a proposed rule outlining its Physician Fee Schedule for calendar year 2015, which includes several health IT initiatives, FierceHealthIT reports.

Among other things, the 608-page proposed rule includes changes to:

  • Covered telehealth services (MacDonald, FierceHealthIT, 7/3);
  • Electronic health record requirements for certain providers (Goedert, Health Data Management, 7/6);
  • CMS’ Physician Compare Website; and
  • The Physician Quality Reporting System.

The proposed rule is scheduled to be published in the Federal Register on July 11, and CMS will accept comments through Sept. 2 (FierceHealthIT, 7/3).

Telehealth Changes

In the proposed rule, CMS said it would add four services to the list of ones that Medicare beneficiaries can receive via telehealth:

  • Annual wellness visits;
  • Psychoanalysis;
  • Psychotherapy; and
  • Prolonged evaluation and management services.

The rule states that the above services would be labelled as Category 1 services, which are defined as “similar to professional consultations, office visits and office psychiatry services” currently covered by Medicare (Bowman, FierceHealthIT, 7/3).

However, CMS declined to propose Medicare coverage for several other services, including:

  • Electrocardiogram and echocardiography imaging services;
  • Certain gynecological services (Goedert, Health Data Management, 7/7); and
  • Several mental health treatments, including psychiatric tests and updating or counseling family members of mentally ill patients (Baum, MedCity News, 7/4).

EHR Requirement Changes

Meanwhile, CMS proposed requiring physician practices that provide chronic care management services to use electronic health records certified to meet 2014 meaningful use requirements, Health Data Management reports.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Specifically, CMS is looking to ensure that such chronic care providers use an EHR system that supports: A problem list;

  • Medications and medication allergy checks;
  • Care coordination; and
  • Electronic exchange of a patient’s medical care record summary to providers inside and outside of the practice (Health Data Management, 7/6).

Physician Compare Website Changes

CMS also proposed expanding public reporting requirements to its Physician Compare website, according to a CMS factsheet (CMS factsheet, 7/3).

In December 2010, CMS launched the Physician Compare site to provide consumers with offered information on providers’:

  • Location;
  • Specialty;
  • Education;
  • Spoken languages; and
  • Sex.

In July 2012, CMS released a proposed rule outlining the next phase for its Physician Compare website, which involved posting performance data from:

  • Accountable care organizations; and
  • Group practices participating in the Physician Quality Reporting System.

In February, CMS added new quality measures to the website that relate to the treatment of diabetes and heart disease (iHealthBeat, 2/24).

In the proposed rule, CMS said it would “expand public reporting of group-level measures by making all 2015 [Physician Quality Reporting System, Group Practice Reporting Option] web interface, registry, and EHR measures for group practices of 2 or more EPs and ACOs available for public reporting on Physician Compare in 2016.” The rule also stated that the data would be required to meet the minimum sample size of 20 patients (CMS factsheet, 7/3).

Open Payments System Changes

CMS also proposed changes to its Open Payments system (Frieden, MedPage Today, 7/3).

In February, CMS released a long-awaited final rule on the Physician Payment Sunshine Act — also known as the Open Payments system — and outlined a timeline for its implementation.

The Sunshine Act requires medical industry companies to disclose consulting fees, travel reimbursements, research grants and other gifts that they give to physicians and teaching hospitals.

As of Aug. 1, 2013, manufacturers of pharmaceutical and biological drugs, medical devices and medical supplies are required to report all transfers of monetary value over $10 to physicians and teaching hospitals.

All data collected from August through December was due to CMS by March 31, 2014, according to the final rule. The agency will publish the data on a public website by Sept. 30, 2014 (iHealthBeat, 6/9).

Among other changes, CMS proposed:

  • Removing an exclusion for reimbursement related to continuing medical education; and
  • Requiring manufacturers to separately report stocks, stock options and other ownership interests (MedPage Today, 7/3).

Other Changes

Also in the proposal, CMS suggested adding new quality incentives for ACOs. The incentives would:

  • Require ACOs to meet certain quality targets while reducing health care spending in order to receive bonus payments; and
  • Allow ACOs to receive awards based on annual quality improvement.

Further, CMS requested comments on future quality measures for:

  • Care coordination;
  • Health outcomes;
  • Nursing home quality;
  • Prevention;
  • Elderly public health; and
  • Utilization (Evans, Modern Healthcare, 7/3).
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