The Centers for Medicare & Medicaid Services late today issued its final rule for the physician fee schedule for calendar year 2018. CMS estimates a 0.41% 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. Section 603 requires that, with the exception of dedicated emergency department services, services furnished in off-campus provider-based departments that began billing under the OPPS on or after Nov. 2, 2015, or that could not meet the 21st Century Cures “mid-build” exception, will no longer be paid under the outpatient prospective payment system, but under another applicable Part B payment system. Today’s rule finalizes a policy to pay hospitals at 40%, rather than 50%, of the OPPS rate for non-excepted services in 2018. “CMS finalized a number of policies, including one that will adversely impact patient access to care by reducing Medicare rates for services hospitals provide in 'new' off-campus hospital clinics,” said AHA Executive Vice President Tom Nickels in a statement. “We are particularly concerned about the impact on rural and vulnerable communities that do not have sufficient access. We also remain troubled that the agency’s continued short-sighted policies on the relocation of existing off-campus provider-based clinics will prevent patients and communities from having access to the most up-to-date, high-quality services. America’s hospitals and health systems will continue to urge CMS to provide adequate support to cover the costs of providing care so that we can continue to serve as the around-the-clock access point for community care.” CMS also will pay for new telehealth services, including psychotherapy for crisis, health risk assessments and care planning for chronic care management. In addition, the rule delays until Jan. 1, 2020, the appropriate use criteria program for advanced diagnostic imaging services. While data submission for the CY 2018 Physician Quality Reporting System has passed, CMS will 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 lowers the maximum negative payment adjustment 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. In addition, only those clinicians and groups failing to report data would experience a negative VM adjustment.

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