Physician Practice

End-of-life care and quality reporting programs addressed in 2016 MPFS proposed rule

Physician Practice Insider, July 14, 2015

by John Castelluccio, Editor
 
CMS has proposed to pay physicians separately for end-of-life counseling sessions with Medicare beneficiaries beginning January 1, 2016, resurrecting a politically controversial provision that was ultimately removed from the final version of the Affordable Care Act (ACA). The proposal for Advance Care Planning is contained in the 2016 proposed rule for the Medicare Physician Fee Schedule (MPFS) released July 8.
 
Advance Care Planning encompasses all situations where a Medicare beneficiary—too ill or incapacitated to make personal medical decisions any longer—has planned in advance whether to be kept alive at all costs or allowed to die and under what conditions. The plan would also potentially identify a healthcare proxy for the patient.
 
The ability for patients to have this discussion with their physicians is not prohibited now—it’s allowed under the Medicare statute during the initial introduction to new beneficiaries to the federal healthcare plan—but this proposal instead allows for separate ongoing counseling sessions when beneficiaries are ready to make a plan. The proposal then sets up separate payment rates and codes for physicians who conduct these sessions with patients.
 
CMS says beneficiaries may not need these services when they first enroll in Medicare, however, which is why establishing separate payment rates and codes offers greater opportunity and flexibility to make use of the planning sessions when patients and their families are ready to make those decisions.
 
The American Medical Association (AMA) and a wide range of other stakeholders support the initiative, CMS notes. The AMA recommended new CPT® codes and associated payments for 2015, but CMS says held off to allow the public full opportunity to comment on the issue. Public comments on the proposal are due by September 8, 2015.
 
End-of-life planning was infamously pilloried by critics of the ACA as akin to “death panels” during fiery national debate prior to passage of the reform bill in 2009. As a result of the strong pushback, the provision was ultimately dropped from the legislation.
 
Among the other changes proposed in the rule, CMS seeks to prepare existing quality reporting programs for a transition to the new Merit-Based Incentive Payment System (MIPS) that would take effect in 2019 under the Medicare Access and Children’s Health Insurance Program Reauthorization Act.
 
Payment adjustments of 2% for satisfactory or unsatisfactory use of the mandatory Physician Quality Reporting System (PQRS) Program would remain in effect through 2018 before fully transitioning to MIPS, although CMS is looking to add reporting measures where gaps currently exist in the program as well as eliminate duplicative or topped-out measures.
 
The Physician Compare website is also being considered for a few policy changes, including a benchmark rating on individual physicians—similar to a five-star rating. CMS is also proposing to place an indicator on profile pages for eligible professionals who satisfactorily report a new PQRS cardiovascular prevention measure, notations on payment adjustments, and indications of physicians who did not report quality measures to CMS but were eligible to do so.
 
The proposed rule will be published in the Federal Register July 15. CMS is accepting all comments on the rule through September 8. The final rule is then expected out by November 1.

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