CMS releases proposed 2018 physician payment rule

The Centers for Medicare & Medicaid Services late today issued its proposed rule for the physician fee schedule for calendar year 2018. CMS estimates a 0.31% increase in physician payment rates for 2018 compared to 2017, after applying a 0.5% payment increase required by the Medicare Access and CHIP Reauthorization Act of 2015 and a misvalued code adjustment required under the Achieving a Better Life Experience Act of 2014. In addition, CMS makes changes to its policies implementing the site-neutral provisions of Section 603 of the Bipartisan Budget Act of 2015. Specifically, the agency proposes to further reduce payments to “new” off-campus provider-based departments, as described today in an AHA news story on the OPPS proposed rule. CMS also proposes to pay for new telehealth services, including psychotherapy for crisis, Health Risk Assessments and care planning for chronic care management. In addition, the rule would delay until Jan. 1, 2019, the appropriate use criteria program for advanced diagnostic imaging services; and establish payment to rural health clinics and federally qualified health clinics for regular and complex chronic care management services, general behavioral health integration services and psychiatric collaborative care model services. While data submission for the CY 2018 Physician Quality Reporting System has passed, CMS proposes to retroactively lower the number of required measures from nine to six to more closely align the program with the new Merit-based Incentive Payment System that will affect payment starting in CY 2019. CMS also proposes to lower the maximum amount of payment at risk under the CY 2018 value modifier program from 4.0% to 1.0% for individual clinicians and groups of under 10 clinicians, and to 2.0% for groups of 10 or more clinicians. The proposed rule will be published in the July 21 Federal Register, with comments due Sept. 11. AHA members will receive a Special Bulletin with further details tomorrow.